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!

Medicaid Matters New York and Health Care for All New York – the two major statewide health care consumer advocacy coalitions – applaud the State Legislature for several historic additions to the adopted state budget for 2021-22 related to funding for public schools and universities, rental and mortgage assistance, assistance to undocumented essential workers and small businesses, and taking some first steps toward restoring progressivity to the state’s tax system.  Millions of low-income New Yorkers who rely on our state’s public health insurance programs will benefit from these improvements to the Governor’s initial set of budget proposals.

However, our State leaders failed to break ground in health care, which is disappointing in light of a decade of austerity budgets and the ongoing nature of the COVID-19 public health crisis.  Medicaid Matters and HCFANY are specifically concerned about the following issues: 

• The arbitrary Medicaid global spending cap was extended for another year.  As a consequence, Medicaid continues to be approached with an austerity mindset.  For ten years, Medicaid has suffered from unnecessary cuts, impacting access to services for low-income people, families, people with disabilities and communities.

• Public health insurance coverage was not expanded to low-income immigrants who have had COVID-19.  Instead, those who are undocumented remain reliant solely on Emergency Medicaid for acute care and charity care programs for ongoing treatment.  As a consequence, many will likely forego seeking necessary care, thereby prolonging illness and suffering, risking death, and incurring medical bills they cannot pay.

• The home care crisis and institutional bias remain unaddressed.  Home care workers play a vital role in serving and protecting disabled New Yorkers and seniors living independently, a role that became even more critical and evident during the pandemic.  However, New York’s failure to invest in home care has created a “worst in the nation” workforce crisis that prevents meaningful access to home care services for thousands of people and results in greater institutionalization.

• This is the first time in decades that New York State has adopted a discriminatory maternity coverage policy.  Instead, only citizen and lawfully residing immigrant women will enroll in free (state-funded) Marketplace coverage after their Medicaid ends—continuing a system that allows for disruptions in care. 

• No new initiatives were created to address inequities that are wide-spread throughout our state’s public health, health care, and health coverage systems, despite significant federal pandemic-related funds the state has received over the past year to address these disparities.  The pandemic has revealed them clearly, and they can no longer be ignored.

On the positive side, we thank both the Governor and Legislature for these new initiatives:

• Eliminating all premiums in the state’s Essential Plan that provides insurance coverage to low-income people and families who are not eligible for Medicaid.  This move will enable them to keep medical, dental, and vision coverage in place without financial barriers, an important step during the ongoing pandemic.

• Protecting the financial stability of community health centers and other safety net providers by delaying the implementation of the planned pharmacy carve-out from the state’s Medicaid Managed Care program.

We also acknowledge and appreciate restorations in funding cuts initially proposed by Governor Cuomo that made no sense given our ongoing pandemic:

• An across-the-board Medicaid rate cut that particularly threatened safety net hospitals that serve large numbers of Medicaid and uninsured patients.

• Elimination of Indigent Care Pool funding to public hospitals.

• Cuts to the state’s Vital Access Provider Assistance Program that keeps certain safety net and rural hospitals financially afloat.

• Additional cuts to Article VI public health funding to New York City.

• Allowing insurers to impose restrictions on the ability of doctors to prescribe certain drugs to Medicaid patients (elimination of the provision known as “prescriber prevails”).

• Another 25% cut to home care workforce recruitment and retention money that would have further harmed community-based long-term care.

• Cuts to programs serving adult home residents.

While as a whole and on the surface it may appear that New York continues to meet the needs of those enrolled in our state’s public health insurance programs and the providers they rely on, the 2021-22 adopted budget fails to make needed investments to turn away from austerity politics, protect all immigrants, expand community-based long-term care, and promote health equity.  A lack of harm must not be confused with a budget that provides for what New Yorkers need.  We can do better, and we must.

There are lots of opportunities coming up over the next couple of weeks to learn more about health policy priorities and how to take action. Here’s a few of them!

TODAY: Statewide Day of Action for Guaranteed Healthcare (link)

The Campaign for New York Health is holding a day of action for the New York Health Act, which would provide comprehensive health coverage for everyone who lives or works full-time in New York. Look for #PassNYHealth to see what people are saying and join in!

• Learn more about why we need the New York Health Act here.
• If you missed the day of action you can always show your support for the New York Health Act by clicking this link and telling your State Assemblymember and Senator to support the bill. If they already do, the link will give you an opportunity to thank them!

Tomorrow: #Coverage4All Virtual Day of Action

There are 400,000 New Yorkers without insurance because of their immigration status. A1585/S2549 would guarantee that all New Yorkers can access life-saving health coverage if they have had COVID-19. Look for #Coverage4All and #PassA1585 all day tomorrow to help get the word out!

What else can you do?

• Sign up for campaign updates here.
• Become listed as a supporting organization here.
• Contact your legislator any time using the instructions here.

Friday, 11:00-12:00: Budget Briefing for Health Justice Advocates

Join the Campaign for NY Health, the Consumer Directed Personal Assistance Association of New York State, Coverage4All, Health Care for All NY, and Medicaid Matters NY for an overview of the FY22 Executive Budget Proposal and its implications for healthcare in New York. Register here.

Friday, February 5 1:00-3:00: HCFANY Annual Meeting

What can we expect from legislative session this year? How do we push forward and ensure quality, affordable health care for everyone in New York State during a pandemic and a budget crisis? Join us to learn more about our legislative and budget priorities for 2021 and how you can take action yourself! Click here to register!

During this virtual meeting we will:

• Award Senator Gustavo Rivera as this year’s Consumer Champion and present a posthumous Lifetime Achievement award to Kristin Sinclair, Director of the Senate Health Committee.
• Share information about the state budget and our legislative priorities, including expanding health coverage to all New Yorkers, ending medical debt, and addressing systemic inequity in our health care system.
• Talk about future workshops that will offer deep dives on different health policy issues and opportunities to take action.