After Years of Waiting, Medicaid Expansion Coming in 2023

Today, an extraordinarily diverse group of 61 organizations representing patients, religious leaders, labor organizations, people who are older, have disabilities, immigrants and people of color and more sent a letter to Majority-Leader Andrea Stewart-Cousins and Speaker Carl Heastie calling on elected officials to include the Ounce of Prevention Act (S1366 (2023) | A8441A (2022)) in the final State budget. The bill would reform the state’s Hospital Financial Assistance Law, enabling much-needed support to low-income families burdened by medical debt.

The letter is part of a united effort to end medical debt in New York state. You can show your support through our Phone2Action tool here.

Six percent of New Yorkers have been put into collections over medical bills, with numbers much higher for people of color in parts of the state. Nonprofit hospitals have sued more than 54,000 patients over medical debt they are unable to pay.

Many hospitals fail to offer meaningful financial assistance to their patients, despite receiving $1.1 billion dollars annually in state and federal funding to provide uncompensated care. Still others secure these funds despite failing the New York State Department of Health’s annual audits of their financial aid policies.

The Ounce of Prevention Act would add crucial patient protections to the existing Hospital Financial Assistance Law and increase the number of patients eligible to receive discounted care.

A copy of the letter can be found here.

Health insurance coverage improves physical and mental health outcomes, including life expectancy and stabilizes enrollees’ financial security by reducing medical debt and bankruptcies. Nearly all New Yorkers can access comprehensive, affordable health care through the Marketplace, except some immigrants because of their immigration status. This situation amplifies existing health disparities.

Last year, Governor Kathy Hochul promised to ask the federal government for a “1332 Waiver” to pay to expand NY’s Essential Plan Program to cover low-income undocumented immigrants in NYS as well as increase the financial eligibility limits for those who were already eligible to participate. The state’s Basic Health Program trust fund has a $2 billion surplus which could pay for this program. Immigrant coverage through the Waiver would also save New York $500 million, which it currently spends providing bare bones Emergency Medicaid coverage to immigrants.

Unfortunately, the Hochul Administration’s 1332 Waiver document and her State budget language exclude immigrants, backtracking on her promise last Spring, without explanation.

Take immediate action to ensure that all New Yorkers regardless of immigration status, can obtain health coverage and live healthier and more productive lives. It’s the morally and fiscally right thing to do:

Two new laws will protect New Yorkers from medical debt in 2023. The first bill, signed by Governor Hochul in November, stops all medical providers from garnishing patients’ wages or placing liens on their homes to collect medical debt judgments (S.6522A/A.7363A). The second bill, signed last week, reforms the practice of imposing facility fees by requiring hospitals and their affiliated providers to notify patients in advance if they charge facility fees and bans the fees for preventive care (S.2521C/A.3470C).

Property liens and wage garnishments were two of the worst consequences for patients sued by their hospitals or doctors after they could not afford medical care. The Community Service Society found that in just two years, New York’s hospitals placed 4,880 liens on patients’ homes. A study of just five hospitals revealed over 1,600 cases where patients’ wages were garnished. Both actions are especially troubling because the data on hospital lawsuits in New York suggests that many patients with medical debt were not adequately screened for financial assistance according to New York State law and IRS regulations (these apply to all hospitals in New York, which does not allow for-profit hospitals). Further, medical debt and all its consequences disproportionately effects people of color. The new law prevents ALL hospitals and other medical providers from taking these extreme actions against their patients—even veterinarians!

Notifying patients about facility fees, and banning them for preventive care, will make medical billing fairer. Facility fees are hospital overhead charges. The Affordable Care Act says that no one may be billed for preventive services, but facility fees still sometimes appear on patients’ bills because they are tied to the location of care, not the service. This law is the first in the nation that prevents facility fees for preventive care. The law also requires providers to notify patients ahead of time about the fee. This gives patients a chance to go somewhere else where they won’t be charged hospital fees for essentially outpatient care.  Providers already know your bill will include these fees before you walk in the door—it’s only fair that you do too! (You can hear more from patients about facility fees here and here).

FAQs: What Do Brand New #EndMedicalDebt Protections Mean for NY’ers?

  1. When do these changes take effect?

Both laws go into effect immediately.

  • Does either law apply retroactively?

Both laws are only prospective, not retroactive.

  • Can private doctors still place a lien on my home or garnish my wages?

No! The new law applies to money judgments arising from debt collection actions by either hospitals or health care professionals. 

  • Does the new law apply to all facility fees?

Yes! The new law requires ALL health facilities to disclose when a facility fee is added, and bars these fees for all preventative services—such as a screening mammogram.

  • What’s next for the #EndMedicalDebt campaign?

Next, we’re fighting to prevent medical debt before it starts. The Ounce of Prevention Act would require all hospitals in the state to adopt a uniform financial assistance application and policy to simplify the process for patients to apply and be eligible for financial assistance. It would also condition distribution of state Indigent Care Pool (ICP) funds to the hospital’s implementation and compliance with the policy.  

By Heidi Siegfried, Center for Independence of the Disabled in New York (CIDNY)

The Affordable Care Act increased the income eligibility level for adults without disabilities to 138% of the Federal Poverty Level ($1,563 a month) in 2012. Despite this change, Michael Howard, a 40-year-old man with a mild intellectual developmental learning disability, whose income is $300 a month below the Poverty Level, takes $110 out of his bank account every month and purchases a money order. He mails it to the Medicaid office at the World Trade Center. He does this to keep his Medicaid health coverage. He has been doing this for 7 years.

Why was this happening? Because when the new income eligibility limits were adopted, the “old” Medicaid income eligibility standards ($934 a month in 2022) were retained for people who are in the “Aged, Blind or Disabled” Medicaid eligibility category. Thus, Mike must either incur medical bills in excess of $110 or pay into the Medicaid program to meet his Medicaid monthly “surplus”. Without this he will not have health coverage.

With some savvy budgeting, Mike manages to pay his rent, his cellphone bill, and a $230 cable bill. He shops for the foods he likes but with the increase in food prices, he must, at times, put some items back. His budget cannot accommodate the rising cost of food and his out of pocket medical expenses. He uses four fans instead of an air conditioner because he is worried about the extra electric utility expenses. He says that if he had an additional $110 a month, he would like to save it for a vacation. He would like to visit some more states. He says, “Surplus must go.”

The good news is that the Governor and legislature rectified this discrepancy in the New York State budget that was adopted in April of 2022. In 2023, people with disabilities will have the same income eligibility levels as people without disabilities. This month the New York State Health Department is sending letters to people who have a surplus in the Excess Income (Spenddown) Program telling them how to request a recalculation of their income. And people like Mike will not need to decide between paying for basic needs or medical expenses.

Michael Howard self-photo.
Michael Howard participating in a Zoom with CIDNY.