Cover Letter to CMS

"Cover letter to CMS 4-13-2011 " is also available in PDF format (PDF, 293KB, 2pg.)

State of New York
Department of Health
Corning Tower
The Governor Nelson A. Rockefeller Empire State Plaza
Albany, New York 12237
Nirav R. Shah, M.D., M.P.H. Commissioner
Sue Kelly, Executive Deputy Commissioner

Apil 13, 2011

Victoria Wachino
Director Family and Children's Health Program Group
Centers for Medicare & Medicaid Services
7500 Security Boulevard, MS S2-01-16
Baltimore, Maryland 21244-1850

Dear Ms. Wachino:
New York State is requesting further amendments to our Section 1115 waiver programs (The Partnership Plan, 11-W-00114/2 and F-SHRP, 11-W-00234/2). These amendments are necessary to implement initiatives of the State's Medicaid Redesign Team (MRT) and changes in State law authorizing such implementation. Due to the unsustainable costs of the Medcaid program Governor Cuomo commissioned the MRT to redesign the provision of services in order to contain costs, create efficiencies, and improve the quality of care provided to over 4 million New York State residents. Two major MRT proposals require amendments to the waiver programs: Expand Medicaid Managed Care Enrollment and Mandatory Managed Long Term Care Plan Enrollment.

The proposal to expand Medicaid managed care enrollment involves enrolling more high cost /high need populations into managed care in order to promote better care management and coordination of services. The State proposes to eliminate most of the existing exemption and exclusion categories and require enrollment over a period of three years according to the attached schedule. Program features necessary to support the enrollment of each population will be developed and implemented prior to the scheduled start date.

Mandatory managed long term care enrollment would require Medicaid beneficiaries who are age 21 and older, dually eligible and in need of community-based long term care services for more than 120 days to enroll into one of the managed long term care plan options available in the State to the extent such options are available in their social services district. Currently, the three program options available are Managed Long Term Care (MLTC) Partially capitated program, Program for All-Inclusive Care for the Elderly (PACE) or Medicaid Advantage Plus. Mandatory enrollment will begin in New York City and be phased in throughout the rest of the State as plan capacity is developed.

Enclosed is a detailed description of these initiatives, a phase-in schedule for the enrollment of previously exempt or excluded populations and proposed Special Terms and Conditions for the Partnership Plan and F-SHRP waivers. In order to implement the proposals consistent with the timeframes developed by the MRT, we are requesting your expedited review of theses waiver amendments. My staff will be available to discuss at your convenience

We appreciate the anticipated cooperation and assistance of CMS and look forward to working with you to finalize these important changes and to move forward with the implementation of these critical initiatives.


Jason A. Helgerson
Medicaid Director
Deputy Commissioner
Office of Health Insurance Programs


CC: Camille Dobson
Vallencia Lloyd