Expanding Health Care Coverage

By

Coalition of New York State Public Health Plans

Funding Area

Expanding Health Care Coverage

Date

April 12, 2012

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This NYSHealth-supported report by the Coalition of New York State Public Health Plans finds that, each year, 1.5 million New Yorkers receiving health insurance benefits through the Health Benefit Exchange could experience a loss of health care coverage as their incomes and eligibility for different coverage programs and subsidies fluctuate, and emphasizes that creation of a seamless coverage system is a critical factor to the successful implementation of the Exchange.

The report also finds that 30% of nonelderly New Yorkers below 400% of the Federal Poverty Level ($76,360 annual income for a family of three) will experience year-to-year income fluctuations that potentially affect their eligibility for public coverage programs like Medicaid or for subsidized coverage through the Exchange. Income fluctuation varies substantially by income level; those with incomes that hover just above the Medicaid eligibility cut-off experience the greatest degree of fluctuation.

To achieve continuity of coverage for lower-income New Yorkers, the report lays out recommendations in four key areas for policymakers to consider: Eligibility and Enrollment Rules; Plan Participation in Medicaid Managed Care and the Exchange; Covered Benefits and Provider Networks; and Administration of Health Plan Products.