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A03020 Summary:

COSPNSRPaulin, Simone, Shrestha, Ardila, Forrest, Gallagher, Levenberg, Ramos, Raga, Mitaynes, Lee, Hevesi, Simon, Burdick, Otis, Thiele, Taylor, Solages, Bronson, Jean-Pierre, Lavine, Clark, Kelles, Joyner, Bichotte Hermelyn, Burgos, Epstein, Weprin, Carroll, Rosenthal L, Dinowitz, Cruz, Reyes, Jackson, Mamdani, Seawright, Glick, Meeks, Jacobson, Kim, Anderson, Davila, Zinerman, Dickens, Gibbs, Rivera, De Los Santos, Shimsky, Colton, Cunningham, Tapia, Bores, Alvarez, Zaccaro, Septimo, Chandler-Waterman, Lucas, Dilan, Cook, Darling
Amd §369-ii, Soc Serv L
Provides for coverage for certain individuals under the 1332 state innovation program.
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A03020 Memo:

submitted in accordance with Assembly Rule III, Sec 1(f)
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 and authorize them to provide coverage to individuals beyond that number if 1332 waiv- er 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 authorize the COH to seek approval from the federal government for additional pass through funding as a result of the reduction in emergency medicaid expenses.. This bill would also expand the 1332 waiver program reporting require- ments to include information on: any enrollment limitations and any savings to the state due to coverage of undocumented individuals.   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, estimates show that state and local governments would generate a combined savings in excess of $400 million. Addi- tionally, 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 document, even with the coverage of additional individuals, the waiver trust fund balance could continue to grow every year over the next five years. 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 problems 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: 2023: S2237A (Rivera) - Passed Senate 2022: S1572A (Rivera) - Reported to Finance 2021: S1572 (Rivera) - Referred to Health 2020: S3900 (Rivera) - Referred to Health 2019: S3900 (Rivera) - Referred to Health   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 federal 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.
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