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									Covering the Uninsured in New York:
  Current and Potential Strategies



          Danielle Holahan
         United Hospital Fund
              May 2006

                                      1
  State Initiatives to Cover the Uninsured:

 Strategies implemented in New York

 United Hospital Fund/Commonwealth
  Fund “Blueprint for Coverage” project

 Background on New York and
  Massachusetts




                                              2
           New York State Eligibility Rules for Medicaid, Child Health Plus,
                    Family Health Plus, and Healthy New York*

                                             Healthy New York
                                             Family Health Plus
                 % of Federal
                 Poverty Level
                                             Child Health Plus B
                    (FPL)                    Child Health Plus A (Medicaid for Children)
                                             Medicaid                                               No
                                                                                                  Ceiling
                     300%

                     250%
                            250% **   250% **   250% **                                    208%
                     200%
                            200%                          200%
                     150%
                                                                    150%
                                      133%
      Public         100%                                                     100%
   Assistance                                    100%                87%
 Need Standard       50%
(varies by county)

                      0%
                                                                      †
                            Infants Children Children Pregnant Parents Childless Employed Small
                                    Age 1-5 Age 6-18*** Women           Adults†† Individuals Business


                                                                                                            3
                Notes to New York State Eligibility Chart
*Medicaid and Child Health Plus A, and Healthy New York eligibility are expressed in net income while
Child Health Plus B and Family Health Plus eligibility are expressed in gross income, as written in HCRA
2000 and Medicaid law. The 2006 Federal Poverty Level (FPL) is $9,800 for an individual.
** Children with gross family income above 160% FPL are charged an income-related premium.
Premiums for children with gross family income between 160-222% FPL are $9/month/child up to $27; for
children with gross family income between 223-250% FPL premiums are $15/month/child up to $45.
***Through March 2005, the Child Health Plus A eligibility level for children ages 6-19 was 133% FPL.
Effective April 2005, the Child Health Plus A eligibility level for children ages 6-19 years was lowered to
100%FPL, at which time children in that age range with gross family income between 100%FPL and
133% FPL who were enrolled in Child Health Plus A were shifted into Child Health Plus B.
† “Parent” is defined as a parent of a child under 21 years who lives in the household. Medicaid eligibility
includes disabled adults and 19- and 20-year-olds up to 87% FPL. FHP eligibility includes 19- and 20-
year-olds living with their parents up to 150% FPL.
†† “Childless adult” is defined as a non-disabled adult aged 21 years and over who does not have a child
living in the household. FHP eligibility includes 19- and 20-year-olds not living with their parents up to
100% FPL.

Note: Low-income, uninsured women who are diagnosed with breast or cervical cancer through
screenings in New York’s Healthy Women Partnerships program are eligible for Medicaid coverage.
Women must have income levels below 250% FPL to qualify for the screenings. Females and males of
childbearing age with income up to 200% FPL are eligible for Medicaid Family Planning Services. As of
July 2003, disabled workers aged 16-64 with net income of up to 250%FPL and non-exempt resources
up to $10,000 are eligible for Medicaid coverage through the Medicaid Buy-In for Working People with
Disabilities program (MBIWPD); enrollees with incomes above 150% FPL will eventually be subject to an
income-related premium.                                                                                        4
        New York State Program Enrollment, September 2005
Medicaid, Child Health Plus, Family Health Plus, and Healthy New York
                                                  Healthy New York
                                                  Family Health Plus
                                                  Child Health Plus B
    2,500,000                                     Child Health Plus A (Medicaid for Children)
                                                  Medicaid
                         2,060,000
    2,000,000
                          340,000
                                                 1,530,000
    1,500,000
                                                  520,000
                                                                       1,040,000
    1,000,000
                         1,720,000

       500,000                                  1,010,000              1,040,000

                                                                                           100,000
                0
                          Children                Adults              Elderly and       Employed Individuals*
                                                                       Disabled          and Small Business
Note: *Healthy New York enrollment includes both subscribers and their dependents.
Categories may not sum to totals due to rounding.                                                               5
Source: United Hospital Fund analysis of NYS Department of Health enrollment reports;
New York State Insurance Department.
A range of policies enacted by the state have simplified
and streamlined enrollment in New York’s public health
insurance programs.

    Self-attestation of resources for Medicaid
     applications and renewals
    Self-attestation of social security number for
     Medicaid applications and renewals
    Self-attestation of income for Child Health Plus B
     renewals
    Simplified renewal forms
    Elimination of face to face interview for Medicaid
     renewal
    Facilitated enrollment
                                                           6
    An estimated 1.3 million New York State residents are
    uninsured but eligible for public coverage.
                    Estimates of Uninsured Children Eligible for Child Health Plus A (Medicaid for
                      Children) and Child Health Plus B and Adults Eligible for Medicaid/Family
                                          Health Plus, New York State, 2003

                          2,000,000       Child Health Plus B Eligible but Uninsured
                                          Child Health Plus A (Medicaid for Children) Eligible but Uninsured
      Number of persons




                                          Medicaid/Family Health Plus Eligible but Uninsured
                          1,500,000                                                                1,330,000


                          1,000,000                                   880,000

                                                                                                   1,330,000
                                         450,000
                           500,000                                    880,000
                                          80,000

                                         370,000
                                 0
                                        Children                       Adults                          Total
Note: Data are for 2003. Child Health Plus A (Medicaid for children) data include children aged 0-20
while Child Health Plus B data include children aged 0-18.                                                     7
Source: March 2004 Annual Social and Economic Supplement of the Current Population Survey.
Tabulations prepared for the United Hospital Fund by the Urban Institute.
Nearly half the uninsured in New York State are eligible for
public health insurance coverage.

                                                                        Eligible
                                                                        children

                                                              15%


                 Ineligible             55%

                                                           30%
                                                                            Eligible adults




                              2.9 million uninsured in 2003

 Source: Urban Institute, 2004. Based on data from the 2004 Annual Social                     8
 and Economic Supplement of the Current Population Survey.
One-third of the uninsured in New York have income
below 300% of the federal poverty level but are not eligible
for existing public programs.

                                 Not eligible
                                   >300%

                                                     21%


                                                                        45%          Eligible
                                                 34%

                      Not eligible
                        < 300%


                                   2.9 million uninsured in 2003

Source: March 2004 Annual Social and Economic Supplement of the Current Population              9
Survey. Tabulations prepared for the United Hospital Fund by the Urban Institute.
 United Hospital Fund/Commonwealth Fund
   “Blueprint for Coverage in New York”

 Goals:
   Develop a framework for bringing New York
    closer to universal coverage
   Inform the debate with independent
    information and analysis


 2-part project:
   Explore various options through policy
    roundtables
   Model a series of coverage expansion options

                                                   10
 United Hospital Fund/Commonwealth Fund
   “Blueprint for Coverage in New York”

 Policy Roundtables:
   50-60 stakeholders
   Data presentation and policy discussion
   Topics:
      Employer Mandates
      Individual Mandates
      Affordability
      Public Program Simplification
      Lessons from Massachusetts and Options for New York


                                                             11
 United Hospital Fund/Commonwealth Fund
   “Blueprint for Coverage in New York”

 Coverage Strategies:
   Further simplification of public program
    enrollment and renewal processes to enroll the
    eligible but uninsured.
   Expansion of public program eligibility.
   Increase affordability of coverage for persons
    with income below 300% FPL.
   Explore mandatory options: employer and
    individual mandates.


                                                     12
                                         Public Health Insurance Eligibility,
                                         New York and Massachusetts, 2005
                                               New York                         Massachusetts
   Income limit as share of FPL



                                  400%


                                  300%
                                             250%
                                                       200%
                                  200%
                                                                                 150%
                                                                                                     133%

                                  100%


                                   0%
                                                Children                                Parents
** Massachusetts has a separate state-only program that provides child coverage up to 400% FPL

Note: Children’s eligibility includes Medicaid and SCHIP. Parents’ eligibility is for Medicaid and
includes eligibility expansions obtained through waivers using Medicaid or SCHIP funds.
Source: Cohen Ross, D. and Cox, L “In a Time of Growing Need: State Choices Influence                       13
Health Coverage Access for Children and Families,”Kaiser Commission on Medicaid and
the Uninsured, October 2005.
New York vs. Massachusetts Non-elderly Coverage Profile

                   New York                                              Massachusetts
  17% Uninsured                                               13% Uninsured
  (2.8 million people)                                        (710,000 people)
  61% Employer-Sponsored                                      68% Employer-Sponsored
  Insurance                                                   Insurance

  45% Eligible but Uninsured                                  23% Eligible but Uninsured

  37% of the uninsured have                                   43% of the uninsured have
  income >200% FPL                                            income >200% FPL


Note: Data are for 2003-2004, except eligible but uninsured data which are for 2003 for New York and 2004 for
Massachusetts. Data include all persons below age 65.
Source: All data except the Massachusetts eligible but uninsured data are from Urban Institute tabulations of the March 2004
and March 2005 Current Population Survey, Annual Social and Economic Supplement. Massachusetts eligible but uninsured
data taken from Oakes, M. “Eligible but Uninsured: Challenges to Getting and Keeping MassHealth,” Massachusetts              14
Medicaid Policy Institute, April 2005.

								
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