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:
- Protect and improve health coverage
- Regulate prices to create a more affordable health care system for New Yorkers
- 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.
With the recent release of the Senate and Assembly One-House budgets, HCFANY is excited to see some of our policy agenda items included. However, HCFANY is also disappointed that key proposals to protect and improve health care coverage for many New Yorkers were left out. Read below for HCFANY’s response to the One-House budgets:
HCFANY supports the following proposals in either the Assembly or the Senate One-House Budget or both:
- Strengthen maternal and reproductive health care access.
- Cover more lactation support services under Medicaid, including allowing certified lactation consultants to enroll as Medicaid providers and covering breast pump supplies.
Primary Care spending: In the United States, less than five cents of every dollar we spend on health care goes to primary care doctors and nurses, even though they handle a third of health care visits. In New York, nearly 70 percent of all emergency room visits are non-emergent and could be better treated in a primary care setting, over double the national rate. HCFANY strongly supports the inclusion of the provisions of the Primary Care Investment Act in the Senate’s One-House Budget, which requires insurance carriers to increase spending on primary care by one percent each year until they reach a target of 12.5 percent. Investment in primary care can reduce the prevalence of chronic diseases and overall health care spending. According to a recently released survey on health care affordability, 79 percent of New Yorkers support requiring insurance carriers to gradually increase spending on primary care. Many other states have also enacted similar policies requiring increased primary care spending (e.g., Colorado, Delaware, Oregon, and Rhode Island). New York should follow suit.
Maternal, reproductive, and lactation care: In New York, Black mothers are five times more likely to have a pregnancy-related death than their White counterparts. HCFANY strongly supports initiatives that tackle racial inequities within New York’s health care system and is excited to see greater and continued support from New York’s Legislature for maternal and reproductive health care. Almost half of births in New York are covered under Medicaid, and with current federal threats that may cut funding for Medicaid—providing health care access to around 7 million New Yorkers. New York can use the budget to safeguard access to care for many New York mothers.
HCFANY supports the following initiatives introduced in the Executive Budget but urges the Legislature and the Governor to adopt slight modifications in the final budget:
- Strengthen the New York Department of Health’s (DOH) oversight of material health care transactions and require public disclosure and allow public participation during the health care transaction process. A material health care transaction includes mergers, acquisitions, or a form of partnership with the purpose of administering contracts with health plans, third-party administrators, pharmacy benefit managers, or health care providers. What is excluded from this definition is partnerships for clinical trials or transactions that result in a health care entity increasing its total gross in-state revenue by less than $25 million.
HCFANY supports granting the DOH authority to determine a health care transaction’s potential market and cost impact and the post-closure impact on costs, quality, access, health equity, and competition. Additionally, the Executive budget proposes that transactions require written notice before the transaction closes to include whether either a party or parent company owns a health care entity that has closed, is in the process of closing, or has reduced its services provided. In the Senate’s One-House budget, HCFANY supports the addition of extending the notification time frame for closures from 60 to 90 days.
HCFANY, separately, urges the Legislature to make amendments to the language to improve transparency and consumer engagement for this process by (1) requiring full public disclosure of the material transactions, (2) extending the time to file such a transaction, and (3) allowing the public to provide input on the proposed transactions to the DOH, similar to the provisions of the Local Input for Community Healthcare Act (LICH) (S1226/A6004) passed by both houses of the Legislature and vetoed by the Governor last year. The LICH bill would require the approval of closures of a hospital or maternity, emergency, or mental health services to consider findings from a Health Equity Impact Assessment, and closures must be reviewed in public sessions by the State’s Public Health and Health Planning Council.
HCFANY is disappointed that the following initiatives are not included in the One-House Budgets:
- Include the No Blank Checks Act (S6375), which would create a uniform patient financial liability form that includes a good faith estimate of what a patient owes financially for the care or service they will receive.
- Include the Fair Pricing Act (S705/A2140), which would limit prices on routine medical services to 150% of the Medicare rate.
- Redistribute some of the $1.4 billion from Managed Care Organization (MCO) tax revenue for direct patient support and a rainy-day fund.
No Blank Checks: When patients walk into an appointment for a health care service, they are often required to sign a form agreeing to pay for any charges not covered by my insurance before they receive any care. This form legally binds them to pay for the service they get without knowing the outcome, how much will be covered by insurance, or whether their provider will bill correctly. It is essentially a blank check. The provisions of the No Blank Checks Act would create a uniform patient financial liability form that includes a good faith estimate of a patient’s financial obligation for their care. If patients are liable to pay for the service beforehand, health care services should inform them of how much it will cost. New Yorkers need greater price transparency, and many agree, as 92 percent of New Yorkers endorse requiring hospitals and doctors to provide up-front cost estimates to consumers.
Fair Pricing: According to 32BJ Health Fund claims data, the exact same service can cost $1,000 more at a hospital-owned outpatient department compared to a doctor’s office. Spending on hospital care is the biggest contributor to rising health care spending in New York, rising twice as fast as income and four times as fast as inflation. Rising prices directly affect New Yorkers as around two-thirds of them have experienced a health care affordability burden this year, with even more worried about affording care in the future. The Fair Pricing Act, which caps prices for routine services at a reasonable 150% of Medicare rates, would save the State an estimated $1.1 billion, $213 million of which would be saved annually by New Yorkers in reduced out-of-pocket costs. It is also supported by 86% of New Yorkers.
MCO tax: The MCO tax allows the State to draw down federal funds by taxing Medicaid and the Essential Plan MCOs to receive a federal match. The State then reimburses MCOs to make them whole and pockets the additional revenue. The Executive budget is allocating a significant portion of this revenue to hospitals. However, HCFANY urges the Governor and the Legislature to come together to reallocate some of these funds to support patients directly in the final budget. With federal threats to cut funding to Medicaid and Affordable Care Act health programs, the State can use this tax revenue to protect New Yorkers’ access to health care coverage by allocating some of this revenue to principal reserves or rainy-day funds. Medicaid provides health and financial security for seniors, children, and working-class families, and it is a critical source of funding for hospitals, clinics, community health centers, and long-term care facilities. The State should use the MCO tax revenue as an opportunity to prepare for potential cuts to federal health programs, including Medicaid.
- Worried about federal threats to health coverage? Call key New York Members of Congress today and ask them to stop federal threats to health care in order to pay for tax breaks for millionaires. They need to hear from New Yorkers on why they need to vote to protect our access to health care: click here.
- Learn how federal threats affect New York State and each of its congressional districts: click here.
Stay tuned for our comments on the final State budget releases.
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:
- 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.
- 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:
- Implement an independent New York Office of Health Care Affordability, like the model created in California.
- 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.
- Improve patient outcomes and reduce inequities by including the provision of the Primary Care Investment Act (S1634|A1915A).
- 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.
- 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.
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.