1 Covering the Uninsured in New York: Current and Potential Strategies Danielle Holahan United Hospital Fund May 2006

2 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

3 % of Federal Poverty Level (FPL) Public Assistance Need Standard (varies by county) 200% 133% 250% ** 87% 100% 150% 250% ** 200% Infants Children Age 1-5 Pregnant Women Parents † Childless Adults †† New York State Eligibility Rules for Medicaid, Child Health Plus, Family Health Plus, and Healthy New York* Employed Individuals Small Business 208% No Ceiling Children Age 6-18 *** 100% 250% **

4 *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 % FPL are $9/month/child up to $27; for children with gross family income between % 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 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. Notes to New York State Eligibility Chart

5 ChildrenAdults Employed Individuals and Small Business Note: *Healthy New York enrollment includes both subscribers and their dependents. Categories may not sum to totals due to rounding. Source: United Hospital Fund analysis of NYS Department of Health enrollment reports; New York State Insurance Department. New York State Program Enrollment, September 2005 Medicaid, Child Health Plus, Family Health Plus, and Healthy New York Elderly and Disabled 2,060,000 1,040,000 1,530, ,000 *

6 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

7 An estimated 1.3 million New York State residents are uninsured but eligible for public coverage. 450, ,000 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, ,330,000 Note: Data are for Child Health Plus A (Medicaid for children) data include children aged 0-20 while Child Health Plus B data include children aged Source: March 2004 Annual Social and Economic Supplement of the Current Population Survey. Tabulations prepared for the United Hospital Fund by the Urban Institute.

8 Nearly half the uninsured in New York State are eligible for public health insurance coverage. 2.9 million uninsured in 2003 Source: Urban Institute, Based on data from the 2004 Annual Social and Economic Supplement of the Current Population Survey. 55% 15% 30%

9 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. 2.9 million uninsured in 2003 Source: March 2004 Annual Social and Economic Supplement of the Current Population Survey. Tabulations prepared for the United Hospital Fund by the Urban Institute. 45% 34% 21%

10 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

11 United Hospital Fund/Commonwealth Fund “Blueprint for Coverage in New York”  Policy Roundtables:  stakeholders  Data presentation and policy discussion  Topics:  Employer Mandates  Individual Mandates  Affordability  Public Program Simplification  Lessons from Massachusetts and Options for New York

12 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.

13 Public Health Insurance Eligibility, New York and Massachusetts, 2005 Income limit as share of 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. ** Massachusetts has a separate state-only program that provides child coverage up to 400% FPL Source: Cohen Ross, D. and Cox, L “In a Time of Growing Need: State Choices Influence Health Coverage Access for Children and Families,”Kaiser Commission on Medicaid and the Uninsured, October 2005.

14 New York vs. Massachusetts Non-elderly Coverage Profile New YorkMassachusetts 17% Uninsured (2.8 million people) 13% Uninsured (710,000 people) 61% Employer-Sponsored Insurance 68% Employer-Sponsored Insurance 45% Eligible but Uninsured23% Eligible but Uninsured 37% of the uninsured have income >200% FPL 43% of the uninsured have income >200% FPL Note: Data are for , 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 Medicaid Policy Institute, April 2005.