MedicaidCoverageMedium impact
Guidance for Centers for Medicare and Medicaid Services Cell and Gene Therapy Access Model
NY Medicaid·NY·Provider Bulletin
Effective date
Apr 1, 2027
We identified it
Aug 7, 2026
Summary
New York State is requesting a five-year extension of its Section 1115(a) Medicaid Redesign Team (MRT) demonstration waiver, scheduled to expire March 31, 2027. The extension proposes to continue existing Medicaid managed care programs, long-term care services, and health-related social needs (HRSN) services, while discontinuing coverage for TANF adults and closing out workforce training initiatives. A 30-day public comment period is open through August 21, 2026, with a second public hearing scheduled for August 11, 2026.
Action Required
By August 21, 2026: Billing and provider leadership should review the NYS MRT waiver extension request and consider submitting comments if the practice serves NYS Medicaid members. By August 11, 2026 at 4 p.m.: If the practice wishes to provide public comment at the second virtual hearing, submit registration via the online form with 'SP' prefix before the name and email 1115waivers@health.ny.gov. By March 31, 2027: Billing teams must prepare for potential coverage changes, specifically: (1) verify which demonstration-eligible populations the practice serves and confirm continuation of coverage except for TANF adults; (2) review current claims workflows for HRSN services (care management, housing, nutrition, transportation) to ensure alignment with any refined program requirements; (3) flag any claims for TANF adult populations for discontinuation after the waiver extension takes effect on April 1, 2027. For practices billing HRSN services through Social Care Networks, monitor for any delivery model updates. No immediate billing system changes are required until final waiver terms are approved by CMS.