N.Y. Gov. Hochul Announces Federal Approval to Expand Access to High-Quality, Affordable Health Insurance

ALBANY, New York, March 5 -- Gov. Kathy Hochul, D-New York, issued the following news release on March 4, 2024:

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Governor Hochul Announces Federal Approval to Expand Access to High-Quality, Affordable Health Insurance

Expansion of Essential Plan Will Give Over 100,000 New Yorkers High-Quality Health Insurance at $0 Monthly Premium and Low-Cost Sharing

Will Save New Yorkers an Average of $4,700 Per Year

Federal Funding Will Also Be Used to Support Health-Related Social Needs Advancing New York's Health Equity Goals

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Governor Kathy Hochul today announced that the U.S. Department of Health and Human Services and U.S. Department of Treasury have approved New York's Section 1332 State Innovation Waiver application to expand the Essential Plan, a public health insurance program offered through the NY State of Health, to New Yorkers with incomes up to 250 percent of the Federal Poverty Line, $37,650 annual income for an individual. Section 1332 State Innovation Waivers allow states to pursue innovative strategies for providing residents with access to high-quality, affordable health insurance. The waiver was approved for five years, from 2024 through 2028. This expansion of coverage is estimated to save New Yorkers an average of $4,700 per year, compared to what they would have spent on health coverage through Qualified Health Plans.

"Federal approval to expand the Essential Plan is an important step toward building a better health care system statewide," Governor Hochul said. "This waiver expands our Essential Plan to another 100,000 New Yorkers and saves them thousands of dollars each year, strengthening our commitment to ensuring New Yorkers have access to quality insurance."

New York State Health Commissioner Dr. James McDonald said, "I thank Governor Hochul for her dedication to eliminating health disparities in the state and working to ensure that New Yorkers have the dignity and security that comes with having access to high-quality health care and affordable health insurance. New York continues to be a leader in addressing social determinants of health, and the approved expansion of the Essential Plan will help us continue this work and reach even more New Yorkers."

NY State of Health Executive Director Danielle Holahan said, "Since introduced by the Marketplace in November 2015, the Essential Plan has served as a critical haven for New Yorkers unable to qualify for Medicaid but still struggling to stay afloat with the cost of health insurance. We are excited to build upon the success of this program to extend affordable, comprehensive health insurance coverage with no monthly premium to more low-income New Yorkers, including the Deferred Action for Childhood Arrival (DACA) population.

The Essential Plan covers over 1 million low-income New Yorkers, providing comprehensive benefits with $0 monthly premiums, no deductible, and low-cost sharing. It also includes free preventive care, adult vision, and dental care without cost-sharing.

Today, eligibility for the Essential Plan is limited to New Yorkers with incomes above Medicaid levels and up to 200 percent of FPL, about $30,000 annual income for an individual. Under the waiver, current Essential Plan enrollees will continue to have the same benefits with no premiums, no deductibles, and current maximum out-of-pocket contribution levels.

Through this State Innovation Waiver, starting April 1, 2024, the Essential Plan will be expanded to New Yorkers with incomes up to 250 percent of the FPL ($37,650 annual income for an individual), making the high-quality, affordable program with a zero cost monthly premium available to an additional 100,000 New Yorkers once fully implemented. It includes nearly 70,000 New Yorkers enrolled in Qualified Health Plans who will now be eligible for significantly more affordable coverage through the Essential Plan, 12,000 DACA individuals currently enrolled in Medicaid/CHPlus, and approximately 20,500 currently uninsured New Yorkers.

Access to coverage through the Essential Plan is estimated to save New Yorkers between 200 and 250 percent of FPL an average of $4,700 per year, compared to what they would have spent on health coverage through Qualified Health Plans. The waiver will have the added benefit of smoothing the transition for many New Yorkers moving from Medicaid as the state implements the end of continuous coverage requirements under the Consolidated Appropriations Act, 2023.

Complementing New York's recently approved Medicaid Demonstration waiver, under this 1332 waiver, New York also seeks to address social determinants of health for Essential Plan enrollees. Waiver funding will support grants that address food insecurity, including through food pharmacies and medically tailored meals, and will support enrollees with persistent asthma by providing them with air conditioners to protect their health and reduce the number of Emergency Department visits. This waiver will also support grants to insurers to increase access to behavioral health providers and services, including mobile crisis units, crisis diversion centers, and crisis respite centers.

U.S. Senate Majority Leader Charles Schumer said, "Today's announcement, coupled with the record enrollment on the individual market we are seeing this year, proves that the fight for better health care has delivered real, meaningful results for New York. In 2022, I secured a historic investment that lowered premiums and health care costs for the hundreds of thousands of New Yorkers who buy coverage on the individual marketplaces, which also led to increased funding for New York's Essential Plan. I am proud to work side-by-side with Gov. Hochul to make health care more affordable and accessible to all New Yorkers."

Senator Kirsten Gillibrand said, "All New Yorkers deserve to have access to high-quality, affordable health insurance. I am thrilled to see the federal approval of New York State's State Innovation waiver, which will give tens of thousands of New Yorkers access to the health insurance coverage they need. I will continue to fight to eliminate health disparities and ensure that every New York resident has access to reliable health coverage."

Representative Jerrold Nadler said, "Healthcare is a human right, and I congratulate Governor Hochul on taking this monumental step to expand the Essential Plan to DACA recipients and other New Yorkers. I look forward to continuing to work with her administration to ensure every New Yorker has access to coverage and care."

Representative Joe Morelle said, "Underserved communities are experiencing a higher rate of negative outcomes due to health inequities. By expanding the Essential Plan, we can address health disparities by allowing more individuals to receive comprehensive benefits and preventative care services. I'm grateful to Governor Hochul for recognizing the need for this state innovation waiver and look forward to our work together addressing the healthcare needs of New Yorkers."

Representative Ritchie Torres said, "Today's news of an expansion in New York's Essential Plan will help to provide high-quality health insurance at a $0 monthly premium to over 100,000 New Yorkers and demonstrates our commitment to health equity. By extending coverage of the Essential Plan to groups like the DACA recipients and those with pressing health-related social needs, we will build a better and more inclusive healthcare system for the future. This waiver, which has been approved for five years, marks a crucial milestone in advancing the well-being of Bronx residents."

Representative Pat Ryan said, "This announcement is a huge step toward achieving high quality, affordable healthcare for all in New York. Expanding the Essential Plan will give more low-income New Yorkers access to comprehensive health coverage at low cost and reduce health disparities. I'm grateful to Governor Hochul for her efforts to expand health insurance coverage in our state and look forward to working together to keep our communities healthy."

Representative Dan Goldman said, "Every New Yorker deserves access to affordable, high-quality health care. I applaud Governor Hochul for her Administration's work to provide over 100,000 New Yorkers with low- to no-cost health care. I'm proud that New York is taking these critical steps to ensure that our health care system can serve our entire community."

State Senator Gustavo Rivera said, "The federal approval of 1332 State Innovation Waiver will help our state address critical healthcare needs. I'm encouraged that this will include an expansion of the Essential Plan to New York's Dreamers that will ensure more New Yorkers can qualify and access affordable health coverage. I want to thank Governor Hochul and her administration for working to secure this waiver."

Assemblymember Amy Paulin said, "It's welcome news that the state's waiver has been approved, helping uninsured, lower- and moderate-income consumers. I thank Governor Hochul for her advocacy to ensure that all New Yorkers have access to high-quality, affordable health insurance."

New York City Department of Health and Mental Hygiene Commissioner Dr. Ashwin Vasan said, "Coverage is the front door to high quality health care for so many New Yorkers. Expanding coverage to our city and state will unlock that door to care for our friends, family members and neighbors. This expansion will save lives and make state and city residents healthier."

Greater New York Hospital Association President Kenneth E. Raske said, "The Essential Plan already provides quality health coverage to a million New Yorkers without any deductible and low-cost sharing and is a major reason why so many of our residents have health insurance. The Essential Plan expansion announced today will cover another 100,000 New Yorkers. GNYHA has long supported health coverage expansion and hopes that New York's Essential Plan serves as a model for other states to cover more of their residents."

New York Health Plan Association President & CEO Eric Linzer said, "We congratulate Governor Hochul and her Administration on the approval from the Centers for Medicare & Medicaid Services to expand the Essential Plan. This is an important step towards ensuring every New Yorker has access to high-quality, affordable health care, building on the successful partnership between health plans and the State. We appreciate the high priority the Governor has made to making sure more individuals will have coverage, as well as providing critical resources to address the social factors that create barriers to equitable care, and we look forward to working with her Administration to fulfill the waiver's promise."

Business Council of New York State Executive Vice President Paul Zuber said, "Access to affordable, quality healthcare is crucial to eliminating health disparities. This expansion of the Essential Plan will keep more individuals and families insured and lead to better health outcomes across the state."

Community Service Society of New York Vice President of Health Initiatives Elisabeth Benjamin said, "The Essential Plan has provided quality affordable coverage for over a million New Yorkers. We applaud the administrations of Governor Hochul and President Biden for extending this coverage to 100,000 more New Yorkers, including immigrants with Deferred Action for Childhood Arrivals status."

This month, current NY State of Health enrollees who meet the Essential Plan expansion eligibility criteria will receive a notice from the NY State of Health stating that they will be automatically enrolled through the Essential Plan beginning on April 1, 2024. The NY State of Health will launch a robust public education campaign in April to promote this expansion.

New Yorkers who completed a NY State of Health application during 2024 Open Enrollment but did not enroll in coverage and now meet the expanded Essential Plan eligibility will receive emails, texts, and outreach from their enrollment assistors that they are eligible for the Essential Plan expansion and must select and enroll in a health plan. Starting in April 2024, first-time applicants of the NY State of Health who meet the Essential Plan expansion eligibility criteria can enroll in the program.

Information about Section 1332 State Innovation Waivers, including a fact sheet on New York's waiver, can be found on CMS' website (https://www.cms.gov/marketplace/states/section-1332-state-innovation-waivers#To%20view%20New%20York's%20application%20materials,%20please%20visit%20the%20New%20York%20waiver%20section%20of%20this%20webpage%20below.).

Information about New York's Section 1332 waiver (https://info.nystateofhealth.ny.gov/1332).

Information about Essential Plan Benefits and Cost Sharing Grid (https://info.nystateofhealth.ny.gov/sites/default/files/Attachment%20G%20-%20EP%20Benefits%20and%20Cost-Sharing_Revised%206%2020%202023.pdf).

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Original text here: https://www.governor.ny.gov/news/governor-hochul-announces-federal-approval-expand-access-high-quality-affordable-health