New York

1
New Yorks Family Health Plus Insurance Expansion
Presentation by Rima Cohen Vice President,
Insurance Options Greater New York Hospital
Association March 1, 2000
2
Background New Yorks Health Insurance System
3
New York States Demographics

• 18 million people
• Approximately 2 million immigrants
• 3 million uninsured

4
Sources of Health Insurance Coverage, Non-Elderly
Population

• Source March 1997 Current Population Survey.

Percent of non-elderly population
5
New Yorks Growing Uninsured Problem

• New Yorks uninsured population is larger and
  growing faster than in the rest of the country
• Source United Hospital Fund, 1998.

Percent of nonelderly population
6
Who are New Yorks uninsured?

• New Yorks 3.1 million uninsured are mostly
  low-income working adults without access to
  employer-based coverage, as in the rest of the
  country.
• Roughly one-third of New Yorks uninsured are
  immigrants.

7
Proportion of UninsuredAdults vs. Children

• 75 of New Yorks non-elderly uninsured are
  adults (ages 19 to 64) and 25 are children
  (under age 19).

8
Over two-thirds of NYs uninsured are below 200
of the federal poverty level (FPL).

• Source United Hospital Fund, 1998.

9
Nearly three-fourths of NYs uninsured are in the
workforce.

• Source United Hospital Fund, 1998.

10
Private coverage in NY is declining faster than
in the nation as a whole.

• 1991 1996
• Source United Hospital Fund, 1998.

Percent of nonelderly population
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Public Health Insurance Programs in NY
Pre-Family Health Plus
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New Yorks Medicaid Program

• 2.7 M enrolled 22.5 B per year 50 Federal
  matching rate 25 State 25 Counties
• Single/childless adults covered under New Yorks
  1115 waiver up to 53 of poverty
• Enrollment declining, especially among
  non-elderly adults and individuals receiving cash
  assistance
• 3.12 M in 1995 to 2.74 M in 1999
• Mandatory Medicaid managed care is being phased
  in
• Enrollment process fairly complicated
• Requires face-to-face interview
• Asset test
• 8-page application

13
New Yorks Child Health Plus (CHP) Program

• Provides comprehensive insurance, with nominal or
  no premiums, to children (through age 18) under
  250 poverty level who are not eligible for
  Medicaid
• Relatively simple application and enrollment
  process
• Covers 435,000 children with 10-20,000 new
  children enrolling every month however, many
  disenroll while they are still eligible
• Costs 450 M per year

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Health Care Reform Act 2000
15
HCRA 1996

• Funded many health programs, including Child
  Health Plus, graduate medical education, and
  charity care for health care providers
• Expired December 1999
• NY Assembly passed HCRA reauthorization (HCRA
  2000) in June 1999
• Includes Family Health Plus insurance expansion
  proposal developed by GNYHA and other groups

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Diverse coalition supports Family Health Plus
insurance expansion.

• GNYHA (hospitals) and 1199 National Health and
  Human Service Workers Union launch multi-million
  dollar public education and advocacy campaign
• TV Radio ads
• Direct mail
• 800-line and phone banking
• Free media
• New York State Health Care Campaign (broad
  coalition that includes consumer advocates and
  public health groups)
• Grassroots initiatives

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HCRA 2000Passed December 30, 1999

• 2.6 B per year for health care programs
• Continued funding for graduate medical education
  and hospital charity care
• Three new programs for expanding health coverage
  in New York
• 55 cent per pack tobacco tax increase and tobacco
  settlement funds dedicated entirely to health care

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HCRA Insurance Initiatives

• HCRA 2000 creates 3 new programs that will expand
  health coverage in New York
• Family Health Plus Provides free health
  insurance to low-income, working adults the
  largest of the 3 programs
• Healthy New York (Small Business and Uninsured
  Workers Programs) Allows uninsured small
  businesses and individual workers to buy
  subsidized insurance.
• Direct Pay Fund Creates a stop loss fund to
  soften premium increases in the individual
  market.

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HCRA Insurance Initiatives

• When fully implemented, these initiatives will
  provide 900 million per year (including Federal
  matching funds) to make coverage available to up
  to 1 million New Yorkers.
• States share of funding provided by proceeds
  from the 55 cents per pack tobacco increase.

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What is Family Health Plus?

• Family Health Plus (FHP) is a new entitlement
  program, modeled on Child Health Plus (CHP),
  that offers comprehensive health insurance at no
  cost to low-income, uninsured adults.

21
Who qualifies for Family Health Plus?

• Adults between the ages of 18 and 65 who are not
  eligible for Medicaid and
• Have dependent children and earn up to 150 of
  the poverty level (25,600 for a family of 4) or
  
• Have no dependent children and earn up to 100 of
  poverty (8,400 for an individual) and
• Meet Medicaids definition of a qualified
  immigrant (e.g. most legal immigrants who
  arrived in the U.S. before 1996 or, if arrived
  after 1996, have lived in the U.S. for at least 5
  years).

22
Health Coverage in New York With Family Health
Plus
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What benefits does Family Health Plus cover?

• FHP provides comprehensive coverage (nearly
  identical to CHP) through managed care plans that
  contract with the State.
• Benefits include hospital care, physician
  services, lab tests, x-rays, prescription drugs,
  DME, radiation therapy, ambulance and emergency
  room care, mental health substance abuse care,
  and dental, hearing, and vision services
  (routine, preventive, and emergency).
• Copayments are nominal.

24
New York needs HCFA approval for FHP Federal
matching funds.

• Parents will be covered under 1931(b) provision
• Waiver needed to modify Medicaid benefits and
  include anti-crowd out provision
• Single/childless adults will be covered under New
  Yorks 1115 waiver
• Amendment to 1115 waiver or a separate waiver
  needed to cover this population

25
How many people will Family Health Plus cover?

• When fully implemented, it is estimated FHP will
  be available to up to 600,000 adults.

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How will people apply for Family Health Plus?

• FHP will have a more simple enrollment process
  than Medicaid
• Individuals can sign up through providers and an
  array of community-based organizations, as well
  as district social service agencies.
  Recertification is annual and can be done through
  a mail-in form.
• Unlike Medicaid, FHP has no resource or asset
  test and CBOs and providers can conduct
  enrollment interviews.
• FHP sets aside funds for an extensive outreach,
  marketing and enrollment assistance campaign.

27
Who pays for Family Health Plus?

• When fully implemented, the total cost will be
  split among

28
What is Healthy New York?

• Healthy NY is a new program that will offer small
  businesses and individual workers subsidized
  health insurance with limited benefits.

29
Who qualifies for Healthy New York?

• To participate, businesses must meet the
  following criteria
• No more than 50 employees
• No employer-based insurance for the past 12
  months
• One-third of employees make less than 30,000 per
  year (or sole proprietor with a household income
  less than 35,500 per year) and
• Employer must pay at least 50 of employee
  premiums.
• Individuals not part of a group plan must make
  less than 35,500 per year to qualify.

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What benefits will Healthy New York cover?

• Healthy NY policies will cover most basic health
  care services, but will not cover certain
  mandated benefits and will have much higher
  copayments than current small group policies.
• For example
• Prescription drug coverage capped at 3,000 per
  year
• 500 copayment for inpatient care
• No coverage of
• Inpatient mental health/substance abuse
• Home health care
• Chiropractic care.

31
How are Healthy New Yorkpolicies subsidized?

• The State will reimburse plans for 90 of claims
  paid between 30,000 and 100,000 per member per
  calendar year.

32
Direct Pay Stop Loss Fund

• To temper premium increases in the direct pay
  market, the State will create a stop loss fund
  that will reimburse direct pay policies for
  claims between 20,000 and 100,000 per member
  per year.
• Stop loss payments, which will total 40 million
  per year by 2003, will be split equally between
  HMO and point of service plans.

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HCRA 2000 Health Insurance Initiatives