New York Medicaid Waiver Expanding Coverage to Uninsured May Be Model for Other States

With the May 30th approval of the Medicaid expansion waiver for working, low-income adults, New York is taking the latest step in its incremental approach toward providing health coverage for more residents, and the New York Times reports that the state "will surely be a model for other states looking for ways to reduce the ranks of the uninsured" (Steinhauer, New York Times, 5/31). Under the new waiver program, titled Family Health Plus, an estimated 352,000 uninsured parents with income up to 150% of the federal poverty level, or an annual income of $25,000 for a family of four, are now eligible for coverage funded jointly by the state and federal governments. Another 267,000 individuals without children who earn annual incomes below 100% FPL, or $8,590 per person per year, are also eligible (Kaiser Daily Health Policy Report, 5/30). Family Health Plus, which the Times reports marks the "first time a state has extended such a government insurance program" to childless adults, joins the state's CHIP program, Child Health Plus, and the state's "relatively generous" traditional Medicaid program in providing coverage for the uninsured. The eligibility limits of Family Health Plus will increase each year for the next two years, "open[ing] the door" for more residents to qualify for the program. The Times reports that the "acceptance" of the expansion "marks a significant shift in Gov. George Pataki's (R) thinking ... about how the uninsured should gain coverage, bringing the onus back on the government at a time of skyrocketing health care costs." Family Health Plus, for instance, is similar to a plan outlined by Sen. Hillary Clinton (D) during her campaign last year. In addition, the Times reports that "Medicaid, not so long ago the vilified health plan of last resort, has become the preferred health plan of many flavors for a broad swath of the state's poor."

Work Still Remains
But with about 3.1 million uninsured residents, the state remains a long way from providing universal coverage, and may face the same problem with Family Health Plus as it did with Child Health Plus: getting eligible people enrolled and keeping them in the program. While 530,000 children have enrolled in the Child Health Plus, "hundreds of thousands" in that program or Medicaid have gone uncovered for some period of time because their parents either did not complete the program's recertification process, which includes a face-to-face interview and an assets test. A bill under consideration in the state assembly would eliminate the interview requirement and ask the federal government to allow for recertification every two years instead of the current annual process. Another difficulty the state has faced has been attracting managed care companies to its Medicaid managed care programs. Under a new plan, called Healthy New York, the state will "require commercial health plans to offer employers of businesses with fewer than 50 employees, or groups of employees working in such businesses, a chance to buy inexpensive coverage subsidized by the state," which the state hopes will provide coverage for an additional 400,000 residents (New York Times, 5/31).