Under the waiver, New York would assume financing and healthcare delivery risk for so-called dual-eligibles and reach capitation or sub-capitation agreements with health plans and providers, the report said. Medicaid and Medicare spending for the state's jointly enrolled seniors totaled an estimated $23.5 billion and $11.3 billion, respectively, in 2010. The waiver could promote development of ACOs, patient-centered medical homes, but New York could also be left with losses should providers fail to curb spending, the report said.
The report also recommended expansion of the state's Medicaid quality measures from managed care to fee for service. The state would start quality reporting for mental health and substance abuse in 2012 and expand it further in 2013-14. Home health would report quality measures in 2012-13, when long-term-care quality measures would also expand, the report said.
Under another proposal, the state would also offer limited financial support to hospitals, nursing homes and home health providers deemed essential to offset costs of closures, mergers or integration or redesign of services. Such financing could help with proposals for the reconfiguration of Brooklyn's hospital market, which were separately submitted to the state Medicaid redesign task force.