1115 Waiver Amendments, Programs, & Extension Requests

The 1115 Waiver has continually made monumental steps to improve health outcomes for New York Medicaid members. Please find specific information below on 1115 Waiver Amendments and Programs. For a summary view of all waiver amendments, please visit the Waiver Amendments At-a-Glance page.

Pending Proposals

Medicaid Buy-In for Working People with Disabilities (MBI-WPD) Demonstration Program and Career Pathways Training (CPT) Program Amendment

This amendment would authorize an 1115 Waiver demonstration program that would become the State's new MBI-WPD program to help more working individuals with disabilities qualify for Medicaid, with the goal of helping to ensure that these individuals are able to pursue employment opportunities without fear of losing or not qualifying for Medicaid coverage. With this amendment, the State is also requesting a change to the Special Terms and Conditions (STC) language governing the maximum number of allowable days for backfill payments in the Career Pathways Training (CPT) Program. The State is requesting an increase from the current limit of two days per week to up to five days per week.

1115 Waiver Extension Request

Approved Amendments and Programs

Children's Continuous Eligibility

Children's Continuous Eligibility is intended to support consistent coverage and continuity of care by keeping children in Medicaid and Child Health Plus under the age of six continuously enrolled in health coverage, regardless of changes in circumstances that would otherwise cause a loss of eligibility or other changes that would affect eligibility, such as a change in income. Expanding continuous eligibility beyond what is allowable in the Medicaid State plan is likely to assist in minimizing coverage gaps and helping to maintain continuity of access to program benefits for these populations, thereby improving health outcomes.

New York Health Equity Reform (NYHER)

The overall goal of the NYHER: Making Targeted, Evidence-Based Investments to Address the Health Disparities Exacerbated by the COVID-19 Pandemic waiver amendment is to advance health equity, reduce health disparities, and support the delivery of social care. New York seeks to build on the investments, achievements, and lessons learned from past 1115 waivers to scale delivery system transformation, improve population health and quality, deepen integration across the delivery system, and advance health-related social need (HRSN) services. This will be achieved through targeted and interconnected investments that will augment each other, be directionally aligned, and be tied to accountability. These investments focus on Social Care Networks (SCNs), Strengthening the Workforce, and Population Health.

Program Webpage

IMD Transformation Demonstration Program

This amendment provides the State with authority to provide high-quality, clinically appropriate treatment to beneficiaries with Substance Use Disorder (SUD) while they are short-term residents in residential and inpatient treatment settings that qualify as an IMD. The amendment also supports efforts to enhance provider capacity, improve the availability of Medication Assisted Treatment (MAT) and improve access to a continuum of SUD evidence-based services at varied levels of intensity, including withdrawal management services.

Managed Long Term Care Plan Eligibility and Voluntary Mainstream Enrollment for Certain Dual Eligibles

This amendment seeks to: (1) Permit dually eligible Medicare/Medicaid members who do not need Community Based Long-Term Care (CBLTC), and who voluntarily sign up for a Medicare Dual Eligible Special Needs plan with a qualified Mainstream Medicaid Managed Care (MMMC) plan, to stay enrolled in that MMMC plan and; (2) Modify the eligibility criteria for MLTC plans.

The State received approval for the first component with the extension request approved by CMS on March 23, 2022. On October 31, 2024, CMS provided guidance on the second component, advising that section 1115 authority is not required for a State to impose medical necessity or level of care requirements, and NYS can move forward without an amendment to the 1115 demonstration.

Reasonable Opportunity Period (ROP) Extension COVID-19 Public Health Emergency (PHE) Amendment

This 1115 Waiver Amendment request sought to extend the 90-day reasonable opportunity period for individuals who have had Medicaid benefits maintained during the Public Health Emergency (PHE), in compliance with the continuous enrollment provision of the Families First Coronavirus Response Act (FFCRA), without a full eligibility determination and whose eligibility rests on verification of their U.S. citizenship.

Managed Care Risk Mitigation COVID-19 Public Health Emergency (PHE) Amendment

This 1115 Waiver Amendment request sought to test whether, in the context of the COVID-19 public health emergency (PHE), an exemption from the regulatory prohibition in 42 C.F.R. § 438.6(b)(1) promotes the objectives of Medicaid. The Centers for Medicare and Medicaid Services (CMS) will investigate how relaxing this regulatory requirement to permit retroactive risk sharing results in either increased or decreased payments to plans, given the significant fluctuations in utilization that may occur during a pandemic.