The Patient Protection and Affordable Care Act of 2010 (ACA) provides states with the opportunity to develop health benefit exchanges – structured marketplaces for the purchase of health insurance coverage by small employers and individual purchasers. If New York State elects to do so, the law provides an array of design choices to the states in an effort to allow the exchanges to reflect varying preferences across the country.
The Affordable Care Act offers states an important opportunity to help low-income residents by providing significant federal funding to establish a Basic Health Plan (BHP). In this report, CSS explores the implications of offering a BHP in New York.
Despite the ACA’s recognition that effective enrollment and consumer assistance is an essential component of health reform, important design questions about the Navigators and CAPs remain unanswered and must be resolved for New York to move forward: What should be the core functions of Navigators and CAPs in New York? How should New York structure and administer its Navigators and CAPs to maximize integration and avoid duplication of efforts? How should New York leverage existing enrollment and consumer assistance resources into the Navigators and CAPs?
The Affordable Care Act (ACA) is a game changer both in terms of the culture of enrollment in
public and subsidized health insurance and in terms of the infrastructure needed to support the
enrollment process. Information Technology (IT) readiness will play a critical role in establishing
a streamlined and integrated “no wrong door” process for accessing both public and private
benefits under ACA.
NYSHealth, in partnership with New York State stakeholders, initiated a project to help New
York State hone the New York vision for implementing health care reform in the most prudent
On March 23, 2010, President Obama signed into law the Affordable Care Act (ACA), sweeping federal legislation designed to bring about near universal coverage and transform how health care is paid for and delivered throughout the United States.
American Health Benefit Exchanges are the
centerpiece of health insurance reforms in
the Affordable Care Act (ACA). Under tight
timeframes, all states are required to establish
these entities, or cede that authority to the
federal Department of Health and Human
Services (HHS). Modeled on Massachusetts’s
Connector, the Exchange will straddle public
and private health insurance markets, and is
charged with a broad range of duties. Some
obligations — determining eligibility for tax
subsidies to make coverage more affordable,
facilitating enrollment in public coverage, and
Medicaid provides health insurance coverage for 4.8 million New Yorkers, more than 25 percent of
people residing in the state.1 With the implementation of federal reform in 2014, perhaps as many as
1 million additional New Yorkers will secure coverage through Medicaid. By any measure, Medicaid is
an important building block of health insurance coverage in New York State.
Now, with the Affordable Care Act of 2010 (ACA), a new vision for health insurance coverage in the
United States is being advanced, bolstered by significant funding to implement that vision. National
The Affordable Care Act (ACA) envisions access
to affordable care for all Americans, a
streamlined eligibility and enrollment process to
obtain coverage, and seamless integration between
Medicaid and the Exchange to ensure
smooth transitions between sources of coverage
as a person’s circumstances change over time.
This paper explores the issues associated
with these coordination challenges and identifies
options for New York as it considers how to best
approach the integration of coverage options
along the continuum from fully subsidized public
This report, the third in a series of exchange-related works undertaken this year with the support of the New York State Health Foundation, focuses on two such areas of state discretion involving “mergers”: merging the individual and small business exchanges, and merging the individual and small group markets.