Proposed Essential Plan Expansion Will Increase Access to High Quality, Affordable Health Insurance for Low to Middle Income Earners
Department Encourages Public Feedback During 30-Day Public Comment Period
ALBANY, N.Y. (February 10, 2023) – The New York State Department of Health today announced its intention to submit a proposal to the Centers for Medicare & Medicaid Services (CMS) for expansion of the Essential Plan, a health insurance option offered through NY State of Health that covers comprehensive benefits with no monthly premium, no deductible and minimal cost sharing, for those who qualify. The State’s proposal, a Section 1332 State Innovation Waiver, must first undergo a 30-day public comment period, which will be open for community input from February 9 through March 11.
“The 1332 Waiver will give more New Yorkers and their families greater access to affordable health insurance than in previous years,” Acting State Health Commissioner James McDonald said. “This Waiver will enable NY State of Health to advance health equity by providing a much more affordable coverage option to uninsured, lower- and moderate-income New Yorkers.”
The Section 1332 State Innovation Waiver seeks to widen Essential Plan eligibility to include consumers with incomes up to 250 percent of the Federal Poverty Level (FPL). Presently, eligibility is limited to those above the Medicaid ceiling but up to only 200 percent of the FPL.
“This 1332 Waiver would allow us to extend significantly more affordable coverage to additional low-income New Yorkers and reach uninsured individuals and families who may otherwise fall through the cracks,” NY State of Health Executive Director Danielle Holahan said. “By expanding the Essential Plan, the Marketplace can improve health equity and increase access to health coverage for all New Yorkers.”
If approved, the 1332 Waiver will expand upon the existing Essential Plan by providing newly eligible consumers (with incomes between 200 percent and 250 percent of the FPL), health insurance with no deductible and low out-of-pocket costs, for a $15 monthly premium, which is significantly more affordable than what is available to them today. Current Essential Plan enrollees (with incomes up to 200 percent of FPL) will continue to have no premiums, no deductibles, and current maximum out-of-pocket contribution levels.
New York’s 1332 Waiver is expected to generate substantial savings for the State and federal governments, while expanding access to health insurance to more New Yorkers than ever before.
A draft of the full public notice is available for review on the Department of Health’s website.
For individuals with limited online access and/or who require special accommodation, please call (518) 486-9102 to access paper copies.
In compliance with federal transparency requirements, in preparation for formally submitting the Waiver, the State is requesting comments from the public from February 9 - March 11, 2023. Individuals wishing to provide written comments may submit them online here or by mail at:
NY State of Health
Empire State Plaza
Albany, NY 12237
In addition to accepting written comments, the State will be hosting two virtual public hearings during which members of the public may provide verbal comments:
Public Hearing Option 1
Wednesday, February 22, 2023, 1:00 PM
Pre-registration by February 20, 2023 is required for anyone providing verbal comment at the following link: https://meetny.webex.com/weblink/register/r9b97d4c0bdb3d30931faaa9c44e913e
Public Hearing Option 2
Thursday, February 23, 2023, 12:00 PM
Pre-registration by February 21, 2023 is required for anyone providing verbal comment at the following link: https://meetny.webex.com/weblink/register/r3769e6dcad0c4d2f9f27fbeee83e2fe7
For both hearings, individuals providing a comment will need to register with an "SP" in front of their name (ex: SP Jane Doe). Individuals will speak in the order of registration. All verbal comments will be limited to five minutes.
The State will consider all written and verbal comments received and include a summary of the comments in the final 1332 Waiver Application submitted to the Departments.
Contact: New York State Department of Health
518-474-2043 x. 2