New York Medicaid officials seek public input on proposed five-year waiver extension
New York is asking CMS to extend a major Medicaid demonstration for five years. Residents can speak Aug. 11 or submit written comments by Aug. 21, 2026.
New York is seeking a five-year extension of a Medicaid demonstration that supports major statewide health care delivery and social-care initiatives, and residents have until Friday, August 21, 2026, to submit written comments.
The state held an in-person hearing July 31 at Empire State Plaza in Albany. A second hearing is scheduled virtually for Tuesday, August 11, from 1 to 4 p.m. People who want to speak must preregister and confirm by 4 p.m. Monday, August 10.
What is happening now
The New York State Department of Health has submitted a request to extend the Medicaid Redesign Team Section 1115 demonstration for five years. The request is not a federal approval. The Centers for Medicare and Medicaid Services, or CMS, must review it and could require changes before approving an extension.
CMS also rescinded its fast-track review process for certain Section 1115 extension requests in July. The federal agency said changes to budget-neutrality requirements and federal policy made the accelerated process no longer feasible. That could add uncertainty to the review timeline, but it does not determine the outcome of New York’s request.
Written comments may be sent to mailto:1115waivers@health.ny.gov through August 21. Speakers at the virtual hearing are generally limited to five minutes. The state says American Sign Language interpretation and closed captioning will be available for the virtual session.
Why the waiver matters
Section 1115 authority gives New York flexibility to test and operate certain Medicaid delivery systems, services and financing arrangements that otherwise would not be available under standard federal rules.
The current demonstration includes or supports Medicaid Managed Care, long-term services and supports, managed long-term care, home- and community-based services, Health and Recovery Plans and initiatives under the New York Health Equity Reform amendment. The request also covers behavioral-health and substance-use-disorder authorities.
Those authorities affect Medicaid members, caregivers, health plans, hospitals, behavioral-health providers, substance-use treatment providers and community organizations across New York. The waiver is not a separate benefit card or a single program that members apply for. It provides federal authority for multiple parts of the state’s Medicaid system.
What New York is asking to continue or develop
The extension request includes continuation or further development of health-related social-needs services and Social Care Networks. Those networks connect Medicaid members with services involving needs such as housing, nutrition, transportation and care navigation. Whether those authorities continue under the waiver, and under what financing terms, depends on CMS review.
The request also addresses workforce initiatives, including programs intended to train and retain health, behavioral-health and social-care workers. The state is seeking authority related to program close-out and remaining commitments rather than a guarantee that every workforce initiative will receive a new five-year extension.
New York is also asking for continued authority related to HERO, or the Health Equity Regional Organization initiative. The request identifies remaining authority for analytics, program operations and fraud, waste and abuse referrals. HERO funding is among the provisions subject to federal review.
The state is asking to continue developing Medicaid hospital global budgets aligned with the federal AHEAD model and to preserve related funding in hospital budget baselines for eligible hospitals. That proposal also remains unsettled and could face federal scrutiny.
The request includes certain financing authorities. A Sachs Policy Group analysis identified about $2.1 billion in unspent or unclaimed Designated State Health Program authority discussed in the proposal, including amounts the state says were drawn but unspent or not claimed. That figure is requested or identified authority, not newly awarded money, and its treatment depends on CMS review.
What has not been decided
New York’s current waiver was last renewed effective April 1, 2022, and remains authorized through March 31, 2027. The pending extension request therefore does not mean Medicaid members will immediately lose coverage or services.
At the same time, future terms are unsettled. CMS will decide whether to approve the five-year request and whether particular financing streams, health-related social-needs services, workforce provisions, HERO funding or hospital global-budget authorities can continue as proposed. Some provisions could be modified, shifted to another Medicaid authority or rejected.
The state’s request combines programs already operating under the current demonstration with requested continuation periods, rollover or close-out authority and additional development time. Those categories should not be treated as equally certain.
Who should pay attention
Medicaid members and caregivers may want to comment on access to care, home-based services, behavioral-health treatment, substance-use services, transportation, nutrition or housing-related support.
Providers and community organizations should review the draft request for provisions affecting managed care, long-term services, health-related social needs, workforce programs and hospital payment arrangements. The proposal could affect how state and federal Medicaid dollars support those activities after the current authorization ends, but the result will depend on federal negotiations and approval.
How to participate
- Virtual hearing: Tuesday, August 11, 2026, from 1 to 4 p.m. Oral commenters must preregister and confirm by 4 p.m. Monday, August 10.
- Written comments: Send comments to mailto:1115waivers@health.ny.gov by Friday, August 21, 2026.
- Speaking limit: Public commenters are generally limited to five minutes.
- Accessibility: ASL interpretation and closed captioning are available for the virtual hearing.
What happens next
New York will collect public comments and continue the federal review process. The current authorization remains in place through March 31, 2027, while the state and CMS determine the terms of any future extension.
Sources
- New York Department of Health: 1115 waiver hearing notice and public forum information
- CMS bulletin rescinding fast-track review for Section 1115 demonstration extensions
- Sachs Policy Group: New York State Posts 1115 Waiver Extension Request
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