NYAPRS Note: Leading Consumer advocacy groups Health Care for All NY and Medicaid Matters NY have been working to ensure a basic health plan for New Yorkers with low incomes. The budget proposal, coupled with a plan to ensure coverage for out-of-network care, requires the attention of legislators but also a concerted commitment from the executive branch. A basic health plan would include insurance provisions for persons with behavioral health treatment needs across NYS who fall into the “Medicaid gap” and are currently ineligible for Medicaid but cannot afford insurance. HCFANYS and MMNY will continue to advocate for these issues on 3/3 and 3/5, respectively, when they take to the Capitol for Legislative action days.
Plans to Expand Insurance Coverage
Crain’s Health Pulse; 2/20/2014
In its lobbying push next week, advocacy group Health Care for All New York will push for better insurance coverage for out-of-network care and the creation of a basic health plan, two proposals that are included in the executive budget. Insurers’ networks would have to meet certain adequacy standards, and patients would not be held responsible for bills for out-of-network care they did not know about, said Heidi Siegfried, director of New Yorkers for Accessible Health Coverage. Instead, insurers and providers would negotiate the payment between themselves. A spokeswoman for HANYS said the group supports expanding out-of-network coverage “so long as reimbursement is fair and adequate and the arbitration mechanism is properly designed and effective.” A basic health plan would give low-cost coverage for low-income New Yorkers who earn too much for Medicaid, said Amanda Peden, a health policy associate at the Community Service Society. Many potential enrollees are already in Medicaid. The basic health plan alternative would save the state money because is 95% federally funded, Ms. Peden said. The advocacy groups have concerns about the budget language in the basic health plan alternative that specifies support only, “if it is the financial interest for the state to do so.” she said. That wording leaves room for the governor to change his mind, she added.