It’s a big year for New York’s massive Medicaid program: Last week the Centers for Medicare & Medicaid Services gave the state a long-awaited green light to implement a $7.5 billion redesign. The goal is to advance health equity among the millions of low-income New Yorkers enrolled in Medicaid by overhauling the program’s infrastructure and authorizing coverage of a broad range of health-related social needs, from food and nutritional counseling to temporary housing and brokers’ fees. “Evidence indicates that these benefits are critical drivers of an individual’s access to health services that keep them well,” the federal government’s approval letter notes. How will this work? The state will invest $500 million to establish nine regional social care networks that will handle Medicaid referrals to social services providers, who will then be reimbursed out of a $3.2 billion funding pool for health-related social needs. That’s nearly half of New York’s budget to implement the initiative, as some experts noted. Not everyone will be eligible for coverage of those newly authorized services — only Medicaid enrollees who meet certain criteria, such as individuals with substance use disorders or a serious mental illness, homeless individuals and young people who have been involved with the juvenile justice system. Another major chunk of the funding — $2.2 billion, to be exact — will be devoted to a “global budget” initiative for private, financially distressed hospitals in the Bronx, Brooklyn, Queens and Westchester that serve large shares of low-income and uninsured patients. Hospitals that choose to participate will get capped amounts of funding based on their historical revenue, patient demographics and performance rather than being paid for services rendered; the idea is to stabilize hospitals’ finances while eliminating monetary incentives for performing unnecessary services. Additionally, the federal government is requiring the state to invest at least $199 million in Medicaid rate increases over the next three years, with an emphasis on primary care, behavioral health and obstetrical care. As far as workforce, $694 million will be invested in recruitment and retention initiatives, including a student loan repayment program for health care professionals who commit to four years’ full-time work caring for a panel of patients that is at least 30 percent Medicaid or uninsured. Qualifying professionals will include psychiatrists, primary care doctors, dentists, nurse practitioners and pediatric clinical nurse specialists. The state will be able to claim up to $6 billion in federal funding to pay for all of this, but time is of the essence: New York only has three years to implement the initiative. And more Medicaid news is set to come later today, when Gov. Kathy Hochul releases her spending proposal for the upcoming fiscal year. ON THE AGENDA: — Thursday, 4 to 6 p.m. The Daniel’s Law Task Force hosts a stakeholder listening session. — Friday at 11:30 a.m. NYC Health + Hospitals’ capital committee meets. GOT TIPS? Send story ideas and feedback to Maya Kaufman at mkaufman@politico.com. Want to receive this newsletter every weekday? Subscribe to POLITICO Pro. You’ll also receive daily policy news and other intelligence you need to act on the day’s biggest stories.
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