With the release of New York’s FY2026-2027 Final Budget, HCFANY thanks the Governor and the Legislature for enacting proposals to help consumers and patients access affordable, quality health care, and hopes to see continued efforts as HR1 policies are implemented over the next several years. HCFANY is disappointed that the final budget fails to protect Essential Plan coverage for half a million New Yorkers who will lose it this July.

HCFANY’s response to this year’s budget falls under four categories: (I) Mitigating Losses from Federal Cuts to Health Care, (II) Protecting and Improving Health Coverage, (III) Enhancing Consumer Transparency, and (IV) Regulating Health Care Prices.

(I) Mitigating Losses from Federal Cuts to Health Care

On July 4, 2025, President Donald Trump signed HR1, also known as the “One Big Beautiful Bill Act”, which has drastically altered eligibility and funding for health insurance for New Yorkers. The New York Department of Health (NYSDOH) estimates that 1.5 million New Yorkers, citizens and immigrants alike, will become uninsured as the changes under HR1 are implemented over the next couple of years.

Action to preserve Essential Plan (EP) coverage for 1.3 million New Yorkers.

Last September, Governor Hochul requested to terminate the State’s Section 1332 Waiver, which would return the EP to the Basic Health Plan under Section 1331 of the Affordable Care Act. This March, New York State of Health announced that the Centers for Medicare and Medicaid Services (CMS) approved New York’s request and will complete this transition on July 1, 2026.

HCFANY is disappointed the final budget did not include funding to keep half a million New Yorkers covered.

In the State’s transition back to the Basic Health Plan, half a million New Yorkers will lose access to health insurance this July, including individuals on the Essential Plan with incomes between 200 to 250 percent of the Federal Poverty Level (FPL), with DACA and PRUCOL statuses, and lawfully present immigrants losing eligibility for premium tax credits. HCFANY fought hard to garner support from the Legislature to sign on to S9589/A10926, a proposal which would preserve coverage for this population, with significant help from the bill sponsors—Senator Rivera and Assemblymember Paulin.   Amid devastating federal health care cuts, HCFANY hopes to see the State take action to provide coverage for the half a million New Yorkers losing health coverage starting this July in next year’s Budget.

Action to terminate continuous coverage for children ages 0-6 years

The federal government has made it clear that the State will be forced to discontinue its continuous coverage program for children up to age six, made possible through New York’s Medicaid 1115 Waiver. Although this waiver ends in March 2027, the final budget repeals this program this July.

(II) Protecting and Improving Health Coverage

Expanding continuity of care protections.

Continuity of care protects patients through network disruptions when (1) their provider leaves the plan’s network or (2) the patient switches plans and the current provider they see is no longer in network. The final budget made the following changes to these scenarios:

(Scenario 1: When their provider leaves your plan’s network) A patient is eligible to continue seeing their current provider at the same in-network costs for up to 90 days, or if applicable, through the end of the patient’s postpartum care.

(Scenario 2: When a patient switches health plans and their current provider is no longer in network) A patient is eligible to keep in-network costs with their current provider if the patient has a life-threatening condition, for up to 60 days, and starting January 1, 2027, up to 90 days, only if the provider agrees to the payment rate and rules of the new plan. If pregnant, the patient will be able to see their current provider through the end of postpartum care.

Protecting consumers from repetitive and redundant health plan utilization reviews for individuals with chronic conditions.

A utilization review is conducted to determine if a treatment, testing, or procedure is medically necessary for a patient. The final budget bans this review from being conducted more than once per year, unless the provider changes the patient’s course of treatment.

(III) Enhancing Consumer Transparency

The final budget implements many requirements for insurers who provide coverage on the New York State of Health Marketplace (NYSOH) to improve consumer transparency, many of which complement the recently released 2027 Plan Invitation.

Improving the Department of Financial Services (DFS) Consumer Guide.

The DFS Consumer Guide, which helps consumers pick health plans on NYSOH, will now provide information on grievances, approvals, adverse determinations, appeals, and other pre-authorization issues filed for each plan. HCFANY hopes the State continues to improve the Consumer Guide to serve more consumers, for example, by including DOH-regulated plans. Currently, the Guide does not report on plans that cover 80% of New Yorkers in the individual market.

Requiring public notice when contracts between hospitals and health plans end.

In the final budget, public notice is now required when contracts between hospitals and health plans are planned to end. This will help consumers stay informed when network disruptions occur.

Requiring health plans to make their formulary drug lists more accessible.

Health plans in New York are required to disclose to patients which prescription drugs are covered under their plan in a formulary drug list. Consumers will now be able to view this list without creating an account or password and will have an easier time determining which plan it applies to, if an insurer offers multiple plans.

Adding more covered services, including vision, dental, and nearby cancer centers, to the Essential Plan benefit package.

Next, the final budget will expand coverage of services in the Essential Health Plan Benefit package, including vision and dental care and services provided by cancer centers licensed by DOH within a nearby service area.

(IV) Regulating Health Care Prices

Weakened government oversight on health care transactions

Initially proposed in the Executive Budget, the final budget omitted the proposal requiring the DOH to conduct a more intensive review of health care transactions for cost, quality, access, health equity, and competition, and implementing additional requirements for written notices of such transactions.  

Medicaid beneficiaries are now excluded from the independent dispute resolution (IDR) process.

The IDR process was implemented to protect consumers from surprise medical bills by establishing a third-party entity that reviews the payment offers from both the insurer and the provider to determine the cost of the out-of-network service.

 

 

Every year, health insurance carriers that participate in New York’s Marketplace, New York State of Health, submit requests to the Department of Financial Services (DFS) on what they would like to charge for health insurance premiums the following year. See below for template language and instructions for submitting a comment on the proposed 2027 premium increases.

Starting five days after the proposed rates are released, consumers have 30 days to submit comments. DFS considers consumer comments to determine the approved premium changes (typically increases) each insurer is allowed. This process, known as prior approval or rate review, is an opportunity for the State to keep premiums affordable for New Yorkers.

This year, New York’s individual market insurance carriers have asked the Department of Financial Services to allow them to increase premiums by an average of 21% in 2027. This increase would force New Yorkers to pay an average of $2,065 more annually, or $172 more monthly, in premiums. HCFANY hopes the State continues its trend of reducing carrier premium increase requests. For the past three years, the State has approved premium increases of 14% in 2024, 13% in 2025, and 7% in 2026.

Up until July 17th, consumers can make their voices heard by weighing in on the prior approval process.  

Depending on the carrier, premiums could increase by 1% to 52% in 2027, limiting New Yorkers’ ability to spend on other essentials like groceries, transportation, or housing. Below is a table showing the breakdown by carrier.

Make your voice heard: submit a public comment before July 17th, 2026, sharing how steep premium increases would affect your budget or loved ones. Below are the steps and an example script to submit a public comment online.

  • Go to https://myportal.dfs.ny.gov/web/prior-approval/submit-a-comment.
  • Select the following in the drop-down boxes. This information can be found on your insurance card or plan letter notice.
    • The type of plan you have
    • Insurance company
    • Whether you are on an Individual or group policy
  • Fill in your First Name, Last Name, and Contact Information (select one of three options: Email, Address, or Phone number)
  • Write a Comment (Use the example script below if you need help!)
    • Comments can be very short and direct. Every comment helps demonstrate that another member will be harmed if the Department approves the carrier’s current request.

“[insert your carrier’s name] is asking for a [insert from table] % premium increase, which means an annual premium increase of [insert from table]. I cannot afford this. Back-to-back increases in premiums are absurd.

I need health insurance to [insert a reason why you need health care, like affording your prescription drugs, needing to access preventative care, or certain medical services].

At this price, I will be forced to give up [insert reason, such as childcare, groceries, or housing] or forgo health coverage. I urge you to curb these increases and consider how this will impact my family and me.”

_________________________________________________________________________________________________________

Look out for HCFANY’s comments on each carrier’s rate application in the coming weeks.  

New York State of Health (NYSOH) recently announced that cost-sharing reduction programs made possible by the State 1332 Innovation Waiver will continue until the end of 2026. These crucial affordability programs reduced deductibles and eliminated co-payments for outpatient maternity care and out-of-pocket costs for diabetes-related treatments for individuals enrolled in Qualified Health Plans on the individual market. On July 1, 2026, the State will transition from the 1332 Waiver back to the Basic Health Plan, but this will not affect these cost-sharing programs through the end of the year. In addition, this transition will not affect the State’s free insulin program for those with State-regulated health coverage, which was enacted through the State budget in 2024. 

 What is changing? 

In March, New York State of Health announced that the Centers for Medicare and Medicaid Services (CMS) approved New York’s request to terminate its Section 1332 Waiver and return to the Basic Health Plan under Section 1331 of the Affordable Care Act. This transition partially mitigates the impact of HR1, known as President Trump’s One Big Beautiful Bill, enacted on July 4, 2025. The transition will preserve health insurance for 1.3 million New Yorkers but terminates free Essential Plan coverage for 444,000 others. As described on HCFANY’s Protect Health Coverage page, the State could have passed S9589/A10926 to prevent this loss of coverage. 

The State’s cost-sharing reduction program is funded by this 1332 Waiver, and the federal government denied the State’s request to keep funding to maintain these programs for the rest of the year. However, NYSOH just announced that this program will not lapse in July and will continue until the end of this year. HCFANY thanks the State for continuing to protect patients from federal cuts to health care. Data from New York State of Health’s latest enrollment report for 2025 reveals that these three initiatives saved over 62,000 New Yorkers enrolled in Qualified Health Plans around $50 million in health care costs. Based on claims data, these cost-sharing programs have benefited 3,800 with prenatal and pregnancy care, 26,600 with diabetes care, and reduced deductibles for 41,800 with Marketplace Silver plans. You can see the entire list of prenatal and diabetes services here. 

Consumers who have Qualified Health Plans and have a household income between 200% and 400% of the Federal Poverty Level can still enroll in these cost-sharing programs. If an individual is already on a silver plan, they will be automatically enrolled in this program. If the individual would like to switch, they can visit NYSOH and make this change by completing a “Life Status Change” in their application. Some consumers may have received a notice in early June indicating the termination of cost-sharing; they should disregard it.  

What is not changing? 

Fortunately, insulin will remain available to those with State-regulated health insurance with no cost-sharing. New York became the first in the nation to fully eliminate copayments, coinsurance, and deductible requirements for covered prescription insulin by amending the state insurance law in the State’s FY2024-2025 final budget. This new law went into effect on January 1, 2026. Research shows that eliminating co-payments for some chronic care medications—including insulin—generates more insurance claims savings. This law replaced a 2020 statute that had capped insulin copays at $100 per month. The State subsequently eliminated co-payments for maintenance and emergency inhalers in a law that takes effect on January 1, 2027. 

HCFANY hopes the State continues to ensure that New Yorkers have access to affordable, quality care, especially for the half a million New Yorkers who will lose Essential Plan coverage this July due to federal health care cuts. Stay tuned, as HCFANY will review the final budget once it is released. 

Over 6.6 million New Yorkers browse and enroll in health coverage through New York’s official health plan Marketplace, New York State of Health (NYSOH). As of January 2026, 4.1 million were enrolled in Medicaid, 210,000 in Qualified Health Plans, 551,000 in Child Health Plus, and 1.7 million in the Essential Plan. Every year, the New York Department of Health (DOH) issues a plan invitation that outlines requirements and guidelines that health insurers must follow to participate in the Marketplace. HCFANY is thankful for the continued efforts of the State to ensure that consumers have an easier time navigating, affording, and accessing health insurance coverage in New York, amid federal cuts to health care.

New Yorkers who receive coverage through NYSOH have been greatly impacted by federal health care cuts, enacted by HR1. Those previously on Qualified Health Plans have already lost enhanced premium tax credits, which expired last year. With the termination of New York’s Section 1332 Waiver, cost-sharing initiatives that helped around 62,000 individuals save $50 million in health care costs will end. Lastly, half a million will lose their Essential Plan coverage starting July, unless the State acts now and implements bill S9589|A10926 in the final budget.

From this year’s 2027 NY State of Health Plan Invitation, HCFANY is pleased to see the following recommendations adopted:

Enforcing greater network adequacy standards:

  • Specialists, or non-primary care providers, must meet the 30-minute or 30-mile time-and-distance standards.

Improving consumer transparency through network disruptions and provider directories:

  • Plans are now required to submit disruption analysis reports earlier to NYSOH, at least 30 days before any consumer notices are scheduled to go out.
  • Plans need to provide hospital network contracting status and anticipated contract end dates on a bi-annual basis for NYSOH to proactively monitor network stability for consumers.
  • Plans must indicate and give consumers advance notice within their online provider directories when a provider, group, or facility will be leaving the network.
  • The Department of Health will start collecting data and metrics on consumer complaints with provider directories.

Protecting consumers during substantial network changes:

  • A special enrollment period will be created for members who experience a mid-year network disruption that materially affects access to covered services to allow consumers to change plans.

Expanding the Consumer Guide:

  • NYSOH will collaborate with Department of Financial Services (DFS) to improve the consumer guide for individual market consumers by including DOH-regulated plans.

Enhancing information access to mental health and substance use disorder services:

  • Plans must now establish and maintain a publicly accessible webpage that provides enrollees with information about behavioral health resources.

HCFANY is grateful that DOH and DFS continue to prioritize consumer protection and transparency. Stay tuned, as HCFANY will review the final State budget in the coming weeks.