Hochul: Federal approval to expand access to high-quality, affordable health insurance

Expansion of Essential Plan will give over 100,000 health insurance at $0 monthly premium and low-cost sharing

√ Governor says this will save New Yorkers an average of $4,700 per year

Information Courtesy of the Office of Gov. Kathy Hochul

Gov. Kathy Hochul announced 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% 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.

“Federal approval to expand the Essential Plan is an important step toward building a better health care system statewide,” 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.”

New York State Health Commissioner Dr. James McDonald said, “I thank Gov. Hochul for her dedication to eliminating health disparities in the state and working to ensure that New Yorkers have the dignity and security that comes with having access to high-quality health care and affordable health insurance. New York continues to be a leader in addressing social determinants of health, and the approved expansion of the Essential Plan will help us continue this work and reach even more New Yorkers.”

NY State of Health Executive Director Danielle Holahan said, “Since introduced by the Marketplace in November 2015, the Essential Plan has served as a critical haven for New Yorkers unable to qualify for Medicaid but still struggling to stay afloat with the cost of health insurance. We are excited to build upon the success of this program to extend affordable, comprehensive health insurance coverage with no monthly premium to more low-income New Yorkers, including the Deferred Action for Childhood Arrival (DACA) population.”

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.

Today, eligibility for the Essential Plan is limited to New Yorkers with incomes above Medicaid levels and up to 200% 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.

Through this State Innovation Waiver, starting April 1, 2024, the Essential Plan will be expanded to New Yorkers with incomes up to 250% 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.

Access to coverage through the Essential Plan is estimated to save New Yorkers between 200% and 250% 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.

Complementing New York’s recently approved Medicaid Demonstration waiver, under this 1332 waiver, New York also seeks to address social determinants of health for Essential Plan enrollees. Waiver funding will support grants that address food insecurity, including through food pharmacies and medically tailored meals, and will support enrollees with persistent asthma by providing them with air conditioners to protect their health and reduce the number of emergency department visits. This waiver will also support grants to insurers to increase access to behavioral health providers and services, including mobile crisis units, crisis diversion centers, and crisis respite centers.

U.S. Senate Majority Leader Charles Schumer said, “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. 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.”

U.S. Sen. Kirsten Gillibrand said, “All New Yorkers deserve to have access to high-quality, affordable health insurance. 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.”

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.

Information about Section 1332 State Innovation Waivers, including a fact sheet on New York’s waiver, can be found on CMS’ website here. Information about New York’s Section 1332 waiver can be found here. Information about Essential Plan benefits and cost sharing grid can be found here.

About NY State of Health

New York opened its Health Plan Marketplace, NY State of Health, in October 2013. The Marketplace’s one-stop health insurance shopping experience offers high-quality comprehensive health plans. NY State of Health, a division of the New York State Department of Health, is the only place where consumers can qualify to get help paying for coverage through premium discounts or tax credits. Eligible New Yorkers can also enroll in Medicaid, Child Health Plus, and the Essential Plan through the Marketplace all year. For more information about the NY State of Health Marketplace, visit https://nystateofhealth.ny.gov/ or call customer service at 1-855-355-5777, TTY: 1-800-662-1220 or find an enrollment assistant.