HCFANY’s Executive Budget Update: What We Won and What We Lost.

 

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HCFANY worked hard on a series of important priorities this budget season, described in this policy brief.  The final enacted budget can be found here.

Here’s the quick summary of how we did:

Comprehensive coverage for immigrants

HCFANY Recommendation: Provide $10.3 million in State funding to offer Essential Plan (EP) to legal immigrants who are barred from federally-funded EP.

Result: Although the Assembly One House bill included the $10.3 million in State funding, the proposal did not make it in the final budget.sad face

Full funding for Community Health Advocates (CHA)

HCFANY Recommendation: Provide $4 million in funding for CHA to help people with their insurance problems and access to health care problems, when they occur.

Result: The final budget included $3.25 million for CHA–$2.5 million from the Executive and $750,000 from the Assembly.  Due to the intricacies of State contracting, this means that the CHA program faces an 18% cut from the past year.

Prior Approval of insurance plan rate increases

HCFANY Recommendation: Reject a Senate One House bill proposal to repeal the State’s right to review proposed insurance premium increases.

Result: The measure was not included in the enacted budget.1_emoji2

Health Guaranty Fund

HCFANY Recommendation: Support with modifications the Senate and Assembly stand-alone bill which sought to set up a Health Guaranty fund to reimburse providers in the wake of a health plan closing (e.g. Health Republic).

Result: The budget establishes a fund that will be financed through “settlement funds” to reimburse providers. The process for distributing the funds is unknown and it appears to include no public representation and/or public reporting on the distributions.sad face

Medicaid beneficiary protections

HCFANY Recommendation: HCFANY opposed the following threats to Medicaid beneficiaries: elimination of spousal/parental refusal, reduction of resources that spouses of people in MLTC or nursing homes can keep, and the repeal of “prescriber prevails.”

Result: None of these proposals made the final budget. That means spousal/parental refusal remains intact, spouses of people in MLTC or nursing homes will not see a cut in the amount of resources they can keep, and “prescriber prevails” will continue to be available in Medicaid. 1_emoji2

 

capitolHCFANY leaders are heading to the State Capitol today to speak to legislative leaders about our 2016 Policy Agenda. Here are a few of HCFANY’s ideas for ways that New York can continue to build on our successes to increase access to affordable quality health care for all.

Comprehensive Coverage for All Immigrants: New York can offer Essential Plan (EP) coverage for the roughly 5,500 New Yorkers who are ineligible for federal EP funding because of their immigration status by allocating $10.3 million in state-only funding for next year. New York should also explore ways to cover all immigrants, including those who are undocumented.

Consumer Assistance:  Community Health Advocates (CHA) helps New Yorkers understand, use and keep their insurance by providing a central, toll-free helpline and community and small business-serving agencies throughout the State. Last year, New York provided $3 million in funding for a 9-month period. This year, New York should provide $4 million to ensure a year-round CHA program.

Consumer Outreach:  While New York has exceeded enrollment expectations, 8% of New Yorkers remain uninsured. New York should build on its success by providing $2 million in funding for outreach and education by community-based organizations (CBOs) and small business-serving groups to reach the remaining uninsured. You can read more about these ideas in HCFANY’s Legislative Agenda Policy Brief and HCFANY Health/Medicaid Testimony on the 2016-2017 NYS Executive Budget.

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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!

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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.