Testimony on Governor Hochul’s 2025-26 Budget Proposal
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.
One Pager: New York’s Reformed HFAL
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.
This week, New York lawmakers made an impressive push toward expanding health coverage for all New Yorkers in Senate and Assembly budget proposals. Still, the proposals leave some key populations behind.
In what would be a major win for immigrant justice advocates, both houses budgeted to expand health insurance to low-income immigrants. The Coverage4All proposal opens the State’s Essential Plan to everyone who meets income requirements — including thousands of New Yorkers currently excluded because of their immigration status.
The Assembly budget bill also extends Medicaid coverage for 12 months post-partum to all New Yorkers—including immigrants. New York currently provides Medicaid coverage during pregnancy and for 60-days postpartum, and the Executive Budget proposal extends this to one full year, but it excluded immigrants from the Medicaid for Pregnant Women program for the first time. The Senate resolution, like the Assembly bill, would include immigrants, although its actual bill language appears to have an inconsistent drafting error and would exclude immigrants. To ensure no New Yorker is left behind, Governor Hochul and the Senate should incorporate the Assembly’s language to make sure no one is left out of this important coverage expansion.
The budget bills include other important coverage expansions for New Yorkers, including equalizing Medicaid eligibility for people over 65 and with disabilities. Currently, people in those groups face higher eligibility thresholds than others. The Executive Budget and both legislative budget bills change this so that both groups become eligible at 138% of the federal poverty level and without an asset test, just like other New Yorkers. The Assembly and the Executive Budget also both eliminate premiums for some children enrolled in the Children’s Health Insurance Program and expand their benefits. An estimated 60,000 children lose coverage for a month or longer every year because of problems paying the premium. Eliminating them will stop this.
Importantly, the Assembly and the Senate proposals would repeal the Medicaid global cap. The cap triggers automatic cuts after the program hits a certain spending level, meaning that the program gets hits with cuts when and where it is most needed. For example, the global cap led to safety-net hospitals being threatened with budget cuts during the height of the pandemic in 2020. Repealing the cap would allow Medicaid to grow with need instead of according to an arbitrary formula. Governor Hochul should include the Assembly and Senate’s proposal in the final State budget.
Finally, the Assembly increases funding for the Community Health Advocates (CHA) and both houses support the Executive Budget’s allocation for the Community Health Access to Addiction and Mental Healthcare Project (CHAMP). Both programs provide similar post-enrollment help, such as finding in-network providers, fighting billing errors, and appealing insurance denials. CHAMP specializes in providing these services to people who need medical care related to their mental health or substance use disorders.
Now that the Legislative budget bills have been introduced, HCFANY is looking forward to the next step in the budget process: reconciling them. Governor Hochul’s initial budget proposal included lots of great health care stuff—HCFANY has high hopes that she’ll consider the expansions on her original proposals that were included in the new budget bills. Stay tuned for updates on New York’s progress toward health care for all!