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!

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.