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CMS only approved DSHP expenditure authority in a subset of states with HRSN 1115 approval (in waivers including CalAIM, New Yorks Medicaid Redesign, and MassHealth)

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[5] The researchers also note that IR and IGF1R act as identical portals to the regulation of gene expression, with differences between insulin and IGF-1 effects due to a modulation of the amplitude of the signal created by the specific ligand-receptor interaction. The IGF-1R is referred to as the physiologic receptor due to its potential higher affinity (approximately 100 times higher) for IGF-1 as compared to the insulin receptor