Health Care for All New York is delighted that the new budget deal includes key HCFANY legislative agenda items, including: the reform of our State’s broken Hospital Financial Assistance Law (HFAL); the elimination of cost-sharing for insulin; a program to provide enhanced subsidies to help offset the costs or premiums of cost-sharing in the Marketplace; and continuous coverage for children up to age six in our State’s public health insurance programs. But HCFANY is hugely disappointed to see that Coverage4All was not included in the final deal. And in a break with the Assembly’s historic support for Community Health Advocates, it maintained over a 50 percent cut to its allocation ($1 million in 2023 decreased to $469,000 in 2025). 

The Budget deal reforming our state’s broken HFAL will provide enormous relief to New Yorkers. Over the past 7 years, New York’s “charitable” hospitals have sued over 80,000 patients contributing to the grim statistic that 760,000 people have medical debt. The ubiquity of these lawsuits will now be significantly curtailed. The new law outright bans lawsuits against patients with incomes below 400% of the federal poverty level (FPL), which is about $60,000 for an individual. It also requires hospitals to provide free care to patients with incomes up to 200% of FPL ($30,000 for an individual), and heavily discounted care – between 10-20% of the Medicaid rate – for patients up to 400% of FPL. Further, hospital payment plans cannot charge more than 5% of a patient’s gross family income in a year. And it eliminates burdensome “asset” test rules that became a cover for bureaucratic applications where patients have to prove the negative: that they are not secretly stashing their wealth in an effort to get help paying for healthcare. Finally, hospitals will be barred from including “immigration” eligibility tests for financial assistance.

Another positive aspect of the budget for healthcare consumers is the inclusion of a law that eliminates cost-sharing for insulin for enrollees in state-regulated health insurance plans. More than 1.5 million New Yorkers have diabetes, of which about 500,000 people rely on insulin. This provision will help many diabetics, but especially people of color, seniors, and people who live in low-income households, who disproportionately suffer from diabetes complications, including kidney failure, blindness, and loss of limbs.

Two key coverage provisions were also included in the final budget. First, New York will join the states of Oregon and Washington to guarantee continuous public insurance (Medicaid and Child Health Plus) coverage of children up to the age of six. This provision will help families avoid costly gaps in health coverage.  Second, the budget includes authorization to improve cost-sharing or premium assistance programs for people enrolling through the Marketplace. Few details are out, but HCFANY will post about these measures as they are finalized.  

While the Budget news is mostly good, HCFANY is hugely disappointed that the Assembly Leadership has broken with its storied tradition of standing up for healthcare consumers in two important areas. First, the Budget deal failed to include Coverage4All, a foregone conclusion by the Assembly’s omission in its one-house budget bill. Second, the Assembly continued to maintain over a 50% cut in its share of funding for the Community Health Advocates program which serves over 35,000 consumers a year, saving them $36 million in health care costs. 

Our work is not done!  For the remainder of the session, which ends on June 6, HCFANY will focus on trying to secure the passage of the stand-alone Coverage4All bill (S2237B|A3020), which would authorize the Governor to amend the 1332 Waiver to secure funding for covering up to 150,000 immigrant New Yorkers, as well as the “Stop SUNY Suing” Act (A8170|S7778), which would prevent the five state-operated hospitals from suing their patients with medical debt. 

The One-House Budgets are released! The Senate One-House Budget includes a significant portion of the HCFANY policy agenda, building on the Governor’s proposals in the Executive Budget. We’re still studying what is included in each bill, here’s what we know so far:

Good news: the Senate and Assembly One-House Budgets both:

• Ban cost-sharing for insulin for enrollees in State-regulated health insurance plans
• Improve affordability of Marketplace plans via premium assistance/ cost-sharing subsidies
• Adopt Kids Coverage to ensure children up to age 6 remain continuously covered in Medicaid or Child Health Plus
• Include Coverage4All, using federal funding to cover income-eligible immigrants in the Essential Plan

Even better, the Senate One-House Budget improves on the Governor’s budget by incorporating all of the HFAL improvements in the Ounce of Protection Act, including:

• Expanding Hospital Financial Assistance eligibility to individuals making up to 600 percent FPL
• Banning Hospitals from suing patients making under 600 percent FPL for medical debt
• Incorporating time-limited debt repayment plans so patients who make an agreed upon number of payments don’t have to spend their lives in debt

Bad news: the Assembly Budget completely cuts the Governor’s proposed medical debt reforms.

Take Action: Use the Phone2Action tool to call your legislators.

• Thank your Senators and ask them to fight to keep the Senate One-House Budget consumer health and medical debt reforms in the final budget.
• Ask your Assembly members to tell Assembly leadership to fight medical debt and fix our broken Hospital Financial Assistance Law.

HCFANY is grateful to have had the opportunity to testify at the 2024 Joint Legislative Budget Hearing on Health. Our detailed written comments are linked here. The Executive Budget includes many positive proposals that will help protect consumers from medical debt and enhance their ability to access affordable health coverage, including:

• Modernizing the State’s Hospital Financial Assistance Law
• Eliminating all cost-sharing for insulin for New York State-regulated plans
• Guaranteeing continuous health coverage for children up to 6 years of age
• Improving subsidies and benefits for public health coverage
• Informed consent for payment reform
• Banning hospitals from suing patients with incomes below 400% of the federal poverty level

In addition to addressing these important reforms in the FY25 Budget, HCFANY also urges the Legislature to provide additional funding to ensure more New Yorkers can enroll in, and use their coverage, including:

• Expanding Hospital Financial Assistance to 600% of the federal poverty level and incorporating time-limited debt repayment plans as would occur if the Ounce of Prevention Act (S1366B/A6027A) were enacted
• Prohibiting state-operated hospitals from suing patients for medical debt by adopting the provisions of the Stop Suny Suing Bill (A8170/S7778)
• Ensuring coverage for low-income immigrants with Section 1332 Waiver surplus pass-through funding
• Funding Community Health Advocates at $5.5 million
• Enhancing outreach funding for Navigators

After she rushed to a hospital-based urgent care facility with a painful tooth, Bebhinn was asked to pay $600 in fees and copays. Her Medicare did not cover dental, so she was denied care and sent to the emergency room where she waited for six hours to be seen.

After she got the care she needed, she was hit with a large ER bill. Instead of being offered financial assistance, Bebhinn now faces a barrage of calls from debt collectors.

In 2022, CSS found that New York’s nonprofit hospitals had sued more than 54,000 patients in just five years—many of whom should have been eligible for financial assistance. The analysis revealed that hospitals disproportionately sue patients who live in low-income zip codes or zip codes where the residents are mostly people of color.

The current HFAL requires all New York hospitals with funding from the State’s $1.1 billion Indigent Care Pool (ICP) to have a financial assistance application and policy. However, continued lawsuits and aggressive debt collection action against patients show that those eligible for financial assistance were not screened, were unable to complete the application process, or were improperly rejected.

New York’s health care landscape evolved significantly since HFAL was enacted in 2006, rendering the current law outdated and ineffective. For example, the current law only provides very modest discounts to patients with limited means (under 300 percent of the federal poverty level).  By contrast, the Affordable Care Act offers financial assistance to people up to 600 percent of the federal poverty level.  In addition, the HFAL requires that only the hospital, and not its providers, offer discounts to eligible patients. As private practices increasingly take over critical hospital functions like emergency rooms, uninsured patients increasingly receive undiscounted bills they are unable to pay.

A new brief by CSS, “An Ounce of Prevention: Reforming the Hospital Financial Assistance Law Could Save Pounds of Patient Debt,” outlines actionable steps to support low-income patients more effectively by updating HFAL. The authors of the brief recommend:

1. Requiring a common financial assistance policy across all New York hospitals and providers;
2. Aligning the current law with other health care programs by raising its eligibility level;
3. Making discounts greater and easier to access; and
4. Protecting patients from lawsuits and other aggressive collections actions while they are being screened for financial assistance.

The Ounce of Prevention Act (S1366/A6027), sponsored by State Senator Gustavo Rivera and Assemblymember Amy Paulin, would enact these critical reforms. If the law is passed, New York would follow the lead of several other states, including New Jersey and Illinois, which have recently enacted fairer financial assistance laws. Learn more about the Ounce of Prevention Act here.