Many of you already follow us on Twitter (@hcfany) to get the latest health care updates in New York State and follow our advocacy efforts. If you don’t already, now is a good time to start!
HCFANY is co-hosting a Twitter chat with MomsRising and U.S. Representative Charles Rangel tomorrow. We’ll be talking about healthcare resources for New Yorkers, with a special focus on the Basic Health Program.
DATE: Wednesday, April 23rd
TIME: 2-3pm ET / 11am-12pm PT
WHERE: On Twitter with the hashtag #WellnessWed
WHO: @HCFANY, @MomsRising, @cbrangel, & YOU
The Basic Health Program, which is part of the Affordable Care Act, gives states the option to provide more affordable, public health coverage to lower-income people whose income is too high to qualify for Medicaid. The New York State legislature recently approved a Basic Health Program in this year’s budget. This is great news for working New Yorkers who struggle to pay the cost of health insurance while juggling rent, utilities and other bills. It’s also good news for our State’s fiscal outlook – the program is projected to save New York $300 million per year once it’s implemented. This is partly because New York State already uses State funds to cover some New Yorkers who will be eligible for the new, mostly federally funded program (e.g. lawfully present immigrants under 138% FPL).
Want to learn more? Have something to add about the Basic Health Program in New York? Make sure to follow @hcfany and #WellnessWed to participate in the conversation. Join in and share your questions, stories, resources and more!
The first open enrollment period for NY State of Health has come to a close, and as of April 16, 960,762 New Yorkers were able to get health care plans through the state marketplace. That means there are nearly one million stories of New Yorkers getting affordable, quality health coverage because of the NY State of Health and the ACA.
Here’s one, from Maryanne Tomazic of Raising Women’s Voices – New York:
For Dustin* and Abigail*, NY State of Health meant their family didn’t have to go without coverage before Dustin starts his new job. Dustin and Abigail live with their family of five in a small town in Westchester County. Dustin was hired by a new company, but the transition meant that his family would experience a gap in health care coverage. “COBRA wasn’t a realistic option for us,” Abigail said. “It was too expensive.”
Fortunately, Dustin was able to get health insurance through NY State of Health. He and his daughter Elizabeth* initially filled out the application online, but had trouble reporting his income due to his job transition. They went to a Navigator, who helped correct the problem. “We also wanted to make sure we could still go to the doctors we’ve been going to for years and also to our local hospital, Westchester Medical Center,” said Dustin. “We called our doctor to confirm that the plan we picked included them in their network.” The family’s previous health care plan had been grandfathered by the ACA, so many preventive services still required copays. “I had to pay $86 a month for my birth control pills,” said Elizabeth. “With this new plan, I can now get the contraception I need at no additional cost.”
The family’s new health care plan took effect on April 1, so thanks to the Affordable Care Act and NY State of Health, their family did not experience a gap in coverage. Like the 960,762 New Yorkers, and the over 8 million Americans, who enrolled during this first open enrollment period, they now have an affordable, quality health insurance plan to help them get the care they need!
Last week, the final NYS budget agreement was released. You can read HCFANY’s response in our press release, here. The budget contains major wins for health care consumers in New York, including all three of HCFANY’s top budget priorities: The Basic Health Program, out-of-network surprise billing protections, and consumer assistance funding.
1. Making health insurance more affordable for low- to moderate-income New Yorkers through the Basic Health Program.
The budget includes authorizing legislation to create a new Basic Health Program (BHP), which will provide low-cost insurance coverage to people just above the Medicaid level up to 200% of the Federal Poverty Level (approximately $23,000 for an individual, $42,000 for a family of four). Those in the higher income levels (between 150 and 200% of FPL) would pay a monthly premium of up to $20. The BHP will help thousands of New Yorkers with incomes too high to qualify for Medicaid but who struggle to afford private insurance even with the financial assistance now available through NY State of Health. It will likely be available starting in 2016. You can read more about the Basic Health Program in our policy brief and recent blog posts from Georgetown Center for Children and Families and Families USA.
2. Expanding consumer rights and protections for those who need and/or receive out-of-network services.
The budget also includes landmark legislation that will protect New Yorkers from out-of-network surprise bills, and will offer expanded rights for consumers, such as the right to go out-of-network when their plan doesn’t have a qualified in-network provider who can meet their needs. HCFANY has been advocating for these protections for several years. The new legislation includes:
- Protection from “surprise medical bills” for emergency services and for scheduled services when an in-network provider is not available or the consumer is not informed in advance that out-of-network providers will be involved in providing care. Consumers will be held harmless (responsible only for the in-network copays and other cost-sharing), and it will now be up to insurers and providers to resolve billing disputes with the help of an independent arbiter.
- The right to go out-of-network at the in-network rate, either for services that an insurer’s network doesn’t provide, or when an insurer’s network does not have an appropriate provider in-network. Out-of-network referrals must be made by in-network providers. An independent, external review process can be used when needed.
- Improved network adequacy. All health care plans will now have to meet the same level of network adequacy standards, whether they are HMOs, PPOs, EPOs, or other types. Insurers that do offer out-of-network coverage will have to market at least one plan that provides it at a decent, fairly robust level.
- Improved disclosure of information. Insurers must keep their network lists up-to-date (within 30 days), and disclose at what rate they reimburse for out-of-network services (when they are covered). Providers must keep their list plans they take up to date (within 30 days) and disclose how much they charge for a given service when provided out-of-network.
- New options to submit claims. Consumers must be allowed to submit out-of-network coverage requests and claims electronically.
3. Continued funding for community-based health consumer assistance services across the state.
Additionally, the budget authorizes $2.5 million in pass through federal funding for Community Health Advocates (CHA), the State’s designated consumer assistance program. CHA helps consumers use their health coverage, access health care services even if they don’t have coverage, and understand how to resolve disputes with health insurers. Now that hundreds of thousands of New Yorkers have gotten health insurance through the “New York State of Health” marketplace, these services are needed more than ever. You can read more about CHA in our recent blog post.
In addition to these important advances, the budget includes continued funding for NY State of Health, the official health plan marketplace. As of April 7, over 908,000 New Yorkers have enrolled in affordable, quality health coverage through the marketplace. Approximately 70% of enrollees were formerly uninsured, and about half qualified for Medicaid or Child Health Plus, while the rest enrolled in one of the new Qualified Health Plans. The State is well on its way to meeting or even exceeding it’s goal of 1.1 million New Yorkers enrolled by the end of 2016.
As strange as it seems, the 1st open enrollment period under the ACA has come to an end. The final count of enrollees from NY State of Health is stunning: more than 865,000 New Yorkers enrolled in private and public plans between October 1 and April 1. While some New Yorkers will not have the opportunity to enroll in NY State of Health Coverage until the next open enrollment period on November 15 of this year, hundreds of thousands will still be able to enroll in private and public health insurance plans in the coming months.
This is due to a series of extensions and special enrollment periods, as well as different enrollment rules for public programs such as Medicaid and CHIP. A short guide to these post-open-enrollment opportunities is below.
New Yorkers who are unable to enroll in NY State of Health due to technical glitches will be allowed to complete their applications after March 31.
The Obama administration announced Tuesday, March 25 that individuals who have started their applications before the March 31 deadline but were not able to complete the process before the deadline will have more time to enroll. Shortly after, New York agreed to do the same for those who had made a “good faith” effort to complete their application. These New Yorkers will have until April 15 to finish up.
Domestic violence victims will have until May 31 to apply.
A little known provision in the ACA prevents married couples who file separately from being eligible for premium subsidies. This causes problems for individuals with a barrier to filing for divorce or legal separation, such as domestic violence victims. Last week, the Treasury department announced it would issue guidance that married individuals living apart from their spouse and unable to file a joint return as a result of domestic abuse, will be able to file separately from their spouse and still claim a subsidy. Domestic violence victims will have an extension through May 31 to apply.
New Yorkers may qualify for a special enrollment period to enroll after the deadline.
As with any insurance, there are special circumstances that qualify people to enroll in NY State of Health after the open enrollment deadline has passed. These circumstances are called “qualifying life events,” and they include:
- Getting married
- Having, adopting, or placement of a child
- Permanently moving to a new area that offers different health plan options
- Losing other health coverage (e.g. due to a job loss, divorce, loss of eligibility for Medicaid/CHIP, expiration of COBRA coverage, a health plan being decertified, aging out of the ACA provision allowing young adults to stay on their parents’ insurance until age 26)
- For those enrolled in Marketplace coverage, having a change in income or household status that affects eligibility for tax credits or cost-sharing reductions.
There are also more complex cases, which you can learn about here.
New Yorkers eligible for Medicaid and Child Health Plus (CHP) can enroll at anytime of the year.
New York’s Medicaid and CHP programs operate under a policy called “continuous enrollment,” meaning people can enroll at anytime of the year. You can learn more about New York’s Medicaid program here and the CHP program here.
So, while open enrollment has ended, there are still plenty of opportunities for New Yorkers to apply for affordable health coverage through NY State of Health.