New York and Florida Seek to Extend 1115 Medicaid Waivers

April 21, 2014

New York and Florida are both in the process of extending 1115 Medicaid waivers to seek ways to better meet the health needs of their residents. These states both have very large Medicaid programs with ongoing waivers that test experimental approaches to improve their health systems

On April 14, 2014 New York governor Andrew M. Cuomo, announced the finalization of a recent waiver proposal to amend its 1115 demonstration waiver, the Partnership Plan. The Partnership Plan has operated since 1997 and has allowed the state to enroll Medicaid beneficiaries into managed care plans. Over time, the state has added several programs to the demonstration that provide comprehensive and coordinated care to improve overall health coverage. In continuation of this theme, on July 16, 2013, the state submitted a request to the Centers for Medicare and Medicaid (CMS) to amend the Partnership Plan. The amendment will create an infrastructure to support New York’s Medicaid Redesign Team’s (MRT) plan to implement health reforms. The MRT amendment will decrease health care costs, support safety-net providers, and ensure access to quality care. The MRT waiver also allows the state to reinvest $8 billion (over a 5-year period) in federal savings generated by MRT reforms.

In 2011, Florida’s Legislature passed legislation to expand statewide managed care services and created the Managed Medical Assistance (MMA) program. The goal of the MMA program is to improve health through care coordination, patient engagement, and fiscal responsibility. This is primarily accomplished through incentives for both providers and beneficiaries, establishing provider choice of plans and benefits, and improving program integrity by utilizing quality measures like HEDIS scores. Another fundamental element is the Low Income Pool (LIP) program, which provides government assistance to safety net providers.  The LIP is currently allotted $1 billion annually, yet Florida proposes to redesign LIP into a System Access and Transformation Incentive Fund that receives $4.5 billion annually. Florida seeks to extend its 1115 waiver for the period of July 1, 2014 to June 30, 2017 (currently authorized to end June 30, 2014) to support the continuation of this program.

If approved, it will be exciting to see the implementation of these respective plans and the resulting outcomes.