Basic Health Plan Program Amendment

Apr 27, 2021

The Department proposes to submit an amendment to the Centers for Medicare and Medicaid Services (CMS) of its Basic Health Program Blueprint.  The amendment updates section 5 to reflect that in April 2021, the state budget establishes a 200 million dollar Essential Plan Quality Pool to promote high quality of care, strengthen provider networks, incentivize providers based on performance, and ensure provider access for all Essential Plan members.

The amendment updates Section 6 to reflect the amendment of NY Social Services Law section 369-gg effective June 1, 2021, which: (i) eliminates the twenty dollar monthly premium for individuals between 150 and 200 percent of Federal Poverty Level; and (ii) eliminates premium and cost sharing for dental and vision services by adding dental and vision services to health care services in the standard basic health insurance plan.

There is no additional estimated annual change to state expenditures as a result of the proposed amendment.  Amounts in the basic health program trust fund shall be used to fund the Quality Pool benefit and the reduced premium and cost-sharing for eligible individuals enrolled in standard basic health insurance plans within the state.

The public is invited to review and comment on the proposed Blueprint Amendment. 

For further information and to review and comment, please contact:


New York State Department of Health

Division of Eligibility and Marketplace Integration

99 Washington Ave – One Commerce Plaza

Suite 1200

Albany, New York 12210


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