New Yorkers will have an easier time applying and accessing affordable hospital care

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.

The Department of Financial Services released its final 2022 rate decisions today, and once again our prior approval law has resulted in huge savings for New Yorkers. Individual market insurers requested an average premium increase of 11.2% this year. After reviewing their requests, DFS knocked that down to just 3.7%, a 67% decrease! That means consumers will save over $138 million in 2022. Small group plans requested an average rate increase of 14%, which was reduced to 7.6%. That reduction will save small business owners over $468 million in 2022.

In the individual market the biggest reductions were for Healthfirst (from a requested increase of 34.4% to an approved increase of 9.7%) and Highmark Western and Northeastern NY (from a requested increase of 18.1% to an approved increase 6.2%. Three plans will lower their rates in 2022: IHBC by 4.4%, MetroPlus by 3.9%, and Fidelis (by 0.1%). These final rates are an average across all the individual plans offered by each carrier.

“Prior approval” means that insurers submit requests to state regulators explaining what they plan to charge next year. The Department’s job is keeping premiums as low as possible while making sure that plans stay solvent. The rate applications include information on the plans’ costs during the current year (though this year they used 2019 data because 2020 was such an outlier) and assumptions the plans have about costs next year. DFS looks at this data and especially at the assumptions plans make to see if they are in line with other sources. For example, the plans provide an estimate of medical trend. Medical trend is the change in what plans spend on health services for members each year due to changes in prices for those services and how often members receive health care. DFS frequently disallows trend estimates that are too high with no justification. DFS has also capped profit in the past to keep rates down. For example, last year it capped profit at 0.5% for all plans.

Prior approval in New York is a public process and members of the public are able to submit comments on the rate requests. You can read our comments on each plan’s request here. This year, many commenters talked about the financial difficulties they are experiencing because of the pandemic. Others talked about paying higher premiums every year but struggling to find doctors and receive care. Some asked why costs aren’t going down given cheaper ways of providing care like telemedicine or the new customers plans will get in 2022 because of the American Rescue Plan’s higher premium subsidies. You can find your individual market plan and the public’s comments on it at these links:

Premium requests made by New York’s insurance companies have been posted, and consumers have the chance to share their thoughts on these requests! New York State requires this approval for all individual market, small group, and Medicare Advantage plans. If your plan is part of this process, you should have received a letter from your insurer explaining what they requested and how you can submit comments to the state’s Department of Financial Services (DFS). The insurers’ applications are available through DFS’s website and are linked below. Public comments are due in late June and can be submitted online here.

It is important to remember that at this point, these are only requested changes; DFS will review insurers’ applications along with consumers’ comments when determining the approved rates for 2022. Last year, DFS decreased insurers’ requested rate for individual coverage from a 11.7 percent increase to a 1.8 percent increase, the lowest rate increase ever approved. The changes saved consumers over $221 million. DFS also reduced rates requests for small group coverage from 11.4 percent to 4.2 percent, a 63 percent decrease that saved small businesses over $565 million.

This year, the average request was 11.2 percent in the individual market. Healthfirst PHSP, Inc. requested the highest increase at 34.4 percent. The plan cites higher provider charges in its new service areas in Westchester and Rockland counties for most of this increase. Six other plans requested double digit increases: Highmark (18.1 percent), MVP (16.9 percent), Unitedhealthcare (13.9 percent), Oscar (13.6 percent), CDPHP (11.4 percent), and HealthPlus (10.2 percent). MetroPlus (-3.9%) and Independent Health Benefits Corporation (-.2%) each requested decreases. For small group plans, the average requested increase was 14 percent, ranging from a 17.6% requested increase by Highmark Western and Northeastern New York (formerly Healthnow) to a 4.5% requested decrease by Aetna Health.

HCFANY submits detailed comments each year, which you can see in our letters from 2020 (link) and 2019 (link). Consumers do not need to provide this much detail; if you do comment publicly, you can speak about how the proposed changes to your plan would impact you. For example, what changes would you have to make if your insurance company were allowed to increase their rates? Would you still buy insurance? HCFANY has longer instructions available (link), but the most important thing is to use your own experience.

Individual Market Applications

We’ve compiled the links to applications for each insurance carrier that participates in New York’s individual market through our health insurance exchange below. We’ve included both the narrative summaries, which are shorter (under 10 page) explanations for the requested rate changes, as well as the complete application links for those who wish to review the applications in greater detail.

CDPHP Health Plan: Narrative Summary (link), Complete Application (link)
Emblem (HIP): Narrative Summary (link), Complete Application (link)
Excellus: Narrative Summary (link), Complete Application (link)
Fidelis (NYHQC): Narrative Summary (link), Complete Application (link)
Healthfirst PHSP: Narrative Summary (link), Complete Application (link)
Highmark Western and Northeastern New York (Formerly HealthNow): Narrative Summary (link), Complete Application (link)
HealthPlus Empire: Narrative Summary (link), Complete Application (link)
Independent Health Benefits Corporation: Narrative Summary (link), Complete Application (link)
MetroPlus: Narrative Summary (link), Complete Application (link)
MVP Health Plan: Narrative Summary (link), Complete Application (link)
Oscar: Narrative Summary (link), Complete Application (link)
UnitedHealthcare of New York: Narrative Summary (link), Complete Application (link)

New York State’s uninsured rate hit an all-time low of 5.2 percent in 2019, according to new data from the U.S. Census Bureau. New York has made continual coverage gains since 2010, when 11.9 percent of New Yorkers were uninsured. Approximately 68 percent of covered New Yorkers had private plans, while 40 percent had some type of public coverage.

New York had the 8^th highest rate of insurance coverage in the United States (after Massachusetts, 3 percent; the District of Columbia, 3.5 percent; Rhode Island, 4.1 percent; Hawaii, 4.2 percent; Vermont, 4.5 percent; Minnesota, 4.9 percent; and Iowa, 5.0 percent). Twenty states experienced significant increases in their uninsured rates. For children, New York has the 5^th best insurance coverage in the country with only 2.4 percent of people under 19 uninsured (after Massachusetts, 1.5 percent; Rhode Island, 1.9 percent; the District of Columbia, 2.0 percent; and Vermont, 2.1 percent).

Coverage changes between 2018 and 2019 were insignificant in most counties, but there were significant coverage gains in Erie, New York, Orange, Wayne, and Warren Counties (see table below). Only one county, Tompkins, experienced a significant increase in uninsured people (from 2.3 percent without insurance to 3.7 percent).

County	Uninsured, 2018	Uninsured, 2019
Erie	3.2%	2.6%
New York	5.2%	4.5%
Orange	5.2%	4.0%
Wayne	4.4%	2.0%
Warren	5.3%	1.7%

Queens County continues to have the highest rate of uninsured residents at 9.3 percent. It is followed by Cattaraugus County (8.3 percent), the Bronx (7.9 percent), St. Lawrence County (7 percent), and Kings County (6.3 percent).

Of course, the COVID-19 pandemic means that 2020 may look very different. But New York’s leaders have taken many steps to protect New Yorkers from coverage losses, including extending open enrollment in the New York State of Health for the entire years and automatically renewing Medicaid, Essential Plan, and Child Health Plus for thousands of New Yorkers.

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