Last week, The Atlantic published an article entitled “The Unconscionable Difficulty of Getting Health Insurance for a Newborn.” The article tells the story of contributing writer Ester Bloom and her difficulties getting immediate Child Health Plus (CHP) insurance coverage for her newborn son. Coverage for Bloom’s son did not begin until six weeks after his birth, and in the interim she instead had to pay for much more expensive individual coverage through the Marketplace.
However, the original article neglected to mention the passage of Bill S4745/A7155 in December of 2015, which allows babies born into low and middle-income families eligible for Child Health Plus from the day they are born. Under this law, which takes effect January 1, 2017, parents who apply before the baby is born, or within 60 days of birth, will have CHP coverage for the newborn from the date of birth. Those who submit an application more than 60 days after the birth will be covered from the date of application. This law addresses the 45 day gap between parent application and newborn enrollment in CHP that Bloom describes in the article. For more details please see HCFANY’s original blog post from December 28, 2015.
We were excited to see a correction published on June 21, which included information about the law and how it will improve coverage for newborns under CHP.
This article also highlights the many challenges that consumers face when navigating the health insurance system as well as the importance of the trained assistance that health care Navigators, Certified Application Counselors, and Community Health Advocates can provide. New York State has been a leader in offering consumer assistance through these programs.
Parents who would like to enroll a child in CHP can do so through the New York State of Health Marketplace or by connecting to the Community Service Society Navigator Network at (888) 614-5400 or through their website.
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:
- Parents and children should be able to choose providers and health care services based on quality and their own preferences.
- All children should receive regular health care through a patient-centered medical home that integrates primary and behavioral health care.
- Children should have access to an adequate number of primary care and specialty providers who are geographically accessible and in their health insurance networks.
- Financing typically restricted to medical services should be expanded to fund services that address the social determinants of health.
- Children’s health care should be both linguistically and culturally competent.
- Payment and delivery system reforms must promote transparency, actively engage all parents and children and equip them to make decisions about their own care.
- 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.
Contact Andrew at
or (212) 697-0642
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!