CMS OKs New York Medicaid demonstration

Photo: Jose Luis Pelaez/Getty Images

The Centers for Medicare and Medicaid Services has given the green light to New York's amended Medicaid Section 1115 demonstration, kickstarting a push to invest in behavioral health and health equity.

The demonstration "bundles a series of actions to advance health equity and strengthen access to primary and behavioral health care across the state," according to CMS.

The approval, the agency said, allows New York to make large investments in wide-ranging Medicaid initiatives, including establishing sustainable base rates for safety net hospitals that serve the state's underserved communities; connecting people to housing and nutritional support services, enhancing access to coordinated treatment for substance use disorders (SUDs), and making long-term investments in the state's healthcare workforce.

WHAT'S THE IMPACT?

Medicaid Section 1115 demonstrations allow CMS to approve projects that promote the objectives of Medicaid, which provides health coverage to low-income adults, children, pregnant people and people with disabilities.

In New York's demonstration, CMS is approving several initiatives to address health-related social needs, as well as support greater integration between primary care providers, community-based organizations and behavioral health specialists. 

The demonstration amendment also aims to support hospitals that help serve the most vulnerable populations, ones that have significantly more adverse health risk factors and poorer health outcomes compared to other parts of the state. It includes funding to support a Medicaid Hospital Global Budget Initiative for a subset of financially distressed safety net hospitals looking to transition payment to rewarding value rather than volume of care provided.

CMS said the demonstration will also help with establishing sustainable base reimbursement rates for safety net hospitals and addressing significant healthcare workforce shortages in safety net settings. The workforce initiatives include a loan repayment program for clinicians who commit to working in community-based practices in underserved areas, and enhanced training for under- and unemployed individuals who assist doctors and nurses as part of broader health provider teams.

Additionally, New York will increase and sustain provider payment rates and Medicaid managed care payment rates for obstetrics, primary care and behavioral health.

THE LARGER TREND

The administration framed the move as a part of other efforts to strengthen the primary care infrastructure, including the recently announced CMS Innovation Center's Making Care Primary and States Advancing All-Payer Health Equity Approaches and Development (AHEAD) models.

In November, the Department of Health and Human Services released a Call to Action to Address Health Related Social Needs to encourage cross-sector partnerships among those working in healthcare, social services, public and environmental health, government, and health information technology. The goal was to create a stronger, more integrated health and social care system through shared decision-making and by leveraging community resources, to address unmet health-related social needs.

Additionally, in November 2023 the White House released the first ever Social Determinants of Health Playbook, which according to CMS, "lays out an initial set of structural actions federal agencies are undertaking to break down silos that provide both healthcare and critical services and support equitable health outcomes."

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com