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. 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 October 2017, the state’s total Medicaid enrollment grew by 13 percent .
In New York’s 2016-2017 budget, $18.5 billion in state funds is allocated to Medicaid. Although the federal government is paying the full cost to cover people who are newly eligible for Medicaid under the ACA, New York’s eligibility guidelines were already so generous that only about 9 percent of the state’s Medicaid enrollees are newly eligible under the ACA — the rest were eligible under the guidelines New York had already put in place. For New York Medicaid enrollees who are eligible based on pre-ACA guidelines, the
For New York Medicaid enrollees who are eligible based on pre-ACA guidelines, the state and federal government split the cost (since NY is a relatively wealthy state, they receive the lowest possible federal match, which is 50 percent). When we consider the state’s entire Medicaid population, as of Fiscal Year 2015, the federal government paid 54.7 percent of the cost, and New York paid 45.3 percent.
2.7 million — mostly Medicaid enrollees — could lose coverage under Trump Administration
New York Governor, Andrew Cuomo, announced in early January 2017 that 2.7 million New Yorkers are at risk of losing coverage if the ACA is repealed and not replaced with something equally robust, and that the state budget impact would be $3.7 billion
The people who would lose coverage include virtually all of the 635,909 New York residents who currently have coverage under The Essential Plan (described below), a significant number of the 218,000 who have enrolled in private plans through New York State of Health, and the majority of the 2.3 million people who have enrolled in Medicaid through New York State of Health.
Although most of the Medicaid enrollees were already eligible under New York’s pre-2014 guidelines, the state estimates that 1.9 million Medicaid enrollees would lose access to Medicaid if the ACA is repealed. That’s because the state was using 1115 waivers to expand coverage eligibility in the years prior to ACA implementation, and the federal government was splitting the cost with the state as called for in the waivers.
But those waivers expired after the ACA’s Medicaid expansion was implemented. If the ACA’s Medicaid expansion is repealed, eligibility would revert to much lower thresholds: parents with dependent children would be covered with income up to 94 percent of the poverty level (which is still much more generous than most states absent the ACA’s Medicaid expansion), and childless adults wouldn’t be eligible at all. The state would be allowed to spend their own money to extend those guidelines, but it would fiscally challenging without the federal match.
If the ACA is repealed and the replacement doesn’t provide the sort of subsidies (via Medicaid expansion, The Essential Plan, and premium subsidies) that the ACA does, 2.7 million people could lose coverage in New York:
- 1.9 million who currently have Medicaid
- 636,000 who currently have The Essential Plan coverage
- Roughly 164,000 of the people who currently have subsidized qualified health plans (QHPs) through the exchange (the rest would presumably be able to continue to afford coverage in the individual market even without the ACA’s subsidies, as only 55 percent of New York’s QHP enrollees had subsidies in 2016).
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 health care 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 138 percent of poverty.
New York went a step further than most other states, and implemented 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 covers New York residents with income up to 200 percent of the poverty level. Premium and out-of-pocket costs for this population are much lower than they would be on qualified health plans in the exchange if the Basic Health Program were not in place. 635,909 New York residents had enrolled in The Essential Plan by December 24, 2016
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 (for Medicaid eligibility determinations, a pregnant woman counts as two people for household income calculations).
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 an enrollment report published in August 2016, NY State of Health reported that 1,966,920 people had enrolled in Medicaid through the exchange by January 31, 2016. The total includes 1.74 million people who had renewed coverage for 2016, along with 223,115 who were new enrollees starting in 2016.
In an enrollment report published in January 2017, NY State of Health announced that Medicaid enrollment through the exchange had reached 2.33 million by December 24, 2016. In addition, 285,627 people had enrolled in Child Health Plus.
Average monthly enrollment was 5,678,417 in late 2013, and had grown to 6,411,923 by October 2016 — a net increase of 13 percent, or about 733,500 people. The net increase is far lower than the total number of people who have enrolled, because while new enrollees join the Medicaid program, existing enrollees transition off if their income increases or they obtain coverage elsewhere.
During the 2016 open enrollment period, 96 percent of the people who were newly enrolled in Medicaid through NY State of Health reported that they were uninsured prior to enrolling (as opposed to just 57 percent of the people who were newly enrolled in subsidized private plan QHPs through the exchange). Medicaid has clearly played an important role in reducing New York’s uninsured rate from 10.7 percent in 2013, and 7.1 percent in 2015.