2021 Advocacy Wins for Patients

New York’s 2021-2022 budget includes some important provisions that will help patients access affordable health care. But the state could have done so much more given its 31 percent increase in tax revenue and budget surplus.

Successful coverage expansions that were advocated for by HCFANY include:

  • Essential Plan: The budget increases the eligibility limit for the Essential Plan from 200% to 250% of the federal poverty level (about $34,000 a year for one person).  The popular Essential Plan currently covers over 900,000 people with no premiums or deductibles. The eligibility increase will mean an estimated 14,000 uninsured New Yorkers will get health insurance, and another 92,000 will have lower cost health care.
  • Medicaid for people over 65 and those with disabilities:  People over 65 and who have disabilities have only been eligible for Medicaid if their incomes are below 84% of the federal poverty level (FPL), even everyone else can quality with incomes up to  138% of FPL (around $18,700 for an individual). They have also faced an asset test, which is not required for everyone else.  The budget increases their eligibility limit to 138% of the federal poverty level to match that of other New Yorkers. It leaves the asset test in place, but increases the value of allowable assets.
  • Medicare Savings Program: The budget also increases the income limit for the Medicare Savings Program from 135% of the federal poverty level to 186% ($25,277 for one person). This means more people will get help paying for their Medicare Part B premiums (currently $170 a month) and paying for prescription drugs. 
  • Post-pregnancy Medicaid: The budget extends post-pregnancy Medicaid coverage to one full year from 60 days for all New Yorkers, regardless of immigration status.

The budget includes other changes that improve the health care system for New Yorkers:

  • The Child Health Plus program will no longer have premiums for households earning below 223% of the federal poverty level (about $62,000 a year for a household of 4). These premiums were associated with the annual loss of health coverage for nearly 70,000 children.  Benefits for Child Health Plus were also improved to cover mental health and orthodontia.
  • The budget increases funding for the Community Health Advocates (to $5.2 million) and the Community Health Access to Addiction and Mental Healthcare Project programs (to $3 million). These programs provide post enrollment assistance, such as helping people appeal insurance denials, medical billing problems or locating in-network care.

Immigrant Coverage

The budget expands Medicaid coverage to all New Yorkers over 65 regardless of immigration status. While the budget did not include HCFANY’s #1 priority, Coverage 4 All, the expansion for older adults is a first step that moves New York closer to states that lead on immigrant coverage, such as California. The budget also includes everyone in the post-pregnancy Medicaid coverage regardless of immigration status, a change from the Governor’s original proposal which excluded some immigrants.

No one should be excluded from health coverage because of their immigration status. The #Coverage4All bill (A880A/S1572A) would have created a health insurance option for low-income immigrants who would be eligible for the Essential Plan just like other low-income New Yorkers but for their immigration status. HCFANY will continue to advocate for the enactment of the Coverage4All stand-alone bill and stands ready to work with the Hochul Administration to secure federal funds for immigrant coverage.

What’s Next

The state legislature is in session until June 2. New York has a lot to do before then! Priorities for health care include:

  • A6058/S5474, the New York Health Act, would create a universal single-payer health care system in New York. It would eliminate barriers to eligibility based on immigration and income. It would also eliminate the medical billing chaos that causes so much grief for so many New Yorkers.
  • A7363A/S6522A would ban medical providers from placing liens on patients’ homes or garnishing their wages to recoup a medical debt judgment. This bill has already passed the Assembly – now we just need to get it through the Senate! Other medical debt bills include A8441A/S6522A, which reforms the hospital financial assistance law so patients can avoid debt, and A3470C/S2521C that would ban facility fees for preventive care and provide for better disclosure. 
  • A6883/S5954 would use $300 million from the state’s indigent care pool to increase Medicaid rates for Enhanced Safety Net Hospitals and qualified safety net hospitals.
  • A2251A/S3131A would require public notice and a public hearing in advance of a planned hospital closure. 

This week, New York lawmakers made an impressive push toward expanding health coverage for all New Yorkers in Senate and Assembly budget proposals. Still, the proposals leave some key populations behind.

In what would be a major win for immigrant justice advocates, both houses budgeted to expand health insurance to low-income immigrants. The Coverage4All proposal opens the State’s Essential Plan to everyone who meets income requirements — including thousands of New Yorkers currently excluded because of their immigration status.

The Assembly budget bill also extends Medicaid coverage for 12 months post-partum to all New Yorkers—including immigrants. New York currently provides Medicaid coverage during pregnancy and for 60-days postpartum, and the Executive Budget proposal extends this to one full year, but it excluded immigrants from the Medicaid for Pregnant Women program for the first time.  The Senate resolution, like the Assembly bill, would include immigrants, although its actual bill language appears to have an inconsistent drafting error and would exclude immigrants.  To ensure no New Yorker is left behind, Governor Hochul and the Senate should incorporate the Assembly’s language to make sure no one is left out of this important coverage expansion. 

The budget bills include other important coverage expansions for New Yorkers, including equalizing Medicaid eligibility for people over 65 and with disabilities. Currently, people in those groups face higher eligibility thresholds than others. The Executive Budget and both legislative budget bills change this so that both groups become eligible at 138% of the federal poverty level and without an asset test, just like other New Yorkers. The Assembly and the Executive Budget also both eliminate premiums for some children enrolled in the Children’s Health Insurance Program and expand their benefits. An estimated 60,000 children lose coverage for a month or longer every year because of problems paying the premium. Eliminating them will stop this.

Importantly, the Assembly and the Senate proposals would repeal the Medicaid global cap. The cap triggers automatic cuts after the program hits a certain spending level, meaning that the program gets hits with cuts when and where it is most needed. For example, the global cap led to safety-net hospitals being threatened with budget cuts during the height of the pandemic in 2020. Repealing the cap would allow Medicaid to grow with need instead of according to an arbitrary formula. Governor Hochul should include the Assembly and Senate’s proposal in the final State budget.

Finally, the Assembly increases funding for the Community Health Advocates (CHA) and both houses support the Executive Budget’s allocation for the Community Health Access to Addiction and Mental Healthcare Project (CHAMP). Both programs provide similar post-enrollment help, such as finding in-network providers, fighting billing errors, and appealing insurance denials. CHAMP specializes in providing these services to people who need medical care related to their mental health or substance use disorders.

Now that the Legislative budget bills have been introduced, HCFANY is looking forward to the next step in the budget process: reconciling them. Governor Hochul’s initial budget proposal included lots of great health care stuff—HCFANY has high hopes that she’ll consider the expansions on her original proposals that were included in the new budget bills. Stay tuned for updates on New York’s progress toward health care for all!

Guest post by Medha Ghosh, Health Policy Coordinator, Coalition for Asian American Children and Families

On December 23, 2021, Governor Kathy Hochul signed the NYS Bill S6639/A6896 on Asian American and Native Hawaiian/Pacific Islander (AA and NH/PI) data disaggregation into law. 

This law mandates that all State agencies, departments, boards, and commissions that already collect demographic data must now collect data on the top ten most populous AA ethnic groups and specific NH/PI ethnic groups of New York State along with data on languages spoken.  The law also specifies that such government entities must release such data to the public on an annual basis. This huge victory in the fight for better data for all was only made possible by over ten years of persistent advocacy by CACF and CACF’s members and partners!   

Over the past two years, the COVID-19 pandemic has emphasized the distinctive struggles faced by our AA and NH/PI communities in New York. While State and City public health data failed to show the disparities experienced by these communities, independent studies showed how Chinese Americans had the highest rates of COVID-related death and South Asian Americans the highest rates of COVID-related hospitalization in New York City. Disaggregated data will allow state officials and community organizations to better serve all communities through this ongoing public health emergency and beyond.

You can read more about the bill here and here.

2021 was a difficult year for New York patients. As the COVID-19 pandemic continued to overwhelm people and systems, patients still faced astonishingly high medical bills and issues getting coverage – putting their finances and well-being at risk during a global crisis. As a result, 2021 saw a major surge in patients avoiding necessary medical care due to cost.

Despite the challenges, advocates scored a number of important policy wins that bring New York closer to achieving health care for all. Those wins include:

  • At least five different hospital systems have changed their debt collection policies, savings thousands of patients from lawsuits and property liens.
  • Both NY houses passed the Fair Consumer Judgment Interest Rate bill, which would cut the medical debt interest rate from 9 to 2 percent.
  • Governor Kathy Hochul signed the Health Equity Assessment bill into law, requiring hospitals and other health facilities to consider the impact on marginalized groups when making sales and closures.

These changes will have a significant impact on access to and affordability of care in New York, but we’re just getting started. Let’s make 2022 the best year for NY patients yet, by fighting to end medical debt once and for all, getting everyone covered regardless of immigration status and passing the New York Health Act to ensure everyone can access the care they need.