New York Medicaid

Medicaid enrollment grows by 12% after expansion, uninsured rate down to 7.1%

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
  • October 1, 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 July 2016, the state’s total Medicaid enrollment grew by 12 percent people.

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 state pays 47 percent of the cost, while the federal government covers 53 percent.

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.

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.

Average monthly enrollment was 5,678,417 in late 2013, and had grown to 6,372,384 by July 2016 — a net increase of just under 694,000 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.