On August 25th, the New York State (NYS) Department of Health (DOH) submitted a concept paper for a new Medicaid 1115 Waiver Demonstration to the Centers for Medicare and Medicaid Services (CMS). Through this proposal, the State is requesting $17 billion to be reinvested over five years to support a transformational effort to address health equity by reforming systemic health care delivery issues that are linked to health disparities and have been exacerbated by the COVID-19 pandemic. Specifically, the waiver proposal seeks to achieve the following four goals:
- Build a more resilient, flexible, and integrated delivery system that reduces racial disparities, promotes health equity, and supports the delivery of social care;
- Develop supportive housing and alternatives to institutions for the long-term care population;
- Redesign and strengthen health and behavioral health system capabilities to provide optimal response to future pandemics and natural disasters; and
- Create statewide digital health and telehealth infrastructure.
This waiver would further advance goals pursued during NYS’s recently ended $8 billion Delivery System Reform Incentive Payment (DSRIP), but would be distinct, in particular by more explicitly targeting health equity goals and incorporating lessons learned from DSRIP, including the need for:
- Regional alignment on objectives;
- Direct investment in and involvement of community-based organizations and behavioral health providers in governance and value-based payment (VBP) arrangements;
- Regional coordination of workforce initiatives to address shortage areas;
- Administrative simplification by avoiding new intermediaries between plans and providers; and
- Deeper alignment of provider and payment incentives, including greater use of subcapitation or global budgets as the highest level of VBP.
SPG’s summary of the concept paper is attached. The concept paper is available here.