Summarize Article

1. How is the article relevant to the current healthcare landscape (in NY)?
2. Discuss the article t from the perspective of a healthcare administrator.
3. Document your thoughts on the article? Do you agree with the article? What do you feel could/should have been done differently?

New York submits final $13.5 billion Medicaid waiver proposal

The state has submitted its final proposal to the Centers for Medicare and Medicaid Services for a $13.5 billion, five-year Medicaid waiver amendment to address health disparities and systemic health care delivery issues that intensified during the pandemic.

The final proposal, which was submitted Sept. 2, pares down the state Department of Health's Office of Health Insurance Programs' original vision of $17 billion over five years in a concept paper released last summer.

The Health Department said it received 433 verbal and written comments on the Medicaid waiver amendment proposal since it released a preliminary version in April.

Among the key changes were the addition of a definition of health equity to frame the state's strategies; more explicit references to children, families, older adults and people with intellectual and developmental disabilities; and a $69 million annual funding increase for social determinant of health networks, which are a new entity conceived by the state to bring together community-based organizations.

The final proposal further clarified the composition and governance of social determinant of health networks and health equity regional organizations, or HEROs, another entity introduced in the state's concept paper. HEROs will be regionally-focused coalitions of managed care organizations, local health departments, hospitals and health systems, community-based providers and other provider organizations. The coalitions' composition will not be limited to just stakeholders that are explicitly named, the state said in its final proposal.

The state ultimately declined to finalize the nine regions that will apply to social determinant of health networks and HEROs. Commenters said the state should have more than nine regions, and they said the regions needed to be carefully defined and reflect natural referral patterns and existing networks. The state agreed with commenters that community-based organizations that operate in more than one region should not be limited to participating in only one social determinant of health network.

Social determinant of health networks will receive $92.5 million in the first year and $185 million in each subsequent year, rather than the $116 million per year budgeted in the state's preliminary proposal. The state said the change accounts for the time it will take to procure the networks.

Some commenters had expressed skepticism about the two new entities. In one public hearing, Kathy Preston, executive vice president of the New York Health Plan Association, shared concerns that HEROs would be "unnecessary bureaucracy." She said the state should instead enhance existing collaborative infrastructure between health plans, providers and community-based organizations.

The state's plan to make a single statewide social care needs referral and data platform also generated discussion. Some commenters urged the state to instead leverage existing infrastructure, and others said the state should not mandate a single system.

Eric J. Beane, vice president of regulatory and government affairs for Unite Us, a Manhattan health-tech startup that serves as the statewide social care platform for several states, said New York's initial proposal would "enable consistent reporting while still allowing for regional autonomy."

But in its final proposal the state said it will leverage existing infrastructure of the Statewide Health Information Network for New York instead of procuring a referral platform. Referral and social care needs data will feed into the statewide repository.

New York's current 1115 waiver demonstration is approved through March 31, 2027, but the state said it plans to begin most provisions of the new waiver amendment Jan. 1, pending federal approval. The new waiver would then extend to Dec. 31, 2027. Maya Kaufman