Expanded Eligibility Under Federal State Innovation Waiver Ensures More New Yorkers Are Now Covered Under State’s Essential Plan
New Enrollees in Essential Plan Will Save Over $6,100 Per Year
New York Receives Nation’s Largest State Innovation Waiver Award to Date
Funding Received Through Affordable Care Act
Governor Kathy Hochul announced today that New York State received a final commitment of $10 billion from the federal government to provide high-quality, affordable health insurance to approximately 1.5 million New Yorkers. Following sustained advocacy by the Governor, New York secured this funding through the federal State Innovation Waiver. The $10 billion commitment received today marks the nation’s largest State Innovation Waiver award to date.
“By securing this nation-leading investment, we’re expanding affordable health insurance for New Yorkers and continuing to address the cost of living in communities statewide,” Governor Hochul said. “I’ll never stop fighting to ensure New Yorkers get the affordable, quality care they need.”
This funding commitment follows through on the Governor’s previous announcement that New York expanded eligibility levels for the Essential Plan, a public health insurance program offered through the NY State of Health. The expanded eligibility ensured that more than 200,000 additional New Yorkers are newly covered under the Essential Plan this year, making a total of approximately 1.5 million covered statewide.
New enrollees in the Essential Plan are estimated to save over $6,100 each year compared to what they would have paid for commercial coverage.
Statewide enrollment includes:
Region | Number of Essential Plan Enrollees |
| NYC Metro | 919,107 |
| Long Island | 198,602 |
| Northern Metro | 76,107 |
| Mid-Hudson | 46,156 |
| Northeast | 45,878 |
| Utica-Adirondack | 34,778 |
| Central | 43,273 |
| Finger Lakes | 43,041 |
| Western | 90,907 |
Grand Total | 1,497,849 |
Senate Majority Leader Charles Schumer said, “I have fought for years to make health care more affordable for New York families and am proud to have secured an additional $1 billion to lower premiums and health care costs for New Yorkers in the Inflation Reduction Act. This is real money back in New Yorkers’ pockets and peace of mind that health care will be affordable when you need it.”
Senator Kirsten Gillibrand said, “This $10 billion commitment will help ensure that more New York families have access to the health care they deserve without breaking the bank, and I am proud to have voted for the Inflation Reduction Act to help make this possible. I am committed to expanding health care and making it more affordable for all New York families and will keep fighting at the federal level so all New Yorkers have access to good-quality, affordable health care when they need it.”
House Democratic Leader Hakeem Jeffries said, “No one should have to choose between putting food on the table and paying for life-saving medical treatment. This $10 billion federal investment is a game-changer in easing the burden of high healthcare costs for over 1 million New Yorkers and their families. I am grateful to the Biden-Harris administration for their work in securing this funding and for their partnership in bringing the Inflation Reduction Act to life to lower costs and strengthen the Affordable Care Act to protect healthcare coverage for millions of Americans.”
Representative Paul Tonko said, “I’m thrilled to celebrate this significant infusion of funding that will help more than a million New Yorkers save thousands per year on health care costs. Thanks to the Affordable Care Act, we’re taking critical steps to ensure that all New Yorkers have access to the affordable, high-quality care they deserve. By expanding coverage under the Essential Plan, we’re moving closer to a future where health care is a right, not a privilege. I’m proud of our ongoing commitment to providing every resident with the support they need to lead healthy, productive lives.”
State Health Commissioner Dr. James McDonald said, “Everyone deserves affordable and quality health insurance regardless of their health status. This investment will allow New Yorkers to maintain and improve their health without a financial burden. In the spirit of the Affordable Care Act, New York will continue to leverage 1332 waiver funding to pursue innovative strategies that deliver quality, affordable health insurance to our residents.”
NY State of Health Executive Director Danielle Holahan said, “Thanks to the Affordable Care Act’s Section 1332 State Innovation Waiver authority, NY State of Health can provide 1.5 million New Yorkers health insurance with $0 premiums, saving individuals and families over $6,100 of their hard-earned money each year. We will continue to work with our federal partners to pursue innovative ways to keep New Yorkers healthy without hurting their pocketbooks.”
The $10 billion in federal funding for 2024 includes approximately $1 billion made possible because of the federal Inflation Reduction Act (IRA). The IRA extended the availability of enhanced premium tax credit subsidies, which are set to expire in 2025 if Congress does not act. IRA-enhanced premium subsidies have been a critical funding source, enabling New York to expand affordable coverage and achieve record enrollment.
On April 1, 2024, New York expanded eligibility levels for the Essential Plan, a public health insurance program offered through the NY State of Health. The Essential Plan is now available to New Yorkers with incomes up to 250 percent of the Federal Poverty Level, $37,650 annual income for an individual in 2024. This expansion resulted from New York’s Section 1332 State Innovation Waiver application, approved by the U.S. Department of Health and Human Services and the U.S. Department of Treasury on March 1, 2024. Thanks to the waiver, approximately 1.5 million New Yorkers across the State are getting health plan coverage with $0 premiums and low or no cost-sharing. New York has received interim payments in April and August that allowed an on-time launch of the program’s expansion in April 2024.
Greater New York Hospital Association President Kenneth E. Raske said, “We applaud the New York State Department of Health for further expanding Essential Plan eligibility. This important development will enable even more New Yorkers to access affordable, comprehensive health coverage. The hospital community has strongly supported New York’s Essential Plan since its inception because it provides comprehensive coverage for low-income New Yorkers not eligible for Medicaid.”
Community Service Society of New York VP for Health Initiatives Elisabeth R. Benjamin said, “The Essential Plan has been a godsend for New Yorkers who struggle to find affordable quality health coverage. This federal funding will go a long way to improving the design of the program so that New Yorkers can achieve healthier lives while reducing their exposure to medical debt.”
New York Health Plan Association President and CEO Eric Linzer said, “This funding is critical in our collective efforts to make affordable coverage available to more New Yorkers through the Essential Plan. The commitment from the federal government builds upon the successful partnership between health plans and the State that has made New York a leader in expanding coverage while providing resources to eliminate health disparities, and we look forward to working with the Hochul Administration in making the waiver’s promise a reality.”
Community Health Care Association of New York State (CHCANYS) President and CEO Rose Duhan said, "CHCANYS applauds the NY State of Health and the federal government for this groundbreaking expansion of coverage. Comprehensive affordable coverage for New Yorkers improves access to high quality primary care provided at community health centers and increases health centers capacity to meet their mission of providing care to everyone. CHCANYS serves as a Navigator for the NYSOH marketplace to advance our shared goal of ensuring all New Yorkers get the health care they need."
The Leukemia & Lymphoma Society Senior Director of State Public Policy Steve Butterfield said, “The Leukemia & Lymphoma Society is excited to see New York embracing a truly innovative, first-of-its-kind program. Blood cancer patients, their families, and other consumers in New York benefit when they can rely on stable and affordable coverage, which this program will provide. We hope to see other states learn from this waiver and pursue similar models where they can.”
American Cancer Society Cancer Action Network (ACS CAN) Senior Government Relations Director Michael Davoli said, “We can never and will never go back to the day when cancer patients couldn’t get health insurance coverage because they couldn’t afford it or are denied coverage just because they survived cancer. The additional money that New York received due to the Section 1332 State Innovation waiver will help ensure that millions of New Yorkers battling cancer can access the care they need.”
Section 1332 State Innovation Waivers allows states to pursue innovative strategies for providing residents access to high-quality, affordable health insurance. New York’s waiver was approved for five years, from 2024 through 2028. Funding amounts for 2025 through 2028 will be determined on a year-by-year basis.
Complementing New York’s recently approved 1115 Medicaid Demonstration waiver, this 1332 waiver New York also seeks to address social determinants of health for Essential Plan enrollees. Waiver funding will support grants that address food insecurity, including through food pharmacies and medically tailored meals, and will support enrollees with persistent asthma by providing them with air conditioners to protect their health and reduce the number of Emergency Department visits. This waiver will also support grants to insurers to increase access to behavioral health providers and services, including mobile crisis units, crisis diversion centers and crisis respite centers.
New York’s high coverage levels are also a result of the State’s fully integrated marketplace model, across public and private health insurance products, which allows the State to maintain higher coverage levels because individuals can seamlessly change programs when their incomes or family circumstances change.
Information about Section 1332 State Innovation Waivers, including a fact sheet on New York’s waiver, can be found on CMS’ website here.
Information about New York’s Section 1332 waiver can be found here.
Information about Essential Plan Benefits and Cost Sharing Grid can be found here.
About the NY State of Health
New York opened its Health Plan Marketplace, NY State of Health, in October 2013. The Marketplace’s one-stop health insurance shopping experience offers high-quality comprehensive health plans. NY State of Health, a division of the New York State Department of Health, is the only place where consumers can qualify for help paying for coverage through premium discounts or tax credits. Eligible New Yorkers can also enroll in Medicaid, Child Health Plus and the Essential Plan through the Marketplace all year. For more information about the NY State of Health Marketplace, please visit: https://nystateofhealth.ny.gov/ or call Customer Service at 1-855-355-5777, TTY: 1-800-662-1220 or find an enrollment assistant.