NY State of Health 1332 Waiver Information Page

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.

• Read Governor Hochul's press release on this approval

• Read the HHS fact sheet on this approval

• Learn more about the Essential Plan

• Use the Essential Plan Expansion Communications Tool Kit to promote this change

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

• Guidance for Health Plans
• Training Webinar for Enrollment Assistors

Timeline of the Waiver Application Process

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:

• Read comments from organizations
• Read comments from individuals

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

The presentations for these sessions and other information regarding the public notice are included in the attachments section below.

November 28, 2023

• Video
• Transcript

November 17, 2023

• Video
• Transcript

February 23, 2023 

• Video
• Transcript

February 22, 2023 

• Video
• Transcript

Tribal Consultation 

• Video
• Transcript