New York Public Health Insurance Dashboards

New York Public Health Insurance

New York has maintained a robust network of public health insurance programs, which was strengthened by the Affordable Care Act (ACA) in 2014. New York chose to expand Medicaid eligibility under the ACA. The ACA included provisions that allowed New York to create EP and QHP, which provide coverage for New Yorkers who are not eligible for Medicaid and who did not have access to other affordable, creditable coverage.

The ACA also allowed “lawfully present immigrants” who had previously been excluded from public health insurance to qualify. Despite the expansion to more immigrants, under the federal rules many immigrants cannot access public or private health insurance. New York has made some expansions for immigrants beyond the federal rules. Specifically, children under 19 and pregnant women are eligible for public insurance in New York regardless of immigration status. In 2024, adults age 65 and older will be eligible for public insurance in New York regardless of immigration status.

Fluctuations in enrollment between the programs reflect changes in the economy and policy. For example, enrollment in public health insurance decreased because of the anti-immigrant public charge policy of the Trump Administration in 2019. In 2020, Medicaid enrollment increased as a result of the economic downturn caused by the COVID-19 pandemic. Enrollment in Medicaid has been stable over the last three years due to a provision from the Families First Coronavirus Response Act (FFCRA) that required states to maintain people’s Medicaid eligibility throughout the public health emergency (PHE) in exchange for an enhanced Federal Medicaid Assistance Program (FMAP) payment. Similarly, enrollment in Qualified Health Plans increased due to enhanced federal subsidies that reduced the out-of-pocket costs of health insurance for consumers.

Medicaid

Medicaid is a federal-state partnership for low-income children, people with disabilities, working adults, and older adults. Federal reimbursement for Medicaid varies by eligibility category but is at least 50% for all federally eligible New York Medicaid members. Eligibility for Medicaid varies based on age, disability, etc. but everyone who qualifies for Medicaid, regardless of eligibility pathway, has access to the same set of comprehensive benefits. Most Medicaid members receive benefits through Medicaid managed care plans. Medicaid can be enrolled in through the New York State of Health (NYSOH) Marketplace for children and working adults, or Local Departments for Social Services (LDSSs) for people with disabilities and older adults (age 65 and older), with limited exceptions. New Yorkers eligible for Medicaid can enroll anytime during the year. No open enrollment period or special enrollment is required. A 3-month retroactive period can also be applied for to cover any medical expenses incurred when there was no coverage. For more information on Medicaid, visit New York State’s Medicaid page.

Child Health Plus (CHP)

CHPlus is a health insurance program for any New York child, regardless of immigration status, based off the federal Children's Health Insurance Program (CHIP). Similar to Medicaid, there is a federal reimbursement for CHP of 65%. There is no premium for lowest-income New York children and low premiums for those with lower incomes. Children whose family incomes are above the low-income limits can still qualify for CHP and pay the full premium. Regardless of income or premium payment, there is no cost-sharing for CHP. Children can be enrolled in CHP through the NYSOH Marketplace anytime during the year. No open enrollment period or special enrollment is required. For more information on CHP, visit New York State’s Child Health Plus page.

Essential Plan (EP)

EP is a health insurance program for low-income adults (ages 19-64) created by the ACA provisions for a Basic Health Program. The EP federal funding is equal to 95% of the premium tax credits or cost sharing reductions an enrollee would have received through the Qualified Health Plan (QHP) program. EP provides comprehensive health insurance for New Yorkers whose incomes are too high for Medicaid but still low and immigrants who do not meet strict federal requirements. New Yorkers can enroll in the Essential Plan through the NYSOH Marketplace anytime during the year. No open enrollment period or special enrollment is required. For more information on EP, visit New York State’s Essential Plan page.

Qualified Health Plan (QHP)

All New Yorkers who are lawfully present under federal rules can receive health insurance through a Qualified Health Plan (QHP). Eligible New Yorkers with incomes above the limit to qualify for Medicaid, CHP, or EP, may be eligible for a premium subsidy, provided through enhanced tax credits to make QHP more affordable. The premium subsidies for QHPs were recently expanded by the American Rescue Plan Act of 2021 (ARPA). The cost of the insurance plan and the amount of the subsidy will depend on several factors including the plan level selected (bronze, silver, gold, or platinum) and the household modified adjusted gross income. New Yorkers can enroll in a QHP through the NYSOH Marketplace during open enrollment (typically November-January) or during a special enrollment period (marriage, divorce, loss of coverage, etc.). For more information on QHP, visit New York State’s Qualified Health Plans page.

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