NYS Department of Health Submits Formal Request to Continue Groundbreaking Medicaid Waiver

  • Expenditure is also available in Portable Document Format

The New York State Department of Health today submitted an 1115 Medicaid waiver amendment that establishes a framework for ongoing efforts to drive value. The formal request to the Centers for Medicare and Medicaid Services (CMS) seeks both a one-year extension of the current waiver program and a subsequent three-year renewal to allow the State to build upon the transformation started in the current waiver and continue on the road to Value-Based care.

This request, which seeks both unused funding from the original waiver to continue supporting the current program and additional federal funding to support a new health care transformation framework, totaling $8 billion over a four-year period, is being submitted following a public comment period and has been finalized to reflect two public forums and hundreds of written comments. The state will continue seeking input on the renewal framework from CMS and the public through the one-year extension period.

The current waiver is in place until it expires on March 31, 2020 and has allowed New York State to reinvest $8 billion of savings achieved through Governor Cuomo's Medicaid Redesign Team (MRT) in critical initiatives that improve how the state delivers Medicaid services. As of June 30, 2018, the waiver reduced avoidable hospitalizations by 21 percent and preventable hospital readmissions by 17 percent, which has resulted in better performance of other significant areas of care, such as behavioral health. The top five providers participating in the current waiver program, also known as performing provider systems (PPS), have each reduced avoidable hospitalizations by almost 40 percent in their respective regions.

The waiver renewal and extension requests submitted to CMS can be found here.

More information about promising practices and results of the current waiver can be found here.