A recently passed waiver, Section 1115 of the Social Security Act, gives the Secretary of Health and Human Services (DHHS) the ability to approve pilot or “demonstration projects” that promote the objectives of Medicaid programs. It lets DHHS waive parts of the Medicaid law, which gives states the freedom to improve their current programs.
According to the authors of the article “Teaching Health Centers Can Meet Objectives for State Medicaid Innovation,” “[t]raditional Medicaid approaches have not always been effective at eliminating barriers to access, and lack adequate focus on a goal of achieving long-term health and economic independence. Section 1115 demonstration projects present an opportunity for states to pursue innovations that go beyond routine medical care.”
Programs under the newest 1115 Medicaid waiver in states such as Massachusetts and Oregon include, but are not limited to, nutrition and cooking education, food prescriptions, and rental insurance.
Amir Bassiri, Medicaid director for the New York State Department of Health (DOH), who joined the Department of Health in 2019 as chief of staff to the Medicaid director, spoke with the Amsterdam News about the newest 1115 Medicaid waiver New York State has received and how it advances health equity.
Bassiri provided an overview of the 1115 waiver, titse recent passage in New York, and future implications for the health and welfare of Medicaid recipients.
This conversation has been edited and condensed for clarity.
AmNews: Can you give us an overview of the benefits of the 1115 waiver program?
The Medicaid Program is a joint federal and state program between the center for Medicare and Medicaid services and the single State Medicaid agencies. Typically, Medicaid is dictated by a very [specific] set of federal rules and an 1115 waiver allows allows the Secretary for Health and Human Services to waive some of the federal rules if they advance and further the underlying goals of the Medicaid Program, whether it’s expanding access to services coverage populations that are eligible for benefits.
Amir Bassiri: New York has a long history of incorporating most of its Managed Care Program into an 1115 waiver. They’re authorized for five-year periods. They are either renewed, , or amended and what we’ve done with the most recent approval is to amend an existing demonstration program to incorporate and integrate health-rated social needs into the managed care delivery system and benefit package.
These are services that are not eligible for federal financial participation or federal match. If the state was funding these services through Medicaid, we would be doing it on a state-only funding basis, which limits the scale and funding for these programs. [Through these programs, we have] integrated new health-related needs [such as] housing supportive services, nutritional supportive services, case management. . .under the premise that inclusion of these services will reduce underlying healthcare and medical spending and improve population health outcomes in the long term.
AmNews: Why is an integrated approach important?
AB: It is no small feat to bring together health care and social service organizations to work together. Medicaid is complex, it’s cumbersome, and it is not necessarily easy to navigate for members, providers, and community-based organizations, so we are establishing social care networks. . .of community-based organizations, as well as other primary care providers…The networks would have to coordinate those services between their community-based organization partners to ensure people are accessing, interested in, and receiving these services.
How are we going to determine that they need the services we are putting forward? A uniform assessment, a screening tool.
We are choosing to use the Accountable Health Communities Health-Related Social Needs Screening Tool, which is a pretty well-established tool that captures a core set of social care needs, whether they be housing-related, nutrition-related. . .every member of our program will receive this assessment.
The purpose and goal is to focus these services on our higher-need, more vulnerable members who are in and out of the healthcare system for whatever reason, whether it’s social circumstances or life events or whatever it may be—homelessness, chronic homelessness. We typically find out about their underlying needs when they show up in the inpatient room or the emergency room, so this is intended to meet people where they are.
AmNews: What process did the 1115 waivergo through to get passed?
AB: The federal government has the Secretary for Health and Human Services and the Centers for Medicare and Medicaid Services—that’s the executive level agency. Then there’s the agency—it’s similar to how we have it [New York]. The governor’s office is required to be part of our application.
AmNews: What else should people know about the program?
AB: We are trying to change fundamentally the way we integrate, deliver, and pay for social services in the Medicaid Program. We have done a decent job on physical health. We’ve integrated behavioral health. We have not previously integrated the social services, so we’re very excited about bringing these two worlds together.
[It’s not] going to be easy—there’s going to be extensive stakeholder engagement in the coming weeks and months. . .We are going to get as much information out there as quickly as possible and ideally begin to see these services delivered in the very near future.
Correction: A previous version of the headline said “medical director” and has been edited to reflect the proper title of Medicaid director.