NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A1710
SPONSOR: Gonzalez-Rojas TITLE OF BILL:
An act to amend the social services law, in relation to coverage for
certain individuals under the 1332 state innovation program
PURPOSE OR GENERAL IDEA OF BILL:
To improve access to care by expanding eligibility for certain publicly
subsidized programs for individuals who currently face barriers to
health care coverage due to their immigration status.
SUMMARY OF SPECIFIC PROVISIONS:
This bill would direct the Commissioner of Health (COH) to modify their
1332 waiver program to seek coverage for certain undocumented individ-
uals that are residents of the state. The bill would authorize the COH
to implement limitations on enrollment of this population with a minimum
coverage expansion of 240,000 individuals and authorize them to provide
coverage to individuals beyond that number if 1332 waiver funds are
available to support it. Any limitations on enrollment would target
coverage opportunities to lower income populations, but would allow the
COH to make exceptions for particular subsets of the population that are
at-risk.
This bill would direct the COH to seek approval from the federal govern-
ment for the use of surplus reserves in the basic health plan trust
fund, which supports the Essential Plan, to support individuals covered
under the 1332 waiver program.
This bill would also expand the 1332 waiver program reporting require-
ments to include information on: any enrollment limitations; any savings
to the state due to coverage of undocumented individuals; and any funds
from the basic health plan trust fund that are utilized to support the
1332 waiver program.
JUSTIFICATION:
Since the enactment of the Affordable Care Act Marketplace in 2010, New
York has drastically reduced the number of uninsured individuals from 3
million to 1 million. However, more than 400,000 immigrant New Yorkers
have not benefited from new coverage options or public coverage through
the New York State of Health Marketplace because of their immigration
status. Numerous studies have found that people without coverage are
more likely to delay seeking preventative care for serious and chronic
health conditions, avoid seeking care for fear of costs, and are at
higher risk of incurring medical debt or bankruptcy. Studies have also
shown that those who have gained coverage have reduced mortality and
morbidity.
Additionally, in many instances these individuals end up being covered
by Emergency Medicaid to address their medical issues, which can often
be a costly alternative to routine preventative care. Emergency Medicaid
is already supported under the current budget of the state, so this bill
would support the delivery of more comprehensive and preventative
services to avoid unnecessary hospitalizations. Recent data shows a
total in excess of $1 billion being spent on Emergency Medicaid. If this
program was implemented with a cap of 240,000 individuals, estimates
show that state and local governments would generate a combined savings
in excess of $400 million. Additionally, this potential coverage option
would likely lead to a similar savings in excess of $400 million to the
federal government, which makes the 1332 waiver application even more
likely to succeed. Based on the Department of Health's actuarially
reviewed 1332 waiver draft document, covering 240,000 additional indi-
viduals leads to the waiver trust fund balance continuing to grow every
year over the next five years to end with surplus reserves in excess of
$1.3B.
The SFY 2022-23 budget contained provisions expanding Medicaid eligibil-
ity to individuals aged 65 or older that are otherwise eligible except
for their immigration status. This bill will provide more adult immi-
grants with access to health insurance coverage that is equivalent to
the coverage offered to their citizens or lawfully present counterparts
who are eligible for the Essential Plan or Medicaid. The program builds
upon New York's success covering children (including immigrant children)
through the Child Health Plus program. It extends coverage to eligible
adult immigrants ensuring that all New Yorkers have access to affordable
health coverage, averting the health insurance cliff many young immi-
grants now face when they turn 19 after years of state investment in
their health. Extending this coverage to all adults would create
savings for the state and improved health outcomes for all New Yorkers.
The lack of coverage for significant numbers of New Yorkers causes prob-
lems for the broader health care system because payers and providers
charge more to the insured population to offset their losses related to
providing care to the uninsured. Even with this cost shifting, the costs
associated with uncompensated care threaten the financial sustainability
of many safety net hospitals and clinics. The program will invest
hundreds of million into the healthcare system, further stabilizing the
state's healthcare economy.
By expanding eligibility for coverage, this bill will provide essential
services to hundreds of thousands of individuals, make New York health
care providers more financially sound, save state and local governments
hundreds of millions in costs, and ensure a healthy fiscal outlay for
the continued operation of the waiver program.
PRIOR LEGISLATIVE HISTORY:
2024: A3020 (Gonzalez-Rojas) - Introduced and reported to Health
2023: A3020 (Gonzalez-Rojas) - Introduced and Reported to Health
2022: A880 (Gottfried) - Reported to Health
A880 (Gottfried) - Reported to Codes
A880 (Gottfried) - Reported to Ways and Means
2021: A880 (Gottfried) - Referred to Health
2020: A5974 (Gottfried) - Reported to Ways and Means
2019: A5974 (Gottfried) - Referred to Health
A5974 (Gottfried) - Reported to Codes
A5974 (Gottfried) - Reported to Ways and Means
FISCAL IMPLICATIONS:
Emergency Medicaid reductions would lead to significant State and Local
savings, with some estimates showing a combined savings in excess of
$400 million. Because the funding to support this coverage expansion
utilizes excess 1332 waiver program revenues, there is zero financial
cost to the state.
EFFECTIVE DATE:
The bill takes effect in the same time and manner as section 3 of part H
of chapter 57 of the laws of 2023.
