Redesigning New York's Medicaid Program
"It is of compelling public importance that the State conduct a fundamental restructuring of its Medicaid program to achieve measurable improvement in health outcomes, sustainable cost control and a more efficient administrative structure."
- Governor Andrew M. Cuomo, January 5, 2011
MRT Waiver Amendment Information
Governor Andrew M. Cuomo announced on August 6, 2012 that New York has submitted an application for a waiver from the federal government that will allow the state to invest up to $10 billion in savings generated by the Medicaid Redesign Team (MRT) reforms to implement an action plan to transform the state's health care system.
Partnership Plan Waiver Extension Information
New York State is requesting that the federal government extend the New York State's Medicaid Section 1115 Partnership plan Demonstration for an additional five years. This extension is necessary to allow the state time to fully implement the MRT amendment's reinvestment and multi-year action plan.
Medicaid Redesign Team Final Report and Action Plan
- Medicaid Redesign Team Final Report and Action Plan (PDF, 2.25MB, 49pgs.)
- Companion Document: Medicaid Redesign Team Work Group Final Recommendations (PDF, 17.57MB, 509pgs.)
About The Medicaid Redesign Team
Governor Cuomo established the Medicaid Redesign Team (MRT) by Executive Order upon taking office in January 2011, bringing together stakeholders and experts from throughout the state to work cooperatively to reform the system and reduce costs.
In Phase 1, the MRT provided a blueprint for lowering Medicaid spending in State Fiscal Year 2011-12 by $2.2 billion. This phase was completed in February 2011 when the MRT submitted an initial report to meet the Governor's Medicaid spending target contained in his 2011-2012 Executive Budget. The initial report included 79 recommendations to redesign and restructure the Medicaid program to be more efficient and get better results for patients. 78 recommendations were approved by the Legislature as part of the enacted budget and are now being implemented. The recommendations met the Governor's Medicaid budget target, introduced significant structural reforms that will bend the Medicaid cost curve, and achieved the savings without any cuts to eligibility.
The MRT continued its innovative work in Phase 2 by establishing 10 work groups to address more complex issues, as well as monitoring the implementation of key recommendations enacted in Phase 1. These work groups provided an additional 175 stakeholders the opportunity to participate in the MRT process. All work group meetings were public and multiple public hearings were held.
The efforts of the MRT will result in a multi-year road map that will lead toward a more efficient program and system that is affordable and will achieve better health outcomes for New Yorkers.
- Medicaid Redesign Team Members
- Governor Cuomo Issues Executive Order Creating Medicaid Redesign Team
- Public Hearings and Meetings
- MRT Work Groups
Medicaid Redesign Team - Progress Updates
- MRT News: August 2012 (PDF, 1MB, 8pg.)
- Monthly Global Cap Updates
- Phase 1 Project Management Plan (as of 3/15/13)
- Open Projects (XLS, 3.2MB)
- Completed, Merged, Cancelled Projects (XLS, 416KB)
- Phase 2 Project Management Plan (as of 3/15/13)
- Phase 2 Project Management Plan (XLS, 431KB)
- Medicaid Redesign Team - January 18 Status Update (PPT, 3.3MB, 26slides)
Supplemental Information on Specific MRT Proposals
Medically Fragile Children Work Group
- 7.19.12 Presentation (PPT, 2.86MB, 24slides)
- 8.2.12 Presentation (PPT, 2.93MB, 24slides)
- 8.13.12 Presentation (PPT, 3.24MB, 21slides)
- 9.20.12 Presentation (PPT, 3.14MB, 24slides)
New York State Medicaid State Plan
Uniform Assessment System for New York
In March 2013, the Office of Health Insurance Programs, Division of Long Term Care began the implementation of the Uniform Assessment System for New York (UAS-NY). The overall goal of the UAS-NY is to utilize a comprehensive assessment system within eight Medicaid home and community-based long-term care services and programs. The transition to the UAS-NY is expected to be completed by March 2014.
Questions can be addressed to: uasny@health.state.ny.us
PCMH Quarterly Report
The Patient-Centered Medical Home (PCMH) Quarterly Report provides a snapshot of the National Committee for Quality Assurance's (NCQA's) PCMH recognition program in New York State. The report includes three main sections: Provider Information, which includes the number of PCMH-recognized providers in the state by recognition level; Enrollee Information, which includes counts of NYS Medicaid enrollees who see PCMH-recognized primary care providers; and Fiscal Information, which includes the amount spent on PCMH by New York State Medicaid through increased capitation rates to recognized providers and fee-for-service 'add-ons' for qualifying visits with recognized providers. The report is intended to provide a snapshot of the PCMH program as well as an illustration of how the program is changing over time.
- Q3 - July 1 - September 30, 2012 (PDF, 580KB)
NYS Balancing Incentive Program
New York State received the below award letter from CMS on March 15, 2013 to participate in the federal Balancing Incentive Program authorized under the Affordable Care Act. This program provides states additional federal funding to implement structural changes that are believed to best facilitate rebalancing the percentage of individuals in need of long term supports and services in home and community based settings as opposed to institutional settings. New York's revised application, submitted to CMS on February 26, 2013, is also available below.
- BIP Webinar 3.28.13 (Archived Webinar).wmv (WMV, 30.6MB)
- BIP Webinar 3.28.13 Presentation (PDF, 156KB)
- NY Balancing Incentive Program Award Letter (PDF, 1.4MB)
- Revised NYS BIP Program Application (PDF, 1.37MB)
State Quality Strategy
As part of the Special Terms and Conditions(STCs) for the New York's Federal-State Health Reform Partnership (FSHRP) and Partnership Plan section 1115(a) Demonstrations, the state is required to revise the State Quality Strategy. The state must make the Strategy available for public comment. Comments may be submitted to qi@health.state.ny.us. Please provide all comments by December 28, 2012.
- DRAFT - Quality Strategy for the New York State Medicaid Managed Care Program 2012. (PDF, 629KB, 28pgs.)
Medicaid Redesign and Quality Measures
- Medicaid Redesign and Quality Measures (PDF, 382KB, 10pgs.)
Care Management For All Transition Summary & Timeline
One of the most important Medicaid Redesign Team initiatives currently underway is the transition of as many patient populations and services as possible to care management. This transition, designated as Care Management for All, began in SFY 11/12 and will take several years. The draft timeline for the transition is included here as an Excel document with three tabs; a summary, the timeline for the populations transition, and the timeline for the benefits transition. The small number of persons and benefits not transitioning is also detailed. To assist in understanding the numerical data and the intent of the initiative, a short narrative document has also been provided.
- Care Management for All Transition Timeline (XLS, 84KB)
- Summary Explanation of Transition Timeline (PDF, 28KB, 1pg.)
HEAL NY Phase 21 - Restructuring Initiatives in Medicaid Redesign Awards Announced
Hospital Medical Home Demonstration Project
The Hospital-Medical Home Demonstration Project will help hospitals training primary care doctors transform outpatient sites serving Medicaid beneficiaries into Patient Centered Medical Homes and improve the quality and safety of medical care provided in the hospital.
For more information and access to the workplan and data reporting site, please visit: http://hospitalmedicalhome.ipro.org
