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

 

A report released this week by Kaiser Family Foundation shows that 58% of uninsured New Yorkers are eligible for free or subsidized health coverage. The majority of them – 548,000 people – are eligible but not enrolled in Medicaid. There are several reasons why people who are eligible for Medicaid have not enrolled: some do not know they’re now eligible under the Affordable Care Act’s Medicaid expansion, some avoid Medicaid because of the stigma of poverty attached to the program, and some have had their income drop since they last applied for coverage.

The 317,000 New Yorkers who are uninsured but would qualify for financial assistance (such as Cost Sharing Reductions and Advance Premium Tax Credits) on the Marketplace includes consumers who are newly-eligible for the Essential Plan, New York’s forthcoming Basic Health Program. Consumers enrolled in the Essential Plan will have monthly premiums of $0 or $20 a month, no deductible, and very low copays; this combination should assuage the fears of people who believe health coverage is too expensive. The New York State of Health hopes to draw consumers back during the third Open Enrollment period, which begins on November 1, by highlighting these new levels of affordability. They’ll be targeting these 317,000 New Yorkers with videos, social media campaigns, and catchy new graphics (stay tuned for more!).

Nearly a third of uninsured New Yorkers – 457,000 people – are unauthorized immigrants. New York City Mayor Bill de Blasio’s recent announcement on connecting immigrants to care through a “Direct Access” program was a crucial first step for those immigrants living in the City, and Health Care for All New York will continue to advocate for comprehensive health insurance coverage for our undocumented neighbors. New York State has done a fabulous job in the first two Open Enrollment periods in connecting people to coverage, and the rollout of the Essential Plan will be another step in the right direction. A critical next step for closing the coverage gap in New York will be expanding affordable coverage to New Yorkers who are excluded from coverage options because of immigration status.

Last week child health advocates from across the country came together in Washington, DC for the Georgetown University Health Policy Institute’s Center for Children and Families annual conference. This year’s conference theme was “Building a Strong Foundation,” including strengthening and protecting Medicaid, CHIP, and the ACA.

Georgetown CCF conference smallWe heard from experts in the field on the Centers for Medicare and Medicaid Services’ (CMS) proposed changes to the Medicaid Managed Care regulations. These changes to Medicaid will affect millions of low-income kids in America. The proposed changes to the regulations would raise the standards for quality assurance and network adequacy, and strengthen other consumer protections. There were also presentations on the future of Medicaid and CHIP.

HCFANY’s Children, Youth & Families Task Force represented New York consumer advocates at the conference. Our own Lorraine Gonzalez-Camastra’s presented on “Health Coverage for People in Immigrant Families.” We also shared the news about recent New York consumer victories, like New York’s CHP effective date bill and our first-in-the-nation special enrollment period for pregnancy, in breakout sessions with consumer advocates from other states. State-based advocacy is stronger when we learn and share from one another!

Pride table

High rates of un-insurance among lesbian, gay, bisexual and transgender (LGBT) people have finally started to drop because of the affordable, nondiscriminatory health coverage options made possible by the Affordable Care Act (ACA). The LGBT uninsured rate fell from 24.2 percent to under 18 percent in the first year of operation of ACA health marketplaces, according to national Gallup surveys. But that was still significantly higher than the 13.2 percent un-insurance rate for the U.S. population as a whole.

That’s why Health Care for All New York is reaching out to uninsured LGBT New Yorkers as they participate in Pride celebrations in June and July. Raising Women’s Voices-NY, a HCFANY Steering Committee member, will be at every Pride Month celebration in the New York City area, handing out LGBT-specific information, and collecting contact information for uninsured people and connecting them to navigators who specialize in working with LGBT consumers for enrollment assistance.

Big selling points this year are the recent New York State policy announcements requiring health insurers to cover all medically-necessary transgender care. HCFANY’s LGBT Task Force is delighted to see that the New York Department of Financial Services responded to our concerns by issuing a guidance letter covering private health plans. HCFANY is also educating LGBT New Yorkers about the March 2015 partial lifting of transgender exclusions in state Medicaid coverage.

We’re letting LGBT New Yorkers know that if they are getting married, having a baby or experiencing one of a list of “qualifying life events,” they are eligible for a special enrollment period to apply for coverage through the NY State of Health marketplace. Low-income LGBT people can apply for Medicaid or Children’s Health Insurance Program coverage for themselves and their families year-round. The third open enrollment period for ACA health coverage starts on November 15.Pride outreach

RWV-NY Community Organizer Liza Lederer and summer intern Christianna Silva were at the Brooklyn Pride festivities on June 13, handing out materials and talking with uninsured LGBT people about how to get covered. More than 10,000 people attended Brooklyn Pride, which occupied six blocks in Park Slope Community. Many of the vendors at the festival were self-employed people interested in getting health insurance for the first time, reported Lederer. The following day, June 14, RWV-NY participated in Rockland Pride, which was held in the village of Nyack, and was attended by more than 2,000 people from the Rockland LGBT community.

 

Coming up on Saturday, June 27, will be Harlem Pride, where RWV-NY staff will do outreach to uninsured LGBT people in the neighborhood. Then, on Sunday, June 28, is the big Pride Festival in Manhattan, which draws more than 200,000 people from around the country. RWV-NY staff and volunteers will be leafleting and collecting names of uninsured people along the parade route and in the exhibit and vendor area that stretches over five blocks in the West Village. Pride activities in the New York City area will conclude on July 17, when RWV-NY will have a table at Bronx Pride, which will be held from noon to 8 p.m. in Crotona Park.