New York

Medicaid program name: New York State Medicaid

Medicaid ACO program name: Accountable Care Organization (ACO)

Status: Active

Summary:
New York passed a Medicaid ACO statute and released regulations governing certification of these entities in 2012, with 10 ACOs being certified to operate as an ACO in the state. Medicaid ACOs in New York are best considered within the context of the large New York federal Medicaid DSRIP 1115 waiver, which stresses population health models and is pushing MCO plans toward value-based payment and coordinated health goals, often via independent practice association (IPA) networks like those often seen in ACOs. There are many Medicaid managed care organizations affiliated with IPAs/ACOs, but they are viewed as delivery system contractors. Current state policy emphasis involves mostly hospital-led Performing Provider Systems (PPSs) with integration and coordination among providers in each PPS. The PPS initiative received extensive funding from the state’s DSRIP waiver program, which expires in 2020. Though CMS denied New York’s request for an additional $8 billion in funding in 2020, the state was allowed to maintain the waiver to spend remaining funds from the first DSRIP grant. In 2021, New York put forth a new waiver demonstration proposal to incorporate lessons learned from the DSRIP experience to create Health Equity Regional Organizations (HEROs), which would be built as a multi-sector regional network, similar to New Jersey’s Regional Health Hubs.

More Information:

• 1115 Waiver Demonstration Conceptual Framework: A Federal-State Partnership to Address Health Disparities Exacerbated by the COVID-19 Pandemic
• Redesigning New York’s Medicaid Program
• FAQs for DSRIP PPS Application for Certificate of Authority for ACOs
• Implementing New York’s DSRIP Program: Implications for Medicaid Payment and Delivery System Reform (2016)