Medicaid, SCHIP, and Federal Authority²

Section 1115 Waiver - In 1997, New York 's section 1115 Medicaid demonstration, the Partnership Plan, was approved. The demonstration moved approximately 2 million Medicaid beneficiaries from a primarily fee-for-service delivery system to a mandatory managed care environment.

In 2001, the Family Health Plus (FHPlus) amendment was approved. FHPlus expanded health insurance to childless adults to 100 percent FPL, and expanded coverage to parents to 150 percent FPL. Prior to 2001, these populations were covered in the state's Safety Net program. FHPlus is delivered via managed care organizations and has a less comprehensive benefit package versus traditional Medicaid.

In 2002, the waiver was amended to include a family planning demonstration which expands family planning services to individuals with net incomes at or below 200 percent FPL.

Reinsurance

The Healthy New York Program is a state-subsidized reinsurance mechanism that reimburses health plans for 90 percent of claims paid between $5,000 and $75,000 on behalf of a member in a calendar year. All Health Maintenance Organizations (HMOs) are required to write Healthy NY. Since its inception in 2001, Healthy NY has enrolled more than 300,000 workers and their families. As of December 1, 2006, the program had approximately 131,000 enrollees. Approximately 55 percent of enrollees are working individuals, 17 percent are sole proprietors, and 28 percent are enrolled through small-groups.

Qualifying small employers, sole proprietors, and individuals are eligible for the program provided they have not been insured in the past 12 months or lost their insurance due to a qualifying event. Small employers may buy into the program if they have less than 50 employees, 30 percent of whom earn less than $35,500 annually (adjusted annually for inflation). Employers must contribute at least half of the premium, and at least 50 percent of employees must participate in the program or have coverage through other sources.

Starting January 2007, Healthy NY will also offer a high deductible health plan option that is designed to be compatible with health savings accounts.

To learn more about the Healthy New York program, read SCI's Profile in Coverage.

Group Purchasing Arrangements

HealthPass allows small businesses (2-50 employees), with an active address in the New York City area, to provide a choice of over 25 health insurance options offered by 6 carriers to their employees. The employer determines their level of contribution and 75 percent of eligible employees must join HealthPass.

LIA Health Alliance is health purchasing cooperative that allows small businesses (2-50 employees) and sole proprietors, located in the greater New York City area, to offer employees to select health insurance from 5 carriers.

For a list of available health insurance options, please visit the Mayor's Office of Health Insurance Access (MOHIA).

	Notes and Sources

Information presented in the profile was summarized in December 2006 from a review of state Web sites and reports, and through contacts with state officials. In most cases the profiles were reviewed by state officials; however, it is possible that states have implemented strategies that are not reflected in this profile.

² The profile only includes Medicaid and SCHIP waivers intended to make comprehensive expansions to the uninsured. At this time, the profiles do not include Family Planning, Pharmacy Plus waivers, or long-term care waivers.

³ Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2005 and 2006 Current Population Survey.