CMS Approves ‘Groundbreaking’ Behavioral Health Integration Waiver for New York

The Centers for Medicare and Medicaid Services (CMS) has approved a $7.5 billion waiver for New York, allowing the state to integrate primary, behavioral health, and health-related social services over the next three years.

One of the main goals of the waiver is to help boost population health and equity outcomes for high-risk Medicaid enrollees, including children, post-partum patients and people with disabilities.

“As the nation’s largest insurer, CMS is proud to approve this critical demonstration amendment, which gets to the heart of Medicaid’s role as an innovator,” said CMS Administrator Chiquita Brooks-LaSure. “The demonstration’s initiatives will provide a broad swath of health and social supports to underserved communities, improving their health and quality of life. We encourage other states to follow New York’s efforts to address health disparities.”


In addition to boosting behavioral health integration, the waiver will also focus on new programs to help address health-related social needs. Additionally, the waiver will help safety net hospitals looking to transition to value-based care models.

New York will also be able to roll out new workforce development programs thanks to the waiver. For example, it will focus on loan repayment programs for clinicians working in underserved communities. The waiver will also allow for new training programs based in underserved communities.

The waiver also focuses on increasing the number of Medicaid providers in the state. If the state’s Medicaid-to-Medicare provider rate ratio goes below 80% in behavioral health, primary care, or obstetrics care, the state will be required to increase and sustain Medicaid-fee-for-service provider base rates and Medicaid managed care payments.


Primary and behavioral health integration has been a top priority for CMS over the last year. In July, CMS announced a new primary care model focused on improving access and quality of primary care and managing chronic and behavioral health conditions.

But it isn’t just CMS interested in moving the dial on primary and behavioral health integration. Several major payer organizations also want to increase physical and behavioral health service integration.

“Themes today are more directly pointing toward integrated or coordinated solutions where mental health and physical health are more meaningfully tethered together,” Cigna CEO David Cordani said at Morgan Stanely’s Annual Global Healthcare Conference.

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