Governor Hochul announces federal approval to expand high quality access to affordable health insurance
ALBANY, NY- Governor Kathy Hochul announced on Monday 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.
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.
“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.”
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.
“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," said U.S. Senate Majority Leader Charles Schumer.
"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.”
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.
“All New Yorkers deserve to have access to high-quality, affordable health insurance," said Senator Kirsten Gillibrand.
"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.”
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.
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.
Image via the office of New York Governor Kathy Hochul.
