Key Themes From Delivery System Reform Incentive Payment (DSRIP) Waivers in 4 States

Prepared for The Henry J. Kaiser Family Foundation

Introduced originally in California and followed by Texas, Massachusetts, New Jersey, Kansas and New York, “Delivery System Reform Incentive Payment” or DSRIP programs are a key feature of the dynamic and evolving Medicaid delivery system reform landscape. DSRIP initiatives are part of broader Section 1115 Waivers and provide states with significant funding that can be used to support hospitals and other providers in changing how they provide care to Medicaid beneficiaries. Originally, DSRIP initiatives were more narrowly focused on funding for safety net hospitals, specifically maintaining supplemental payments for safety-net hospitals. Reflecting a growing emphasis at the Centers for Medicare & Medicaid Services (CMS) to strengthen accountability for Medicaid waiver dollars, a defining feature of these waivers is that they require providers—and, recently, states—to meet benchmarks as a condition of receiving Medicaid funds.

This analysis provides an early look at the impact of DSRIP waivers on Medicaid payment and delivery systems. Building on an earlier brief that provides an overview of the DSRIP waivers, it relies on interviews with stakeholders to identify emerging trends and themes. It is based on interviews conducted with state officials, providers and advocates in three states that have adopted the Medicaid expansion (California, Massachusetts, and New York) and one state that has not adopted the expansion (Texas).

Additional Authors:
Robin Rudowitz (Kaiser)
Alexandra Gates (Kaiser)



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