Important advances in the state’s Medicaid program are likely only a few months away from being finalized with federal officials, Medicaid Director at the New York State Department of Health Amir Bassiri announced at United Hospital Fund’s annual Medicaid Conference on July 20.
These include primary care investments, coverage of social services, and other key steps to improve health equity in the program. Mr. Bassiri said the state expects an agreement this fall with the Centers for Medicare and Medicaid Services (CMS) on New York’s application to amend the 1115 Medicaid waiver. While negotiations are ongoing, Mr. Bassiri noted that the overall goal of making Medicaid more equitable remains at the center of the waiver agreement.
“Fundamentally, the core premise of the waiver and our thesis has not changed,” he told more than 600 virtual and in-person attendees. “[It] is the integration of social care with health care to support population health and improve health outcomes focused on health equity and reducing health disparities.”
Among the confirmed components of the waiver agreement, which falls under Section 1115 of the Social Security Act, will be a plan to drive value-based investments in primary care, various measures to support the health care workforce, and setting up Social Care Networks to integrate reimbursable social services like housing, nutrition, and transportation for non-medical appointments into Medicaid.
The 1115 waiver updates were in line with this year’s Medicaid Conference theme, "Charting a Path to Equitable Integration.” The conference was attended by more than 200 people in-person at the New York Academy of Medicine and nearly 500 people who tuned in virtually, an option provided for free thanks to sponsor Unite Us. The event was sponsored generously by the Commonwealth Fund, Acentra Health, findhelp, NYSTEC, Public Health Solutions, New York Academy of Medicine, Big Apple Event AV and Unite Us, who helped provide free virtual access to attendees.
In his address, Mr. Bassiri also updated attendees on a similarly important effort: the unwinding of the COVID-19 public health emergency. Given the end of continuous enrollment measures enacted during the pandemic, New York is tackling the enormous task of reassessing eligibility and renewing coverage for more than 9 million New Yorkers enrolled in Medicaid, Child Health Plus, and the Essential Plan. More than a third of New Yorkers are enrolled in Medicaid alone, a record number largely due to these pandemic measures, UHF CEO and President Oxiris Barbot, MD, noted at the conference.
“Our state is presented with challenges and opportunities to remain at the forefront of progressive policies that center keeping people covered and connected to usual sources of care that maximize good health outcomes," said Dr. Barbot.
So far, Mr. Bassiri said, officials are “cautiously optimistic” their outreach efforts are reaching members who might lose their coverage, but that more work is ahead. Preliminary data shows that 72 percent of enrollees renewed their coverage before the first June deadline. “[We] will not rest until we get through this process and ensure everyone who is eligible retains coverage,” Mr. Bassiri said.
After Mr. Bassiri’s keynote address, attendees heard from a panel of experts about “Strategies for Providing Substance Use Disorder Treatment and Care to Medicaid Members” with moderator Ken Shatzkes, program director at Foundation for Opioid Response Efforts. Panelists Shonny Capodilupo, senior director of behavioral health services at Open Door Family Medical Center; David Collymore, chief medical officer at the Acacia Network; and Daniel Schatz, medical director for substance use disorder services at NYC Health + Hospitals, noted that significant barriers and stigma still exist for these Medicaid patients, despite the help of telehealth and recent policy changes in improving their access to care. Integration of substance use disorder treatment in primary care, strengthening the behavioral health workforce, and focusing on prevention among children and teens will all be critical in overcoming the opioid crisis, panelists said.
“It's incredibly important that prevention be reimbursed as part of this care continuum as much as treatment—in the long game, it is really going to make the difference,” said Ms. Capodilupo.
Addressing behavioral health concerns sooner rather than later was also a focus of afternoon panelists, who tackled “Challenges in Providing Primary Care to Medicaid Members” with moderator and UHF Medicaid Institute Director Alex Brandes. Adam Aponte, chief medical officer at Boriken Neighborhood Health Center; Paulo Pina, network pediatric medical director of Family Health Centers at NYU Langone Health; and Stephanie Wang, senior medical director of care transitions and population health at Mount Sinai St. Luke’s Hospital, emphasized the role primary care providers play in connecting Medicaid members to other health-related services. But each added that a lack of staff and resources often makes it difficult to do so.
“We are passionate about the work that we do, but we also need the resources to do it,” Dr. Pina said.
The panelists highlighted opportunities in the 1115 waiver—including a switch from fee-for-service to a value-based reimbursement system and Social Care Networks—that can help spur progress.
The 2023 Medicaid Conference wrapped up with a keynote address from president and CEO of the Camden Coalition, Kathleen Noonan, who underscored her own organization’s experience creating an ecosystem of care that can address the entirety of a patient’s needs.
“We all use the words teaming and collaboration, but unless we really, really figure out how to do it in a very different way...we are not going to get this right,” she said. “To truly move the needle, we have to work simultaneously.”
To find a video of the Medicaid Conference and a copy of the presentation slides, click here.
Please note: The waiver discussed in July was subject to CMS negotiations, as noted in the presentation, and differs slightly from the final approved waiver, which can be found here: https://www.health.ny.gov/health_care/managed_care/appextension/docs/2024-01-09_cms_ltr.pdf