New York’s Medicaid Waiver: What’s Next for Health Justice?

by Shena Elrington, Director – Health Justice Program

Last month, Governor Cuomo announced a groundbreaking waiver approved by the federal government that will allow New York State to reinvest $8 billion in savings created as a result of the Medicaid Redesign process.

This money could potentially go a long way toward revamping New York’s health care delivery system, which in recent years has failed to adequately meet the needs of many low-income communities across the state, particularly in Brooklyn. As a result of this funding, New York’s health system could become more coordinated, sustainable, efficient, and responsive to the needs of its diverse communities. In particular, the waiver calls for the creation of the Delivery System Reform Incentive Payment (DSRIP) program, which aims to reduce avoidable hospital use by 25% over five years by encouraging provider and community collaborations to achieve broad-based reform.

DSRIP holds tremendous promise. It creates for the first time a performing provider system (PPS) under which various providers will work together to create structural reform, break down silos in care, and collectively meet the needs of Medicaid beneficiaries. PPS explicitly includes community-based organization participation in its care model. This inclusion is critical; CBOs tend to be more connected and attuned to the dynamic and diverse health needs of the communities they serve. They provide a potentially powerful vehicle for meaningful, on-the-ground input and feedback.

 

While the inclusion of CBOs is encouraging, lingering questions remain about how significant their engagement in PPS will actually be. New York State, specifically the NYS Department of Health (DOH), should lay out specific mechanisms to ensure that community participation is both meaningful and sustainable. For example, DOH should require community representation in any planning meetings involving potential PPS providers, create a means through which CBOs, residents and advocates can offer input concerning DSRIP provider applications, and establish a space for continued community feedback following application approval.

In addition, the overall DSRIP process will only be successful if it is transparent and accountable. DOH has already taken great strides to explain the process, timeline, and goals in a digestible manner. DOH should maintain this level of transparency throughout the entire process.

Finally, the program needs to include a focus on decreasing racial and ethnic health disparities and addressing the social determinants of health, such as access to housing. In order to achieve its goal of a 25% reduction in avoidable hospitalizations, DRSIP will have to address health disparities head on. The program will need to collect data on race, ethnicity, disability status, and primary language of Medicaid beneficiaries and uninsured patients seeking services in order to inform reform efforts. DOH should also require DSRIP applicants to explicitly collect information on health disparities in the needs assessments they must complete to secure funding.

In the next few years, DSRIP can fulfill its potential to reform the delivery of health care across New York State and improve access to healthcare for Medicaid and uninsured beneficiaries, but only if it responds to these concerns.  Otherwise, it will continue to replicate the same deficiencies of the past.

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