Contents
- Overview
- Key Components of the Waiver
- Guidance on the Expansion
- Reports
- Timeline of the Waiver Application Process
- Public Hearings and Tribal Consultation
Overview
On March 1, 2024, the U.S. Department of Health and Human Services (HHS) and U.S. Department of Treasury approved New York's Section 1332 State Innovation Waiver application to expand the Essential Plan. 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.
Key Components of the Waiver
This approved State Innovation waiver expands health insurance and covers health-related social needs, improving health care and advancing health equity. The waiver includes the following key components:
Extending Affordable Health Insurance to Over 100,000 New Yorkers – The Essential Plan will be expanded to New Yorkers with incomes between 200 and 250 percent of the FPL, making the high quality, affordable program available to over 100,000 additional New Yorkers.
Social Determinants of Health Grants – Complementing New York’s recently approved Medicaid Demonstration waiver, this approved Essential Plan State Innovation waiver seeks to address social determinants of health through grants in the following focus areas:
Food insecurity, including medically tailored meals, food pharmacies, and personalized coaching
Preparing for climate change by providing enrollees with persistent asthma with an air conditioner to protect their health, reduce the number of Emergency Department visits, and help communities prepare for extreme weather
Knowledge sharing, including provider training on mental health services and social determinants of health
Behavioral Health Grants – This waiver seeks to improve behavioral health for Essential Plan enrollees through grants to insurers support improved access to behavioral health services, including mobile crisis units, crisis diversion centers, and crisis respite centers
Promoting Individual Market Premium Stability – Federal funding from this waiver will also support an Insurer Reimbursement Implementation Plan established to mitigate premium increases for individual market enrollees from the impact of the population with estimated household income 200-250% of FPL moving to the Essential Plan. In addition to maintaining stable premiums in the individual market, this waiver will also support stability with respect to plan participation for the individual market.
Guidance on the Expansion
- Frequently Asked Questions: Start Dates for Essential Plan Coverage
- Guidance for Health Plans
- Training Webinar for Enrollment Assistors
- Essential Plan Eligibility & Enrollment Standards
Reports
On 3/31/25, New York submitted its 1332 Annual Report for Plan Year 2024. Materials submitted include:
- Annual Reporting Template
- Second Lowest Cost Silver Plan Attachment
- Annual Report Excel Template
- Waiver Alignment Application
- June 2024 Public Forum Presentation
- 2024 Plan Invitation Attachment G – Essential Plan Benefits and Cost-Sharing Grid
Timeline of the Waiver Application Process
12/11/24 Update: New York updated its request to set the term of NY’s approved Section 1332 waiver in alignment with the approved amendment. The request is available for review here.
12/9/24 Update: New York submitted its request to set the term of NY’s approved Section 1332 waiver in alignment with the approved amendment. The request is available for review here.
11/27/24 Update: The New York State Department of Health is requesting comments on a request to set the term of the approved Section 1332 State Innovation Waiver to be in effect for a full five-year term from the implementation date of January 1, 2025, through December 31, 2029. The State will receive comments during a 10-day public comment period from Wednesday, November 27, 2024, to Friday, December 6, 2024, for consideration before submitting an amendment application to the U.S. Department of Health & Human Services and the U.S. Department of Treasury. The State will hold three public hearings on the draft amendment on December 2 at 1p, December 3 at 2.30p, and December 4 at 11:30a. More information on the Section 1332 Waiver Essential Plan Expansion Draft Request can be found here.
6/28/24 Update: New York submitted a 1332 Waiver Amendment Application. The amendment is available for review here.
5/28/24 Update: New York released a draft amendment for its approved 1332 Waiver. The State will receive comments during a 30-day public comment period from May 28, 2024 - June 27, 2024 for consideration prior to submitting an amendment application to the U.S. Department of Health & Human Services and U.S. Department of Treasury. The State will hold a combined annual 1332 Waiver public forum and public hearing on the draft amendment on June 12, 2024 at 2:00PM and June 14, 2024 at 9:00AM. The draft amendment is available for review here.
Overview of Draft 1332 Waiver Amendment
The State Fiscal Year 2025 Enacted Budget granted the Commissioner of Health authority to provide premium or cost sharing subsidies to improve affordability for consumers in the Qualified Health Plan (QHP) market. New York submitted a Letter of Intent to the Departments of Health & Human Services and Treasury on April 26, 2024 to use passthrough funding on cost sharing subsidies. The State received a Response Letter on May 24, 2024.
New York is submitting an amendment to its approved 1332 Waiver for approval to use federal passthrough funding to further increase affordability and reduce the cost sharing burden for New Yorkers enrolled in QHPs beginning January 1, 2025. The amendment does not seek to waive additional provisions of the Affordable Care Act nor does it change the approved waiver programs. The draft amendment remains in compliance with statutory guardrails.
New York intends to use passthrough funding to implement three cost sharing reduction (CSR) subsidies for consumers 1) with incomes up to 400% of the FPL, 2) consumers receiving diabetes services, and 3) consumers receiving pregnancy and postpartum care services beginning in 2025. An average of 117,687 consumers are estimated to benefit from the CSRs annually, resulting in a total of $1.3 billion of consumer savings over four years under the waiver.
Public Hearings
New York will hold two virtual public hearings to provide updates on the implementation of the approved 1332 Waiver and solicit comments on the draft amendment. American Sign Language (ASL) interpreters will be available virtually. The State will provide other accommodations and language interpretation services to members of the public who request these services by emailing NYSOH.Team@health.ny.gov by 4PM Eastern on Friday, June 7, 2024. The presentation for the public hearings is available here.
Public Hearing 1: Wednesday, June 12, 2024 at 2:00PM Eastern Time (ET)
- Pre-registration by 4PM ET on Tuesday, June 11, 2024 is required for anyone who wants to provide a comment.
- Please register here.
- Please provide “SPK” in front of your first name when registering if you want to provide comments.
- You will receive a calendar invite to log in.
Public Hearing 2: Friday, June 14, 2023 at 9:00AM Eastern Time (ET)
- Pre-registration by 4PM ET on Wednesday, June 12, 2024 is required for anyone who wants to provide a comment.
- Please register here.
- Please provide “SPK” in front of your first name when registering if you want to provide comments.
- You will receive a calendar invite to log in.
Written Comments
Members of the public may also submit written comments on New York’s draft 1332 Waiver Amendment. The State will consider all comments received.
- Comments may be emailed to nysoh@health.ny.gov through June 27, 2024.
- Mailed comments must be postmarked by June 27, 2024 and sent to:
NY State of Health
Attn: 1332 Waiver
Empire State Plaza
Corning Tower , Room 2580
Albany, NY 12237
5/7/24 Update: Announcement of 1332 Waiver Annual Public Forum & Public Hearing on June 12 & June 14
NY State of Health intends to hold two virtual public forums on Wednesday, June 12, 2024 at 2:00 PM Eastern and Friday, June 14, 2024 at 9:00 AM Eastern. The purpose of the forums is to provide an update on the progress of the waiver and to receive comments on a proposed waiver amendment. Both sessions with be held virtually through WebEx. Additional information on the proposed amendment and how to register to attend and provide comment will be posted here.
12/18/23 Update: New York has submitted updates to its 1332 Waiver Application to the Department of Health and Human Services (HHS) and Department of Treasury for the expansion of its Essential Plan. The application has been revised to reflect comments received and now includes Deferred Action for Childhood Arrivals (DACA) recipients as part of the proposed Essential Plan expansion. The updated materials are available for review here.
11/14/23 Update: New York has submitted updates to its 1332 Waiver Application to the Department of Health and Human Services (HHS) and Department of Treasury for the expansion of its Essential Plan. The updated materials are available for review here. New York will be holding two public hearings on the proposed changes on Friday, November 17, 2023 at 10:00AM Eastern Time (ET) and Tuesday, November 28, 2023 at 10:00AM ET.
Federal Comment Period
The federal government will also be accepting written comments on New York’s proposed changes through December 2, 2023. To submit a written comment, email stateinnovationwaivers@cms.hhs.gov. Visit https://www.cms.gov/marketplace/states/section-1332-state-innovation-waivers for details.
6/6/23 Update: The Centers for Medicare & Medicaid Services (CMS) under the Department of Health and Human Services (HHS), and the Department of the Treasury, have determined New York's application complete and opened the Federal public comment period for New York’s Section 1332 waiver application. The waiver completeness letter is available below. The Federal Public Comment Period will be open until July 5, 2023. To submit a public comment, please email stateinnovationwaivers@cms.hhs.gov. The CMS notice is available for review here.
5/12/23 Update: New York submitted its final Section 1332 State Innovation Waiver application to expand the Essential Plan to New Yorkers with incomes up to 250% of the Federal Poverty Level to the U.S. Departments of Health and Human Services and Treasury. Through this expansion of Essential Plan coverage, the State seeks to increase access to high quality, affordable health insurance for low- and moderate-income individuals.
The final application materials are available for review here.
The public comments and materials related to the public comment period are available for review as follows:
2/10/23 Update: The NYS Department of Health issued a press release on its intention to submit a proposal for the expansion of the Essential Plan. Read it here.
Public Hearings and Tribal Consultation
To view the files for each session, click the session date.
- December 4, 2024
- June 14, 2024
- June 12, 2024
- November 28, 2023
- November 17, 2023
- February 28, 2023 Tribal Consultation
- February 23, 2023
- February 22, 2023