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
DSRIP and MRT Waiver Amendment Information
On April 14, 2014, Governor Andrew M. Cuomo announced that New York has finalized terms and conditions with the federal government for a groundbreaking waiver that will allow the state to reinvest $8 billion in federal savings generated by Medicaid Redesign Team (MRT) reforms. The MRT waiver amendment will transform the state's health care system, bend the Medicaid cost curve, and ensure access to quality care for all Medicaid members.
The Medicaid 1115 waiver amendment will enable New York to fully implement the MRT action plan, facilitate innovation, lower health care costs over the long term, and save scores of essential safety net providers from financial ruin. The waiver allows the state to reinvest over a five-year period $8 billion of the $17.1 billion in federal savings generated by MRT reforms.
The waiver amendment dollars will address critical issues throughout the state and allow for comprehensive reform through a Delivery System Reform Incentive Payment (DSRIP) program. The DSRIP program will promote community-level collaborations and focus on system reform, specifically a goal to achieve a 25 percent reduction in avoidable hospital use over five years. Safety net providers will be required to collaborate to implement innovative projects focusing on system transformation, clinical improvement and population health improvement. Single providers will be ineligible to apply. All DSRIP funds will be based on performance linked to achievement of project milestones.
Public comment on the MRT waiver amendment will be solicited through the MRT website, webinars and public hearings to take place over the next several weeks. Additional information, including the waiver special terms and conditions, list of eligible safety net providers, descriptions of eligible projects, and other overview documents are available at the DSRIP link below.
More information is available at:
New York 1115 Waivers
MRT News and Updates
Medicaid Redesign Team Progress Updates
MRT listserv is a notification system that allows subscribers to receive emails updates on MRT news, events, and initiatives.
Medicaid Redesign Team Final Report and Action Plan
- Medicaid Redesign Team Final Report and Action Plan (PDF, 2MB)
About The Medicaid Redesign Team
To address underlying health care cost and quality issues in New York's Medicaid program, within days of taking office, Governor Andrew M. Cuomo created the Medicaid Redesign Team to both craft a first year Medicaid budget proposal as well as develop a multiyear reform plan. He invited key Medicaid stakeholders to the table in a spirit of collaboration to see what could be achieved collectively to change course and rein in Medicaid spending, while at the same time improving quality.
Medicaid Redesign is premised on the idea that the only way to really control costs is to improve the health of program participants. The MRT action plan launched a series of innovative solutions designed to better manage care and reward providers that help keep people healthy. This approach differs from other states, which have relied on taking away benefits from low-income people or by cutting provider payment rates as ways to cut Medicaid costs. MRT hasn't been just about cost control. The quality of care is also being improved.
More than 200 initiatives were created as a result of MRT. These initiatives will implement programmatic changes to the way health care is provided, reimbursed and managed to ensure that we are providing quality care in the most efficient manner.
- Medicaid Redesign Team Members
- Governor Cuomo Issues Executive Order Creating Medicaid Redesign Team
- Public Hearings and Meetings
- MRT Work Groups
Supplemental Information on Specific MRT Proposals
New York State Medicaid State Plan
Key MRT Initiatives
- On September 29, 2015, OHIP and CMS held a long term care forum on the future of MLTC and FIDA. As part of the forum, the state released a white paper with draft ideas for modifications. At the meeting there was a lively discussion and many opinions were shared. We would like additional feedback and stakeholder input and encourage interested parties to read and react to the following documents:
- Fully Integrated Duals Advantage (FIDA) Demonstration
The Centers for Medicare & Medicaid Services (CMS) and the State of New York will work together in a partnership to improve health care for about 170,000 Medicare-Medicaid members.
- Behavioral Health Transition to Managed Care
The NYS Behavioral Health (BH) Transition Team for Medicaid, comprised of leads from OASAS, OMH, and DOH, is updating the target dates for implementing the transition of BH services.
- Basic Health Program Workgroup
A Basic Health Program (BHP) Workgroup has been created in order to provide input on whether NYS should adopt the Basic Health Program option (BHP) for individuals who are not eligible for medical assistance under title eleven of article five of the social services law. This workgroup shall: evaluate federal guidance related to the basic health program; discuss fiscal, consumer, and health care impacts of a BHP; and consider benefit package, premium and cost-sharing options for a BHP
- Basic Benefit: Evidence Based-Dossier Submission Process
As an essential component of the New York Medicaid Redesign Team's (MRT) reforms, New York State is committed to structuring the Medicaid benefit to ensure that all members have access to the clinically effective, efficiently delivered services they require. To that end, the New York State Department of Health established a systematic process for making decisions about Medicaid benefits using the best available research evidence. The Dossier Process is designed to support transparent and consistent coverage and payment decisions that align with the Centers for Medicare and Medicaid Services' Triple Aim vision for health care of achieving better health, better quality, and lower costs.
- Supportive Housing Initiatives
MRT Supportive Housing Initiative seeks to ensure that Medicaid members have proper housing that promotes a healthy environment and lifestyle.
- NYS Balancing Incentive Program
Authorized under the Affordable Care Act, the NYS Balance Incentive Program (BIP) 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.
- NYS Money Follows the Person Demonstration
Authorized under the Deficit Reduction Act of 2006, and extended through the Accountable Care Act, the Money Follows the Person (MFP) Federal Rebalancing Demonstration Program involves transitioning eligible individuals from facilities into qualified community based settings.
- Quality Strategy of the Medicaid Managed Care Program
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 maintain a Quality Strategy for all Medicaid Managed Care Programs. Any updates, amendments, or waivers to the FSHRP or Partnership Plan require revision of the Quality Strategy to incorporate changes. The Quality Strategy is also assessed every three years using assurance reports, surveys, and findings. Changes in the Quality Strategy are made available for public and stakeholder comment.
- Medicaid Redesign and Quality Measures (PDF, 382KB)
The Medicaid Redesign Team seeks to embrace triple aims outlined by the Center for Medicaid Services (CMS) as follows: 1) improving care, 2) improving health and 3) reducing costs. In order to evaluate the fulfillment of these aims, the Medicaid quality of care and population health indicators are measured.
- Care Management For All Transition Summary & Timeline
Care Management for All, started in 11/12, is one of the most important Medicaid Redesign Team initiatives currently underway, which entails the transition of as many patient populations and services as possible to care management.