- New York expanded Medicaid under the ACA, but the state’s pre-ACA eligibility guidelines were already generous.
- How will New York handle Medicaid renewals after the pandemic?
- Medicaid covers more than 7.7 million New Yorkers.
- New York Medicaid relies on managed care, and numerous plans provide Medicaid coverage; plan availability varies by county.
ACA’s Medicaid eligibility expansion in New York
New York has long been a healthcare reform front-runner, creating a guaranteed issue individual health insurance market decades ahead of the Affordable Care Act (ACA), and also expanding Medicaid to cover many low-income parents and childless adults long before the ACA reformed the nation’s health insurance system.
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How will New York handle Medicaid renewals after the pandemic?
The end of the COVID-related federal continuous coverage requirement for Medicaid is scheduled for March 31, 2023. So as of April 1, 2023, states will resume regular full eligibility redeterminations and can start disenrolling people who are no longer Medicaid-eligible. States have 12 months to initiate eligibility redeterminations for everyone enrolled in Medicaid as of April 2023, and up to 14 months to complete the process.
New York plans to keep each enrollee’s already-scheduled renewal date, so a person’s whose coverage is scheduled for renewal in October will receive their renewal notice in early September. So although the COVID-related continuous coverage requirement will no longer be in effect as of April 2023, many enrollees will not receive their renewal notice until several months after that.
New York has an overview page where they will provide additional information related to the end of the continuous coverage requirement and the return to normal eligibility redeterminations. It includes an important reminder to the state’s Medicaid enrollees about the need to ensure that their contact information on file with the state is up-to-date, as coverage will not continue for a person who doesn’t complete the renewal process. That will require being able to receive the renewal packet that the state sends to enrollees, and replying with any necessary information.
New York Medicaid enrollees need to pay close attention to any communications they receive from their local Medicaid office or NY State of Health, and reply as soon as possible if additional information is needed. If they are no longer eligible for Medicaid, they should familiarize themselves with their coverage options. This could include an employer-sponsored plan (if available), Medicare, or a plan purchased through the exchange/marketplace (note that there is a limited enrollment window to sign up for any of those coverages). Some enrollees who lose eligibility for Medicaid will find that they’re eligible for New York’s Essential Plan, which is available to people with household income up to 200% of the poverty level. And enrollment in the Essential Plan continues year-round.
As of September 2021, New York’s Medicaid expansion was covering nearly 2.4 million people. But New York’s eligibility guidelines were already so generous that fewer than 426,000 of those people were newly eligible as a result of the ACA’s expansion of Medicaid. The rest — nearly 2 million people — were already eligible for Medicaid prior to 2014 under New York’s rules. But the federal government pays 90% of the cost for the entire Medicaid expansion population, which is significantly higher than the federal government’s funding for the rest of the state’s Medicaid population. So the expansion of Medicaid in New York under the ACA has been particularly beneficial to the state from a financial perspective.
For New York Medicaid enrollees who continue to be eligible based on pre-ACA guidelines, the state and federal government split the cost (since New York is a relatively wealthy state, they receive the lowest possible federal match, which is normally 50%, but states are receiving an additional 6.2% federal match during the COVID public health emergency period, under the terms of the Families First Coronavirus Response Act; this additional funding will be phased out over the course of 2023).
New York has the majority of its Medicaid population enrolled in managed care programs, under an 1115 waiver that dates back to 1997. Total New York Medicaid enrollment, including both pre-ACA eligibility categories and ACA Medicaid expansion categories, was more than 7.7 million as of late 2022.
New York has accepted federal Medicaid expansion
- 7,723,474 – Number of New Yorkers covered by Medicaid/CHIP as of November 2022 (source)
- 1,626,666 – Increase in the number of New Yorkers covered by Medicaid/CHIP fall 2013 to September 2021 (source)
- 56% – Reduction in the uninsured rate from 2010 to 2019
- 29% – Increase in total Medicaid/CHIP enrollment in New York since Medicaid expansion took effect
Medicaid expansion in New York
New York’s progressive stance on access to health care meant that much of the state’s low-income population were already eligible for Medicaid or Family Health Plus for many years prior to the ACA.
In 2000, New York began implementing Family Health Plus, which was designed to insure up to 600,000 of the state’s low-income working adults. The pre-2014 New York Medicaid program covered childless adults with incomes up to 50% of the poverty level, and Family Health Plus expanded coverage up to 100% of poverty. For parents with dependent children, the existing eligibility rules allowed Medicaid coverage up to 75% of poverty level, and Family Health Plus increased that threshold to 150%.
The ACA’s Medicaid provisions allowed New York to utilization federal funding to expand Medicaid to everyone with incomes up to 138% of poverty.
New York went a step further than most other states by implementing the ACA’s Basic Health Program, which covers people with income a little too high for Medicaid. The Essential Plan became available in January 2016, and it covers New York residents with income up to 200% of the poverty level. There is no longer a premium for The Essential Plan. For more information, read here.
Who is eligible for Medicaid in New York?
Adults in New York with incomes up to 138% of poverty level are now eligible for Medicaid. Pregnant women and children under the age of one are eligible with an income of up to 218% of poverty level (for Medicaid eligibility determinations, a pregnant woman counts as two people for household income calculations). And starting in March 2023, Medicaid for the mother continues for 12 months postpartum, instead of ending after two months. This is due to legislation that the state enacted in 2022 to take advantage of an American Rescue Plan provision that provides five years of funding for extended postpartum Medicaid coverage (the federal spending bill that was enacted in late 2022 makes this funding permanent, instead of ending it after five years).
Children from age one to eighteen are eligible for Medicaid with a household income up to 149% of poverty, but the state also has separate CHIP (Children’s Health Insurance Program) coverage available for children with household incomes up to 400% of poverty level – the highest threshold in the country.
How does Medicaid provide financial assistance to Medicare beneficiaries in New York?
Many Medicare beneficiaries receive Medicaid financial assistance that can pay for Medicare premiums, lower prescription drug costs, and cover expenses not reimbursed by Medicare – such as long-term care.
Our guide to financial assistance for Medicare enrollees in New York includes overviews of these benefits, including Medicare Savings Programs, long-term care coverage, and eligibility guidelines for assistance.
How do I enroll in Medicaid in New York?
New York offers several options for enrolling in Medicaid:
- NY State of Health, The Official Health Plan Marketplace or (855) 355-5777
- Managed Care Organizations (MCOs)
- Navigators and Certified Application Counselors
- Medicaid Helpline: (800) 541-2831
- If you are 65 or older or have Medicare, apply by visiting a Human Resources Administration Office (in NYC) or a Local Department of Social Services Office (outside NYC)
New York Medicaid enrollment numbers
As of November 2022, New York Medicaid enrollment was more than 7.7 million. This was an increase of 1.6 million people enrolled since early 2020, right before the COVID-19 pandemic. The increase in unemployment during the pandemic and Families First Coronavirus Response Act contribute greatly to this increase in enrollment. The FFCRA provides additional federal Medicaid funding for states, but on the condition that states not disenroll anyone from Medicaid for the duration of the COVID public health emergency. As noted above, the federal spending bill that was enacted in late 2022 has de-linked the continuous coverage requirement from the public health emergency. The continuous coverage requirement now ends at the end of March 2023, and states will resume eligibility redeterminations and disenrollments in April 2023.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.