While we haven’t seen all the fine print, HCFANY is delighted to report that this year’s budget deal includes important protections for New York’s health insurance consumers.  The new budget deal includes:

• Co-premium assistance for people between 138-150% of poverty (people with children that are currently eligible for Family Health Plus ).  Those who enroll in the Exchange with Silver-level plans will pay no premiums.  This measure is NOT conditional on federal financial participation.
• Protection for people who currently have out-of-network coverage in the individual market.  These consumers will have the option to pay for a Platinum-level plan on the Exchange with an out-of-network rider and be “risk pooled” with the rest of the State’s individual market.
• A requirement for SDOH to create a workgroup to study whether New York should adopt a Basic Health Plan
• Fair consumer protections on the State’s new Navigator program
• Funding for consumer assistance for New York’s health insurance consumers through Community Health Advocates
• Still waiting details on Medicaid budget, but it looks like most optional benefits have been saved….

A special thanks to everyone who added their names to our sign-on letter, called the Governor’s office, and worked hard to get these important consumer protections. These budget victories would not be possible without you!!!

Stay tuned for more on the budget!

The Assembly got it right in their one house budget bill by including a “premium wrap” for those people eligible for Family Health Plus to make a seamless transition into the new Health Insurance Exchange.  The Assembly is also “authorizing” the Basic Health Plan – but we hear the Governor’s office isn’t going for EITHER in final budget negotiations.

We all must make calls TODAY! 

First, urge the Governor and Department of Health to accept the Assembly’s changes to the phase out of Family Health Plus and help all those eligible pay for premiums on the new health insurance exchange come 2014.  The Governor’s Executive budget got us started by helping those currently enrolled in Family Health Plus be able to make a seamless transition to the Exchange in 2014 – but left out all those at the same income levels who aren’t currently enrolled.  They’ll need to enroll come 2014 and they should get the same deal! The Assembly budget got it right.

Tell the Governor & The Department of Health: Provide a “premium wrap” for the entire Family Health Plus eligible popultion, not just those currently enrolled. 

The Governor’s office also does not want to move forward to even authorize the state to look into implementing a Basic Heath Plan to receive additional federal funding to help provide quality, affordable coverage for families and individuals who make less than 200% of poverty a year (that’s around $22,000 a year for an individual and $47,000 for a family of four).  Why would we wait to create a program the Affordable Care Act sets up as a great way to help those who need it most!?! There is NO reason to wait.

Tell the Governor & the Department of Health:  Include authorization for the Basic Health Plan in the final budget negotiations so ALL low income New Yorkers will have access to affordable health coverage.

Final budget deals will be made this weekend. We need ALL groups making these calls and sending off emails and letters TODAY!!!

Call:

• Governor Cuomo: (518) 474-8390
• Director of Healthcare Redesign James Introne: (518) 408-2500
• NYS Medicaid Director Jason Helgerson: (518) 474-3018
• Commissioner of Department of Health Dr. Nirav Shah: (518) 474-2011

Email us if you have any questions:  Elisabeth Benjamin: ebenjamin@cssny.org and Jessica Wisneski: jwisneski@citizenactionny.org

Thank you for your very important actions today.

UPDATE: Click here to view HCFANY’s Memorandum of Support/Opposition on the 2013-2014 NYS Executive Budget and One-House Budget Bills

HCFANY is happy to report that our letter to Governor Cuomo and the NYS Legislature on the budget’s elimination of the Family Health Plus program and out-of-network benefits on the individual market has been delivered!

The letter was actually hand-delivered around the capitol early this afternoon, and sent out to the press shortly thereafter.  Thanks to everyone who signed on – at final count we had 37 groups listed!  You can view the final letter sent by clicking here.

It looks like the budget will be closing down this weekend, but there is still time to make phone calls!  Call your legislators today and tell them to protect low-income families and New Yorkers with special health needs by providing a solution to the elimination of the Family Health Plus program that would treat all consumers equally, regardless of family composition, and provide additional subsidies to all eligible consumers up to 150% of FPL, and to preserve the requirement that insurers offer consumers on the individual market the option of out-of network care.

We can do this!!!

The Governor’s proposed 2013-2014 Executive Budget aims to get rid of New York’s Family Health Plus (FHP) program by closing off enrollment by the end of this year.  Enrollees who earn below 138% of FPL (about $26,000 per year for a family of three) will get the current Medicaid benefit (with the exception of long-term care).  Parents up to 150% of FPL (about $28,000 for a family of three) will get subsidized coverage on the forthcoming Exchange.

However, eligible folks who aren’t able to enroll by the cutoff date, or whose income shifts into the eligible range after the cutoff date will be out of luck.  These folks will have to look for affordable coverage on the Exchange.

The Exchange will provide premium tax credits to help lower the cost of insurance for most low- and moderate-income folks who purchase coverage on the Exchange.  But, it will still be too expensive for many families.  For example, a family of three earning 150% of FPL will still have to come up woth $1,099 per year on their own for coverage on the Exchange whereas the same family would have gotten free coverage with very low cost-sharing through FHP.

But there is a solution to this affordability problem.

• First, we ask the State to apply for an 1115 waiver – similar to those being pursued by Massachusetts and Vermont – to provide an affordability wrap for premiums and cost sharing for folks up to 200% of FPL not eligible for Medicaid.  This would help to get out-of-pocket costs on the Exchange down as close as possible to FHP levels. If NY can’t get federal matching funds, the State should earmark a portion of the $2.5 billion in State Medicaid savings under the ACA for this.
• Next, New York should lay the foundation for a Basic Health Plan (BHP) by authorizing establishment of this program starting in 2015.  The ACA gives states the option of creating a federally-funded BHP to cover adults up to 200% of FPL not eligible for Medicaid.  This program would result in State savings of between $500 million and $1 billion each year.

This is a big opportunity for State lawmakers to ensure affordable coverage is available to the individuals and families who need it most.  And, when federal funds or state savings are factored in, it would require little or no additional cost to the State.

Quite simply, it’s the right thing to do.