The season of giving is coming early for many New Yorkers seeking hospital care this year. As of last month, amendments to New York’s Hospital Financial Assistance Law (HFAL) will make it easier to apply for and cover more patients under financial assistance programs. The HFAL, also known as Manny’s Law, was implemented in 2006 in response to the death of Manny Lanza, 24. Lanza passed away after being denied life-saving surgery due to his uninsured status.

Financial assistance programs help many patients receive affordable care on a sliding fee scale based solely on their household income. This includes patients who are uninsured or those with insurance, but medical costs are a big strain on their income. Rising hospital prices in recent years have left many patients unable to afford the care they need, often leading them to incur medical debt. A 2023 Urban Institute reported that 740,000 New Yorkers had medical debt, with nearly half of them owing $500 or more. This updated HFAL will streamline the process and expand the eligibility of hospital financial assistance. New Yorkers will finally be able to have some more relief from medical debt and rising healthcare costs.

The following changes will be made to HFAL and medical debt in New York.

• All hospitals licensed by the New York State Department of Health (NYSDOH) are required to use a Uniform Hospital Financial Assistance form and inform patients of financial assistance availability in writing during registration and at discharge (regardless of the hospital’s participation in the Indigent Care Pool). Eligibility will not consider the patient’s immigration status. Before this amendment, many patients were never informed financial assistance existed and many hospitals requested information that was not legally required, like Social Security Numbers or tax returns, which often scared patients away from applying.
• Patient eligibility for financial assistance will be expanded for those uninsured and underinsured. Under the new law, being underinsured is defined as patients whose paid medical expenses, excluding insurance premiums, exceeds 10 percent of their income within the last 12 months. Uninsured patients will now qualify if their household earns up to 400 percent of the federal poverty level (FPL) and will receive free or discounted care based on a sliding scale (see the table below for eligibility guidelines based on household size and the payment sliding scale). These guidelines will be solely based on the FPL and are updated through the Poverty Guidelines | ASPE.
• Individuals can now apply for hospital financial assistance at any time.
• Hospitals may not sell patients’ debt to third party entities like debt collection agencies. Often these agencies use aggressive and threatening practices to make patients pay medical debt.
• Hospitals are prohibited from bringing lawsuits against patients earning up to 400 percent FPL to collect unpaid medical bills. And lawsuits to collect unpaid balances cannot be brought until 180 days after the first medical bill. Lawsuits have disproportionately affected people of color and low-income residents. For example, according to a 2024 Community Service Society of New York report, over a third of lawsuits filed by State-run hospitals were filed against patients who lived in zip codes where residents are disproportionately people of color. Additionally, nearly all these cases were filed against patients that should have been eligible for hospital financial assistance.
• To measure this impact, hospitals will report to the DOH the number of people that have applied for financial assistance annually including age, gender, race, ethnicity, and insurance status.

With this series of reforms, more New Yorkers will be able to receive affordable hospital care and reduce their chances of incurring medical debt. The HFAL was a landmark reform back in 2006 and has been far improved with these amendments.

Here’s a copy of the form hospitals must use now.

If you need assistance in applying for hospital financial assistance, contact Community Health Advocates at 888-614-5400.

Every September, healthcare providers see a rise in asthma-related hospitalizations. The third week of September is known as Asthma Peak Week; ragweed levels—a common fall pollen allergy—are peaking, mold counts are increasing as leaves start to fall, children are catching respiratory infections as they go back to school, and flu season is just beginning. Proper asthma control is essential to stay healthy and manage symptoms during this month. However, for many, healthcare costs are making it difficult to manage or control their symptoms.    

In New York, asthma impacts more than 1.4 million adults and an estimated 315,000 children, according to the New York State Department of Health and the US Center for Disease Control, respectively as of 2021. The price of asthma inhalers, a lifesaving and sustaining device, has drastically increased over the past decade and can cost an individual up to $645 a month, according to the Senate Committee on Health, Education, Labor and Pensions (HELP). At these high prices, some patients are rationing doses or even abandoning their inhalers—which can lead to unnecessary hospitalizations and even preventable deaths. Though with insurance, patients share the cost of an inhaler with their insurance provider through a deductible or copayment—even those with health coverage struggle to afford inhalers.

Asthma rates and asthma-related complications disproportionately affect communities of color and low-income communities in New York. Black New Yorkers are over nine times more likely to visit the Emergency Department (ED) for asthma-related complications than their White counterparts—four times more likely for Hispanic New Yorkers. Asthma-related ED visits are also three times as frequent for individuals in low-income zip codes when compared to those in higher-income zip codes. Asthma is an apparent public health issue affecting those already facing economic and environmental disparities.

Earlier this year, with pressure from the HELP committee and Senator Bernie Sanders, three of the largest producers of inhalers—AstraZeneca, Boehringer Ingelheim, and GlaxoSmithKline—agreed to cap their inhaler products, for both asthma and chronic obstructive pulmonary disease, at $35 or less per month. This price cap will be available for those on commercial insurance and those uninsured, which will be automatically applied at local pharmacies or accessed with a copay card. However, those enrolled in government insurance programs, like Medicare or Medicaid, are left behind due to federal restrictions.

Luckily, New York legislators, Assembly Member Jessica González-Rojas and State Senator Gustavo Rivera, have proposed a bill to remove this financial barrier by eliminating deductibles, copayments, coinsurance, or other cost-sharing requirements for inhalers and require insurance coverage for inhalers at no cost. González-Rojas introduced this legislation because of its significance to her district, representing communities in Queens, that have high rates of hospitalization due to asthma. Rivera represents the northwest Bronx, a borough with substantially higher asthma mortality rates than other New York City boroughs. We commend both González-Rojas and Rivera for taking these necessary actions in trying to address New York’s asthma crisis.

Minnesota and Illinois, Washington, and New Jersey have passed similar legislation that caps the cost-sharing requirements of inhalers at $25, $35, and $50 per month, respectively. We need New York to step up to the plate to save lives and treat asthma. “This smart bill will ensure that insurance cost-sharing is never a barrier to accessing life-sustaining inhalers for those who need it,” said Elisabeth R. Benjamin, Vice President of Health Initiatives at the Community Service Society of New York.  

New Yorkers anticipating health insurance premiums in the individual market will face
disappointing developments in 2025. The latest data shows that individual market rates
are expected to increase by an average of 13 percent next year. Insurance carriers initially
requested a 17 percent average rate surge for 2025, but through New York’s prior approval
process, the Department of Financial Services has marginally trimmed this figure down. The table below compares health plans’ initial rate requests with rates that were ultimately approved, providing insight into how this process impacts your healthcare costs (you can also review our detailed comments on each carrier’s rate request).

The prior approval process acts as an important safeguard; and while expanded advanced premium tax credits—enacted through the American Rescue Plan during the COVID-19 pandemic—have helped make health insurance more affordable, these tax credits are set to expire in 2025. This 13 percent increase will be a financial burden for many New Yorkers. New York should consider additional strategies to protect consumers from steep premium increases beyond the rate review process. States—such as Connecticut, Delaware, Massachusetts, Nevada, New Jersey, Oregon, Rhode Island, and Washington—have already taken steps in this direction, setting up Health Care Cost Containment task forces or agencies.

If you’re concerned about health insurance costs, there’s good news. Most New Yorkers
purchasing their own health coverage are eligible for subsidies that can help. To explore
your options and learn more about available subsidies, visit the NY State of Health
enrollment site. If you need help switching plans or finding affordable health insurance, the
Navigators program offers free, unbiased guidance and can help you understand your
premium assistance and coverage options. You can contact Navigators through the CSS
Navigator Network at 888-614-5400 or email enroll@cssny.org. Additionally, you can reach out to NY State of Health assistors online or by calling 855-355-5777.