New York Medicaid

Medicaid enrollment grows by 13% after expansion, uninsured rate down to 8.3%

Where in your state to call or visit for Medicaid.How to apply

CHIP and Medicaid enrollment can both be completed through NY State of Health.

Who is eligible in your state to get Medicaid?Who is eligible

Adults with incomes up to 138% poverty level.  Pregnant women and infants with income up to 218 percent of poverty level.  Separate CHIP is available in NY for all children with income up to 400% of poverty level.

  • By
  • contributor
  • September 26, 2016

New York has long been a healthcare reform front runner, creating a guaranteed issue individual health insurance market decades ahead of the 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.  The state accepted the ACA’s provision to use federal funding to expand Medicaid as of January 1, 2014, and between the fall of 2013 and June 2015, the state’s total Medicaid enrollment grew by 763,485 people.

Medicaid expansion history in NY

As the ACA was written, it called for expanding Medicaid to 138 percent of poverty in every state.  In 2012, however, the Supreme Court ruled that states could not be penalized for opting out of Medicaid expansion, and 19 states have not yet taken any steps to expand their Medicaid programs.  Fortunately for New York’s residents, hospitals, and economy, the state further expanded Medicaid under 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 state’s existing Medicaid program covered childless adults with incomes up to 50 percent of poverty level, and Family Health Plus expanded coverage up to 100 percent of poverty.  For parents with dependent children, the existing eligibility rules allowed Medicaid coverage up to 75 percent of poverty level, and Family Health Plus increased that threshold to 150 percent.

New York’s progressive stance on access to healthcare meant that much of the state’s low income population was already eligible for Medicaid or Family Health Plus for many years prior to the ACA.  It was a perfect fit for the state to accept the ACA’s provision to utilize federal funding to expand Medicaid to everyone with incomes up to 133 percent of poverty.

Who is eligible?

Adults in New York with incomes up to 138 percent 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 percent of poverty level (a pregnant woman counts as two people for household income determination).

Children from age one to eighteen are eligible for Medicaid with a household income up to 149 percent of poverty, but the state also has separate CHIP (Children’s Health Insurance Program) coverage available for children with household incomes up to 400 percent of poverty level – the highest threshold in the country.

How do I apply?

Family Health Plus stopped taking new enrollments at the end of 2013, and applicants are now directed to the state-run exchange (NY State of Health), where they can enroll in the streamlined and expanded Medicaid program (income limits for eligibility).  Most people will apply through NY State of Health, but some enrollees will need to use their Local District Social Services Office instead

CHIP and Medicaid enrollment can both be completed through New York’s state-run exchange, NY State of Health.  There is no open enrollment period for Medicaid or CHIP – anyone who qualifies can enroll at any time.

How many people have enrolled?

In a press release on July 29, NY State of Health reported that 1,568,345 had enrolled in Medicaid through the exchange as of the end of February 2015 (cumulative, from October 2013).  An AP story on July 19 noted that NY’s Medicaid enrollment had grown by 1.1 million people since October 2013, with roughly half the enrollees newly-eligible under the expanded guidelines, and the other half comprised of people who were previously eligible but not enrolled prior to 2014.

But average monthly enrollment was 5,678,417 in late 2013, and had grown to 6,441,902 by June 2015 – a net increase of 763,485 people (while new enrollees join the Medicaid program, existing enrollees transition off if their income increases or they obtain coverage elsewhere)

During the 2014 open enrollment period, roughly 63 percent of the total enrollment through NY State of Health was for either Medicaid or CHIP.   The expanded Medicaid eligibility was a significant factor in reducing New York’s uninsured rate from 12.6 percent to 10.3 percent during the first half of 2014 (official US census data pegged both numbers a little lower, with 10.7 percent of the state uninsured in 2013, and 8.7 percent in 2014 – but the overall reduction is similar in both surveys).

Medicaid/CHIP enrollment are year round, but tend to spike during open enrollment due to the education and outreach activities of the exchanges nationwide.  During the 2015 open enrollment period, NY State of Health enrolled 357,456 people in Medicaid/CHIP (new enrollments) and 408,841 people in private plans (including new enrollments and renewals).

The uninsured rate dipped further in the first half of 2015, reaching a new low of 8.3 percent of the state’s population.