HCFANY is thankful to have the opportunity to testify at the 2026 Joint Legislative Budget Hearing on Health. Find HCFANY’s detailed Executive FY27 Testimony here. The Executive Budget includes many proposals to help protect and enhance New Yorkers’ access to affordable health coverage. 

HCFANY’s budget testimony covers three topics:  

  1. Protect and improve health coverage 
  2. Regulate prices to create a more affordable health care system for New Yorkers 
  3. Robustly fund consumer assistance and enrollment programs and increase Article 6 funding to help New Yorkers navigate new complex hurdles 

(I) Protect and Improve Health Coverage

The enactment of HR 1 will drastically alter eligibility and funding for health insurance, leaving an estimated 1.5 million New Yorkers at risk of losing their coverage. Coverage losses for individuals on the Essential Plan may go into effect as soon as July 2026, so it is imperative that the State have a plan in place to mitigate these federal cuts.  

  • Support the transition from 1332 Waiver to 1331 Basic Health Plan (BHP) to allow 609,000 lawfully present immigrants to stay covered. 

If the federal government approves this change, 444,000 people enrolled in New York’s Essential Plan with incomes between 200-250 percent of the Federal Poverty Level (FPL) will become newly ineligible for the Essential Plan mid-year. The State should provide coverage options and financial support for this population: 6,000 individuals with Deferred Action for Childhood Arrival (DACA) immigration status or who are Permanently Residing Under Color of Law (PRUCOL), and 30,000 lawfully present immigrants with incomes over 200 percent FPL. These policy options are detailed in Community Service Society’s recently released report: Mitigating the Impact of HR 1 on New York’s Health Insurance Landscape: Four Policy Proposals to Preserve Coverage. 

  • Delay the repeal of continuous coverage of children up to age six. (Health and Mental Hygiene [HMH] Article VII, Part M) 

The federal government has made it clear that New York’s continuous coverage program for children up to age six will be discontinued. The Executive Budget includes a proposal to repeal this program on July 1, 2026. However, New York’s Medicaid 1115 waiver does not expire until March 2027. 

HCFANY recommends delaying the repeal until January 1, 2027, to ensure a smooth transition and keep these children covered for as long as possible. 

  • Support the reforms to prior authorization, with some recommendations. (Transportation, Economic Development, and Environmental Conservation [TED] Article VII, Part HH) 

The Budget requires additional information to be added to the Department of Financial Services (DFS) Consumer Guide, which helps consumers compare and select health plans offered in the New York Marketplace. HCFANY supports this addition but critically notes that the Consumer Guide currently does not report on plans that cover 80 percent of New Yorkers in the individual market. The Consumer Guide, and its additions, should be expanded to serve all consumers in the individual market.  

HCFANY supports language in the budget that expands the period insurers must cover out-of-network services for new enrollees, also known as continuity of care. In addition, HCFANY supports the budget proposal to improve consumer access to information on health plans’ formulary drug lists, helping patients understand which prescription drugs are covered under their plan.  

  • Enact the New York Health Act S3425|A1466, which would make many of the above changes unnecessary and better address the long-term health care needs of New Yorkers. 

(II) Regulate Prices to Create a More Affordable Health Care System for New Yorkers

Over the past few decades, New York’s health care spending has increased rapidly, and the State ranks second nationally in highest health care expenditures and premiums. Hospital prices are a primary contributor to these high health care costs.  

The FPA would cap payments at 150 percent of the Medicare rate for a defined list of low-complexity procedures. This would reduce cost disparities between hospital and non-hospital providers, such as doctors’ offices. Currently, a new patient office visit costs around $88 at a non-hospital site but can cost $436 (540 percent of the Medicare rate) in a hospital outpatient department. Adopting the Fair Pricing Act could save New York $1.14 billion annually, including $213 million in reduced out-of-pocket costs for consumers with commercial insurance. The Community Service Society recently released a brief, “How the Fair Pricing Act’s Site Neutral Policy Boosts Health Care Affordability by Ensuring Savings Will Be Passed Through to Patients and Payers“, exploring proposed solutions to curb this trend and make health care more affordable for New Yorkers. 

  • Invest in primary care by including provisions from the Primary Care Investment Act (PCIA) S1634|A1915A. 

The PCIA would require New York to measure and report the current percentage of its health care expenditures that are spent on primary care. It would also require insurers to gradually increase spending by 1 percent each year until reaching a benchmark of spending at least 12.5 percent of their overall health spending on primary care. Nationally, only 4.6 percent of health care spending is spent on primary care, despite primary care accounting for nearly half of office visits each year. Adopting provisions from the PCIA will reduce health care costs, improve patient outcomes, and promote health equity.  

  • Create an independent New York Office of Health Care Affordability. 

California’s Office of Health Care Accountability is an independent entity that regulates the state’s health care spending growth, quality, and market consolidation. It also requires its members not to receive compensation from health care entities. Currently, New York’s Public Health and Health Planning Council (PHHPC) is comprised of political appointees affiliated with hospitals and other health care industry representatives. 

HCFANY recommends that the Legislature consider creating an independent office to address long-term structural issues to improve health care affordability in New York. 

  • Support strengthening the Department of Health’s oversight of health care transactions, with further recommendations for transparency. (HMH Article VII, Part H). 

HCFANY supports tracking the impact of material transactions on health care costs, quality, access, health equity, and competition. HCFANY urges the Legislature to go further and require an annual summary of this impact to be publicly posted for advocates and consumers to understand the impact of these transactions.  

HCFANY also supports the additional requirements for written notice of health care transactions and the utilization of cost and market impact review (CMIR) for material transactions. However, HCFANY urges the Legislature to expand the language to require public posting of documents related to the review process and results.  

(III) Robustly Fund Consumer Assistance and Enrollment Programs and Increase Article 6 Funding 

Given devastating cuts to federal health programs, consumer assistance advocates and navigators are more important than ever to help New Yorkers through coverage transitions and to reduce barriers in accessing affordable care.  

  • Increase funding for health insurance enrollment navigators. 

The Navigator program, predominantly run through trusted community-based organizations (CBOs), helps New Yorkers enroll, keep, and use their health insurance. Navigators provide unbiased, personal assistance year-round and speak over 40 languages.   

HCFANY is grateful that the Governor’s budget includes $28.3 million for Navigators and urges the Legislature to fund the Navigator program at $38 million to guarantee continued high-quality enrollment services. The State should also allocate $5 million in grants to CBOs to conduct outreach in underserved communities.  

  • Maintain funding for Community Health Advocates (CHA). 

CHA helps individuals with any type of health insurance access in-network care, resolve billing issues, avoid medical debt, appeal coverage denials, and address other barriers to obtaining affordable medical care. In FY 24-25, CHA saved consumers $25 million, yielding a 407% return on investment.  

HCFANY is grateful that the Governor’s budget includes $5.5 million for CHA and urges the Legislature to allocate an additional $1.7 million to maintain CHA’s funding at its current $7.2 million.  

  • Increase Article 6 funding in New York City. 

Under Article 6, New York City is reimbursed for essential public health services at a lower rate than all other localities in the State, receiving just 20 percent for spending above its base grant compared to 36 percent for all other local health departments.  

HCFANY strongly supports increasing Article 6 funding for NYC.  

Stay tuned, as HCFANY will review the Governor’s 30-day amendments, the One-House bills, and the finalized FY27 Executive Budget.  

Today, Governor Hochul delivered her 2026 ‘State of the State’ address. HCFANY commends the Governor for proposing initiatives that protect patients from rising health care costs, mitigate federal cuts to health care, and reduce barriers to care.

The Governor also acknowledged some key victories last year, many of which HCFANY has advocated for. This includes banning insulin cost-sharing for State-regulated insurance plans and preventing medical debt from negatively affecting New Yorkers’ access to credit. HCFANY thanks the Governor for her continued support in protecting patients.

Looking into the new year, the Governor has proposed many initiatives that align with many HCFANY advocacy goals falling under five categories: (1) protecting New York from federal health cuts, (2) immunization access, (3) oversight of hospitals and health systems, (4) prior authorization, and (5) individuals with disabilities. Her proposals plan to:

(1) Protecting New York from Federal Cuts to Health Care

  • Negotiate with the federal government to find and implement another affordable coverage option for the 450,000 New Yorkers who will lose their current Essential Plan coverage

HCFANY lauds Governor Hochul’s commitment to maintaining coverage for New Yorkers affected by federal cuts. HCFANY will continue to monitor how federal health cuts will affect New York; find up-to-date impacts by county and congressional district HERE. Additionally, HCFANY recently released information on how these cuts will affect immigrants’ eligibility for health coverage HERE.

(2) Immunization Access

  • Establish the State’s own immunization requirements and standards to ensure they are based on medical science and public health needs

(3) Oversight of Hospitals and Health Systems

  • Require ongoing reporting and an external review on the impacts of closed health care material transactions

(4) Prior Authorizations

  • Require health plans to publicly post a list of medications that they cover, also known as formularies, using a standard format
  • Require insurers to report on how many claims are subject to prior authorization and how often those requests are denied
  • Expand “continuity of care”—the period insurers must cover out-of-network treatment for new patients—from 60 days for life-threatening conditions or late-stage pregnancy to 90 days for all health conditions and the full postpartum period
  • Extend the period during which prior authorization for designated chronic conditions is valid

(5) Individuals with Disabilities

  • Direct the Department of Health’s Disability and Health Program to collect and analyze data on the structural inequities New Yorkers with disabilities face to identify barriers to care

HCFANY thanks the Governor for introducing these initiatives that defend New Yorkers’ access to health care. Stay tuned, as HCFANY will review the Executive Budget in the coming weeks to determine how these proposals will be implemented.

HCFANY is thankful to have the opportunity to testify at the 2025 Joint Legislative Budget Hearing on Health. Our fully detailed written comments are here. The Executive Budget includes many proposals to help protect and enhance New Yorker’s access to affordable health coverage. However, the current federal landscape on health care access is uncertain, as proposed cuts to federal health programs could cost the State $10 billion to maintain health coverage for New Yorkers (Learn how these federal threats affect New Yorkers statewide and by Congressional District here).  

The Managed Care Organization (MCO) tax revenue provides an opportunity for the State to ensure New Yorkers have access to and can afford health care. HCFANY urges the Legislature to consider alternatives to the distribution of $1.4 billion of this tax revenue, which currently does not include direct support for patients.  

HCFANY recommends:  

  1. Expanding subsidies for Child Health Plus to eliminate premium cliffs and align coverage start dates to the first day of the month of application.  

This would help ensure that middle-income families can afford their children’s health insurance. Once families surpass the 400% Federal Poverty Level (FPL) income threshold, their children’s annual insurance premiums increase by around $3,000 per child. Additionally, the State should follow similar rules as Medicaid and the Essential Plan for CHP coverage start dates. 

  1. Addressing New York’s expensive health care system.  

New York is ranked second in the nation for the most health care spending per person, and HCFANY proposes three solutions to remedy this: 

  1. Implement an independent New York Office of Health Care Affordability, like the model created in California.  
  1. Include provisions of the Fair Pricing Act (S705|A2140) to ensure consumers and payers are charged a fair reimbursement rate for routine medical services, regardless of where the patient gets care.  
  1. Improve patient outcomes and reduce inequities by including the provision of the Primary Care Investment Act (S1634|A1915A).  
  1. Creating a principal reserve or a rainy-day fund to ensure New Yorker’s access to care is protected from the threats of federal cuts.  

This funding could help keep lawfully present immigrants enrolled in Medicaid covered if the federal government cuts access to health insurance for this population.  

  1. Increasing funding for consumer assistance programs like Navigators and the Community Health Advocates (CHA) program.  

These are only a few initiatives that HCFANY is urging the Legislature to consider, please see our full written testimony here. 

On January 14th, Governor Hochul delivered her 2025 ‘State of the State’ address. HCFANY commends the Governor for proposing sweeping protections for consumers and patients across the State. Her proposals feature many HCFANY advocacy goals falling under six categories: (1) mental health, (2) reproductive health, (3) chronic health conditions, (4) prescription drugs, (5) dental health, and (6) improving insurance coverage. Her proposals plan to:

(1) Mental Health

  • Implement a teen mental health first aid program to equip youth with the ability to respond and address signs of mental health and substance use distress for themselves and their peers.
  • Introduce an initiative that connects youths to critical mental health resources during state-funded after-school programs.
  • Allocate new resources to strengthen compliance oversight and investigate more insurance complaints.

In New York, youth struggling with mental health has been on the rise; in 2023, 48 percent of teens experienced depressive symptoms ranging from mild (27 percent) to severe (11 percent) in New York. Through these proposed initiatives, the Governor hopes to provide basic skills for youths to support themselves and their peers and reduce the impacts of bullying and social violence. Additionally, the State aims to partner with the State University of New York to match social work graduate students with state-funded after-school programs to complete their required fieldwork and support vulnerable youths. 

The current law requires insurers to offer an accessible network of providers, pay at least Medicaid rates for in-network services, and reimburse school-based mental health services at Medicaid rates. Through her proposal, the Governor hopes to improve compliance oversight and investigate and find solutions to mental health care access needs and complaints.

We commend the Governor for her continued commitment to protecting youth mental health and proposing reforms to improve coverage for mental health care.  

(2) Reproductive Health

  • Expand funding for reproductive health care facilities to enable renovations and equipment upgrades to help providers deliver the full range of comprehensive services.

In New York, reproductive health care facilities often lack the proper infrastructure to provide the full range of comprehensive services needed. The Governor hopes to support these facilities through the Reproductive Freedom and Equity Grant Fund and security grant funding to ensure a broader network of providers can deliver quality reproductive health care throughout the State.

HCFANY is excited to see the Governor’s continued effort to ensure New Yorkers have access to reproductive care. Earlier this year, she announced a first-in-the-nation initiative to provide 20 hours of paid leave for prenatal care for privately employed, pregnant New Yorkers, both full-time and part-time.

(3) Chronic Health Conditions

Obesity is a significant concern for New Yorkers; in 2023, around one in three New Yorkers were found to be obese. This chronic condition increases the risk of diabetes, asthma, cardiovascular disease, cancer, and other chronic health conditions. Recently, GLP-1s have transformed obesity treatment, but many face cost barriers to this life-saving treatment. The Governor proposes to provide greater access to GLP-1 drugs for Medicaid members at high risk of cardiovascular events and pressure drug companies to lower prices.

The effects of climate change have increased the severity, duration, and frequency of extreme heat events, also known as heat waves, and these events are deadly for vulnerable populations with chronic health conditions. Heat-related deaths are more likely to occur at home, highlighting the importance of home cooling access. Last year, the Governor implemented an initiative to distribute air conditioners for Essential Plan members whose asthma poses a significant medical risk. Her proposal builds upon this by expanding eligibility to more individuals whose symptoms worsen through these heat events.

HCFANY applauds the Governor’s outstanding support for New Yorkers with chronic health conditions. These initiatives build upon the first-in-the-nation diabetes initiative that HCFANY supported, eliminating co-pays for insulin covered by state-regulated insurance plans, which went into effect this year. As of 2023, 1.8 million New Yorkers have been diagnosed with diabetes, and this initiative is estimated to save eligible New Yorkers up to $1,200 per year totaling around $14 million in 2025.  

(4) Prescription Drugs

The United States spends more on prescription drugs than any other peer country—like Australia, Canada, and France—with prices around two to four times higher for major brand-name drugs. A nationwide survey finds that 82 percent of Americans believe the cost of drugs is unreasonable, and over half of Americans worry about being able to afford their family’s prescriptions. Last year, a bill aiming to implement prescription drug importation program to lower costs (A7954A/S604) was passed in the Senate but fell short in the Assembly. Luckily, the Governor plans to participate in the Food and Drug Administration’s Section 804 Importation Program, which achieves a similar goal in importing low-cost drugs from Canada.

Additionally, the Governor is seeking to introduce a first-in-nation initiative to improve transparency and hold PBMs and drug manufacturers accountable to uncover any unnecessary costs they add to drug prices.

(5) Dental Health

  • Set minimum standards for dental plans available through New York’s insurance marketplace, New York State of Health (NYSOH).
  • Expand the scope of practice for dental hygienists.
  • Direct health plans to improve the availability of dental care.

It is well documented that dental care is essential to oral health, yet many New Yorkers face substantial barriers to accessing essential oral health services. HCFANY is thrilled to see the Governor’s proposal announcing plans to make minimum standards for dental plans available through New York’s insurance marketplace, New York State of Health (NYSOH)—an initiative that HCFANY has been advocating for.

The Governor also aims to introduce legislation to expand the scope of practice for dental hygienists and direct health plans to improve the availability of dental care.

(6) Insurance Coverage

  • Identify and address equity gaps in quality and outcome measurements for those on Medicaid Managed Care plans.
  • Create an integrated care system for Medicaid patients.
  • Perform a comprehensive review of the State’s network adequacy standards and increase enforcement of plan compliance.

In 1994, New York implemented Quality Assurance Reporting Requirements (QARR), which measure and report on health care quality. Though current Medicaid Managed Care (MMC) plans meet or exceed national benchmarks for quality measures, these measurements from QARR cannot identify health inequities within the population. The Governor has proposed to direct MMC plans to analyze gaps in quality and outcomes within their populations, as well as develop strategies to address gaps, including creating a value-based payment.

New York is one of the three states where Medicaid patients can enroll in a separate MMC plan for long-term care along with their medical care coverage, called a partial capitation plan. Many also have separate Medicare coverage. This fragmentation reduces the ability for effective, person-centered, coordinated care. Through her proposal, the Governor plans to work with MMC plans to increase the availability and adoption of integrated care options and limit non-integrated offerings.

Lastly, in New York, network adequacy requirements have not been updated in decades despite variations in health care access across the state. Network adequacy standards require that health plans meet basic standards for members’ access to in-network providers without unreasonable delay or excessive travel. Currently, consumers are often directed to unavailable or out-of-network providers, which leads to untimely care and an increased risk of incurring medical debt. The Governor’s proposal intends to instruct the Department of Health to perform a comprehensive review on network adequacy standards and increase enforcement of plan compliance. HCFANY supports the Governor’s continued investment in proposing initiatives that help protect consumers from incurring medical debt, an issue that HCFANY continues to advocate for.

HCFANY commends the Governor for introducing these initiatives to protect patients and consumers in New York. HCFANY will review the newly released Executive Budget to determine how these proposals will be implemented.