New York Protects Contraceptive Coverage Without Co-pays

Guest blog by Lois Uttley, MPP, Director, Raising Women’s Voices-NY.

More than 55 million women across the United States have gained contraceptive coverage without co-pays as part of their health insurance policies, because of the Women’s Preventive Services Amendment to the Affordable Care Act (ACA). This coverage benefit, which applies to most employer-sponsored insurance as well as to health plans purchased through ACA marketplaces, is estimated to have saved the average woman about $240 a year in avoided out-of-pocket costs.

However, research by Raising Women’s Voices-NY has consistently found that insurers offering plans in New York are not always complying with ACA birth control coverage requirements. (Similar problems have been found in other states.) RWV-NY wrote to state officials in 2014 and 2016 to cite numerous apparent violations of the contraceptive coverage rules by New York insurers. Problems identified included failing to cover some of the 18 FDA-approved methods of contraception – especially IUDs, the patch and emergency contraception – inappropriately charging co-pays for some contraceptives and giving inaccurate or confusing information to women who called health plan customer service lines.

This week, the Cuomo administration took action against one New York insurer – Excellus Health Plans – for illegally denying consumers contraceptive coverage, among other problems. The state Department of Financial Services (DFS) fined Excellus $1 million for these violations. That action underscored the Department’s intention to hold insurers accountable for providing contraceptive coverage without co-pays. DFS sent a circular letter to insurers back in January, reminding them of their obligation to comply with the birth control coverage requirements of the ACA, and asserting that New York law independently requires such coverage.

The Cuomo administration went even further to articulate and expand contraceptive coverage requirements in New York through a regulation proposed in January, just as women’s organizations were expressing concern about a new federal administration that could move to rescind the ACA contraceptive coverage benefit.  The new Secretary of Health and Human Services, Tom Price, has been an outspoken opponent of contraceptive coverage requirements and of the ACA as whole.

Both Health Care For All New York and Raising Women’s Voices-NY submitted comments in March supporting the proposed state contraceptive coverage regulation and suggesting ways to make the requirements even stronger, such as by including coverage of male contraceptive methods (vasectomies and condoms) and requiring insurers to cover dispensing of a 12-month supply of birth control pills at once (which has been shown to help women avoid gaps in contraceptive use caused by having to refill prescriptions).

HCFANY and RWV-NY are also supporting legislation – the proposed Comprehensive Contraceptive Coverage Act – that would place robust contraceptive coverage requirements into state law. The bill has passed the state Assembly, but has not seen action in the state Senate.

WowLast week, the NY State of Health (NYSOH), New York’s official health plan Marketplace, announced that more than 3.6 million New Yorkers have enrolled in health coverage through NYSOH. This represents an increase of 28 percent since January 2016. More than 45,000 New Yorkers enrolled in the final two days of the 2017 open enrollment period.

According to the press release, more than 242,000 people enrolled in Qualified Health Plans, and nearly 60 percent qualified for federal subsidies to make monthly premiums more affordable.

The release also highlights the major success of the Essential Plan, New York’s Basic Health Plan, which now has more than 665,000 New Yorkers enrolled – a 75 percent increase since last year.

There are also more than 2.4 million New Yorkers enrolled in Medicaid through the Marketplace and nearly 300,000 enrolled in Child Health Plus.

Open enrollment has ended, but New Yorkers eligible for Medicaid, Child Health Plus, or Essential Plan coverage can enroll at any time through the NYSOH website. If you need help enrolling, Navigators are available to provide in-person assistance. Please visit https://info.nystateofhealth.ny.gov/IPANavigatorSiteLocations or call (888) 614-5400 to find a Navigator in your area.

CelebrateNew York State’s official health plan Marketplace, the NY State of Health (NYSOH), announced this morning that more than 3.4 million New Yorkers have signed up for health coverage as of December 24, 2016. This represents more than a 22 percent increase in Marketplace participation since the end of the 2016 open enrollment period, and there is still almost a month left to enroll.

According to the press release, enrollment has increased in all 62 of New York’s counties and nearly 18 percent of the state population is now enrolled through NYSOH.

The release also notes the incredible success of New York’s Basic Health Plan, branded the Essential Plan, which now has more than 635,000 individuals enrolled.

Open enrollment continues through January 31, 2017. You can enroll in health coverage through the NYSOH website. If you need help enrolling, Navigators are available to provide in-person assistance. Please visit https://info.nystateofhealth.ny.gov/IPANavigatorSiteLocations or call (888) 614-5400 to find a Navigator in your area.

Sign HereLast week, the Enhanced Safety Net Hospital Reimbursement Bill, which HCFANY endorsed in May 2016, was sent to Governor Cuomo for his signature. The bill provides enhanced funding to safety net hospitals that:

  • Have at least 50 percent patients enrolled in Medicaid or uninsured
  • Have at least 40 percent of inpatient discharges covered by Medicaid
  • Have no more than 25 percent of patients commercially insured; and
  • Are facilities part of one of the state’s five public health systems or federally designated as a critical access or sole community hospital

This enhanced reimbursement is critical for true safety net hospitals, such as New York City Health + Hospitals System, that serve patients most in need and are struggling financially.

The bill passed unanimously in both the Senate and Assembly in June, and the Governor has until this Saturday, December 31 to sign it into law. No signature is tantamount to a veto.

Help make sure that Governor Cuomo signs the Enhanced Safety Net Hospital Reimbursement Bill into law. Please send a message to the Governor’s Office here or call (518) 474-8390 to tell Governor Cuomo to sign the bill and help our true safety net providers continue to serve the neediest New Yorkers.