New York's 1115 Waiver Amendment

A groundbreaking amendment to New York’s Medicaid Section 1115 Demonstration was announced on January 9, 2024, marking a significant step forward in the state’s ongoing efforts to build an inclusive healthcare system. The Centers for Medicare and Medicaid Services (CMS) approved the amendment, which involves a comprehensive set of actions and a substantial investment of $7.5 billion over the next three years. This amendment aims to address health disparities, enhance access to primary and behavioral healthcare, and improve the overall quality of health outcomes for all New Yorkers.

Key Components of the 1115 Waiver Amendment

Health-Related Social Needs (HRSN)
  • The waiver amendment focuses on integrating primary care providers and community-based organizations (CBOs) to address health-related social needs (HRSN).
  • Social Care Networks (SCNs) will play a pivotal role, providing HRSN screening and referral services to Medicaid beneficiaries in targeted populations.
  • Two tiers of HRSN services (Level 1 and Level 2) aim to offer a spectrum of care, including referrals to existing programs and new benefits packages for those with complex care needs.
Health Equity Regional Organization (HERO)
  • The creation of the Health Equity Regional Organization (HERO) to reduce health disparities and advance health equity.
  • HERO, a contracted statewide entity, will focus on data aggregation, analytics, and reporting, conduct a regional needs assessment and planning and facilitate regional stakeholder engagement sessions.
  • HERO’s role is administrative, focusing on coordination, assessment, and the development of value-based payment goals to align with health equity priorities.
Medicaid Hospital Global Budget Initiative
  • The amendment authorizes up to $2.2 billion for the Medicaid Hospital Global Budget Initiative, supporting financially distressed safety net hospitals in transitioning to a global budget alternative payment model.
  • The initiative aims to incentivize population health, improve quality, stabilize finances, and advance accountability.
Strengthening the Workforce
  • Approximately $694 million over three years will be allocated to support workforce recruitment and retention through initiatives such as Student Loan Repayment and Career Pathways Training (CPT).
  • These programs target healthcare professionals facing shortages and unemployed individuals, promoting equitable access to care in Medicaid.

New York’s 1115 waiver amendment represents a bold stride toward a healthcare future that prioritizes equity, accessibility, and innovative solutions. The multifaceted approach, spanning HRSN integration and HERO administrative structures, underscores the state’s commitment to addressing the complex challenges in its healthcare system. The journey to health equity is underway, and New York’s initiative is poised to leave a lasting impact on the national healthcare landscape.

Aigilx Health, a fervent advocates for advancing health equity through healthcare interoperability, is elated to witness significant strides in this critical endeavor. Leveraging our expertise in aggregating Social Determinants of Health Data, Aigilx Health stands poised to wholeheartedly support the endeavors of Community-Based Organizations (CBOs) and Social Care Networks (SCNs). Together, we aim to vigorously address healthcare disparities and propel towards the realization of a more equitable and inclusive healthcare delivery system. Our commitment to this transformative journey underscores the crucial role that collaboration, data-driven insights, and interoperability play in reshaping the future of healthcare for all.

Aigilx health specializes in developing Interoperability solutions to create a healthcare ecosystem and aids in the delivery of efficient, patient-centric and population-focused healthcare.


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