New York State has released a framework for the much anticipated 1115 "MRT Waiver," which will attempt to capture $10 billion over five years of the $17.1 billion in federal savings expected over the same period in the savings expected from the State’s Medicaid Redesign efforts. The money from the waiver would be invested back into the healthcare system to fully implement the Medicaid Redesign Team (MRT) initiatives and further transform the healthcare system.
The SuperWaiver will be an amendment to the State’s existing 1115 “Partnership Plan” or “F-SHRP” waiver and will also be expected to streamline the various other state Medicaid waivers.
The Framework
The MRT final report will serve as a policy framework for the waiver application. The State’s initial plan for reinvestment of the savings falls into the following categories:
Primary care expansion. This would include capital funding to existing providers. “Special focus” will be given to (1) expanding “high quality” primary care; and (2) converting existing hospital capacity into ambulatory settings. Funding preferences would be given entities that meet federal quality standards and participate in Health Homes.
Health Homes. The State would provide capital and operating funds to Health Homes to address HIT, staffing and training issues. For those doubting the viability of the Health Home program, the State mentions a goal of “long term viability” for the Health Home program.
New Care Models. The State wishes to explore other replicable integrated models of care to improve outcomes and lower costs (e.g., ACOs, hospital/nursing home partnerships, telehealth, and “new approaches that integrate physical and behavioral health.”
Vital Access and Safety Net Providers. Under the Waiver, the State would expand these programs which provide added funds to essential institutions that care for high Medicaid or uninsured populations. Providers participating in the program would “implement restructuring plans” to “address their financial challenges” and to improve outcomes.
Public Hospitals & the Uninsured. Establish “pre-emergency” Medicaid services to uninsured under a demonstration program.
Supportive Housing Expansion. The Waiver will be used to expand access to housing supports.
Managed Long Term Care Preparation. This program would fund the modernization of nursing homes to facilitate integration, care management and expansion of services.
Capital Stabilization of Safety Net Hospitals. Funds would be made available to safety net hospitals to reduce debt and allow for capital funds for modernization consistent with ACA and MRT principles. Health Home participants will be given priority.
Hospital Transition. The State would provide funds to hospitals to transform to become the “hospitals of the future,” which would be smaller, provide greater out-patient services and primary care services, and be more integrated with the community.
Workforce. This funding would be directed to training in new technologies and home-based care, expanding Doctors Across New York and the Primary Care Services Corps, and paying teaching institutions whose residents work in underserved areas. Additionally, the State would create a “Health Workforce Incentives and Opportunities Clearinghouse” and “Health Workforce Data Repository” to facilitate access to information and data regarding the workforce, and workforce funding opportunities.
Public Health. The following initiatives are specifically targeted in the waiver: (1) expanding the Nurse-Family Partnership program; (2) asthma and lead poisoning prevention and treatment; and (3) pre-diabetes screenings and prevention.
Regional Health Planning. The State would focus on a regional collaborative planning model that engages all stakeholders in a data-driven planning process.
