On February 16, 2011, the U.S. Department of Health and Human Services (HHS) announced that New York was chosen as one of seven "Early Innovator" states. The State received a grant award of $27.4 million over two years to design and implement the information technology (IT) infrastructure needed to operate the Exchange, including eligibility and enrollment systems. As an early innovator, the State will share components it develops with other states to use as they develop their Exchanges.
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.
In 2010, New York received a $1 million award from the U.S. Department of Health and Human Services (HHS) for the first round of funding for the State Planning and Establishment Grants for the Affordable Care Act's Exchanges. The Exchanges will provide a marketplace where individuals, small groups and small businesses can purchase affordable health insurance. This funding the State has received will be used for initial planning activities related to the potential implementation of the Exchanges.
This report provides a health care reform implementation roadmap for New York State,
summarizing the major provisions of the ACA, analyzing their implications unique to the State,
and outlining the key implementation tasks and issues that New York will confront as it begins
In 2010, the NYS Department of Health was awarded $2,300,000 for consumer assistance activities. Funds will be used to facilitate the following goals: •Enhance the capacity of partnering community based organizations (CBO) to strengthen their geographical reach, provide more services and increase helpline capacity •Deepen the CBOs’ presentation skills to educate consumers •Ensure that the CBOs have the capacity to determine the merits of and assist consumers with appeals and grievances •Strengthen technical assistance to CBOs in upstate New York
This report provides a comprehensive profile
of New York’s public and private health
insurance markets. We use the term “market”
to include transactions in which buyers pay
intermediaries to arrange coverage or cover
health care services. Fully insured commercial
health insurance markets are surveyed in
detail. The self-funded market is reviewed as
well, within the limits of available data. State
programs such as Medicaid Managed Care
and Child Health Plus, and federal programs
such as Medicare Advantage and Medicare
Part D, are also profiled.
On July 9, 2012 Governor Cuomo submitted a declaration letter to the Centers for Medicare & Medicaid Services confirming New York's intent to establish a State-based Health Benefit Exchange consistent with the Affordable Care Act. The letter indicates the State's intent to perform advance premium tax credit and cost sharing reduction eligibility determinations and designates Donna Frescatore, who will serve as the Executive Director of the New York Health Benefit Exchange, as the primary point of contact for the State's Exchange Blueprint Application.