New York's Medicaid waiver, which allows the state to have most of its Medicaid population in managed care, will continue through 2021.
The CMS also approved Arkansas' Medicaid expansion program, which has been a model for Republican-led states. The Arkansas program asks people living between 100% and 138% of the federal poverty level to pay up to 2% of their income in monthly premiums.
New York first received its waiver in 1997. It was amended in 2014 to draw down $8 billion in funds to launch a Delivery System Reform Incentive Payment program.
Under that effort, providers in the state formed new delivery networks aimed at improving care and reducing readmissions. As of April, 25 such networks had launch in the state, according to a Commonwealth Fund report.
The state received several temporary extensions after the waiver first expired two years ago. Medicaid officials were trying to prove the waiver was budget-neutral, meaning the same amount of money would have been spent in the state had the waiver not existed.
The recently approved waiver also allows New York to expand the number of beneficiaries with disabilities or HIV who receive a set amount to hire their own support staff. Many use these funds to pay family caregivers.
Last week, the CMS approved a tweaked version of Arkansas' waiver request, giving them expanded authority to offer incentives for employers to pay for the insurance of employees who agreed to drop out of Medicaid. Another new provision requires unemployed people to seek jobs or job training to receive Medicaid.
Republican Gov. Asa Hutchinson expressed some disappointment with how the CMS altered his version of the employer-sponsored coverage initiative.
"Mine was broader than what this administration wanted to give. It's more narrow, which impacts, really, the effectiveness,” he told Arkansas' Times Record newspaper.
Hutchinson said he recently spoke with President-elect Donald Trump and is confident Medicaid expansion will continue in the next administration. Hutchinson supports the state block grant idea that Trump and other Republicans have touted. The plan gives state more flexibility to impose more cost-sharing and work requirements while maintaining expanded eligibility.
In 2013, Arkansas became the first state in the nation to receive approval from the federal government for a customized approach to Medicaid expansion via a demonstration waiver spearheaded by Democratic Gov. Mike Beebe. More than 200,000 people in the state have gained coverage as a result.
