Making Sure Health Transformation Works for Kids



Kid Broken Leg

(National Library of Medicine)

 By: Andrew Leonard, Senior Health Policy Associate, Children’s Defense Fund – New York

Children’s Defense Fund and other HCFANY members are monitoring health transformation in New York State and looking for ways that stakeholders can get involved. Part of that work is thinking about how different groups will be affected. In this post, and in this new fact sheet, I look at children’s health care.

As children’s health advocates, it is important to ensure that health transformation efforts reflect the unique health care needs of children.  Although children tend to be healthier on average than adults, young New Yorkers receive the same inefficient and sometimes ineffective care as adults. Not surprisingly, the most common diagnoses associated with pediatric hospitalizations in New York State are issues that providers can better manage through a preventive approach in a primary care setting – conditions like asthma, bronchitis, and mood disorders.  Done properly, health transformation could create a system that is much more focused on that preventive care.

Advocates have to pay attention and get involved to make sure transformation occurs in a way that works for children. We’ve developed seven guiding principles that can help advocates make this happen.  Those principles are:

  1. Parents and children should be able to choose providers and health care services based on quality and their own preferences.
  2. All children should receive regular health care through a patient-centered medical home that integrates primary and behavioral health care.
  3. Children should have access to an adequate number of primary care and specialty providers who are geographically accessible and in their health insurance networks.
  4. Financing typically restricted to medical services should be expanded to fund services that address the social determinants of health.
  5. Children’s health care should be both linguistically and culturally competent.
  6. Payment and delivery system reforms must promote transparency, actively engage all parents and children and equip them to make decisions about their own care.
  7. Payment and delivery system reforms should utilize appropriate reimbursement levels for pediatric service delivery and incorporate child-specific outcomes measures when evaluating the success of these initiatives.

Keep an eye out for more HCFANY publications about health transformation, including a set of general principles later this week and fact sheets about how transformation could affect health care for women and the LGBTQ community. You can also watch a webinar with more information about children and health transformation at this link.

Health Care For All New York
Invites you to participate in a webinar on:

HCFANY Children, Youth and Families Task Force’s 2016 Policy Priorities

Friday, January 22, 2016

11:00 a.m. – 12:00 p.m.


On Friday, January 22nd at 11am, the Children’s Defense Fund – New York (CDF-NY), through its work in Health Care for All New York (HCFANY), will host a webinar to present HCFANY Children, Youth and Families Task Force’s 2016 Policy Priorities.  Speakers from HCFANY partner organizations will join CDF-NY to provide a robust perspective on the most pressing issues of 2016.  This one-hour webinar will outline health care access and quality issues facing New York’s children and families, such as network adequacy concerns, Essential Plan implementation, consumer assistance, and patients’ rights during payment and delivery system reforms.  Speakers will provide the context for these issues and offer examples for how CYF members can engage in state-level advocacy.  The webinar is intended for children’s health providers, advocates and stakeholders, and others who are interested in improving the health of children and families.


Register now!


Contact Andrew at
(212) 697-0642 

mom baby docter

On December 22, 2015 Governor Cuomo signed into law S4745/A7155, a bill that will allow babies born into low and middle-income New York families eligible for the Child Health Plus (CHP) from the day that they are born. This is great news for families across the state, and a first-of-its-kind bill nationwide!

Parents who apply before the baby is born, or within 60 days of the birth, will have coverage for their newborn from the date of birth, whereas those who submit an application more than 60 days after the birth will be covered from the date of the application.

The new law – one that HCFANY is proud to have strongly advocated – is a significant victory for thousands of families in New York State. Child Health Plus is a wonderful program that has been helping New York children access healthcare since 1991. Until today, however, there was a significant gap in the program. Under the old system, it took up to 45 days from the day that parents applied for CHP for enrollment to kick-in. That meant that babies could go over a month without health insurance coverage during the vulnerable newborn period when timely access to health care is essential.

The American Academy of Pediatrics recommends that all babies be examined by a pediatrician three times in the first two months of life. Babies born with health problems may need more frequent care. Some may need urgent care for emergency situations. In the past, many parents, fearful of large medical bills, were hesitant to seek health services for their babies during the waiting period between CHP application and enrollment. Now, they will be able to obtain the care that their infants need without concern about being burdened by potentially high medical bills.

Children in New York State may be eligible for Child Health Plus if they’re not eligible for Medicaid, a public employee state health benefit plan or another insurance plan (such as a plan through a parent’s employer). Families with incomes up to 400% of the federal poverty level receive free or low cost health insurance this way. In 2015, a family of four earning under $38,796 a year could obtain free insurance for their children.   Families with higher incomes paid a reasonable monthly premium of $9, $15, $30, $45, or $60 per child per month, depending on family size and income. Plus, there is no deductible or co-payments with CHP, so parents do not have to pay anything when their child visits the doctor!

This new effective date provision won’t go into effect until January 1, 2017. In the meantime, parents who would like to enroll a child in CHP can do so through the New York State Marketplace or by connecting the Community Service Society Navigator Network at (888) 614-5400 or through their website for free enrollment assistance.

A happy and very healthy New Year to the littlest New Yorkers and their families!

pregnant woman doctor

As we celebrate the holidays and ring in the New Year, we now have more reason for merriment – Governor Cuomo has just signed legislation that gives pregnant women the right to enroll in Qualified Health Plans through the State’s Marketplace at any time during the year! Until now, pregnant women had to wait to apply for health insurance until the annual open enrollment period. HCFANY is proud to say that New York is the first state in the nation to adopt such an important law, demonstrating leadership in promoting access to health insurance for all!

The passage and signing of S5972/A6780 is significant and commendable because having health insurance during pregnancy can improve the health of mothers and their babies.   Timely, quality pre-natal care can decrease the likelihood that a pregnant women will face health problems or that her baby will be born premature. According to the March of Dimes, nearly 9% of babies born in New York State are pre-term, which puts them at risk for many health problems. The new legislation should help decrease that percentage, assuring that more babies in New York get a healthy start in life.

The new special enrollment period may also significantly decrease healthcare costs for pregnant women who sign up for health insurance. Charges for pre-natal care and hospital care can be daunting for uninsured women. The costs quickly add up due to numerous pre-natal visits, ultrasounds, blood work and screening tests. Giving birth in a hospital is very expensive. On average, health insurance companies pay $9,800 for a normal delivery and $15,000 for a c-section, according to the International Federation of Health Plans. As of today, women in New York State will not have to worry about the full cost of pre-natal care and giving birth. Thanks to the new law, they will be able to access the full array of health services needed for a healthy pregnancy, birth and healthy baby.

HCFANY applauds New York State lawmakers and Governor Cuomo for working to protect the health of mothers and babies. You can read the governor’s press release here. Pregnant women will now be able to enroll on the Marketplace as soon as a doctor confirms they are expecting by going to the New York State of Health Marketplace. Women can also contact the Community Service Society Navigator Network for free enrollment assistance.