New York's primary care waiver

Only 5% of spending goes to primary care

New York has received approval from the Centers for Medicare and Medicaid Services (CMS) for a Medicaid waiver.

While the Medicaid waiver is not an expansion of coverage-New York has already expanded-it is an agreement to use Medicaid funds for other uses outside of direct service. In this instance, the Medicaid waiver is $8 billion to restructure and transform New York’s health system using patient-centered primary care to improve health, lower costs and reduce disparities.

According to the Primary Care Development Corporation, a not-for-profit, 2.3 million people across the state lack sufficient access to primary care, and only about 5% of healthcare spending goes to primary care. The shortage of providers is one of the chief reasons New York has one of the highest rates of avoidable hospital use and cost in the country.

In 2011, Governor Andrew Cuomo established a Medicaid Redesign Team by executive order with the goal of bending the 13% cost-growth curve for Medicaid. A stakeholder group has recommended phasing out fee for service and replacing it with a delivery system focused on care management.

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Utah was the most recent state to announce expansion, and New Hampshire is waiting in the wings.