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Affordable Care Act --New York State Health Exchange Open Year-Round for Medicaid Applications and for Certain "Special Enrollment" categories

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Posted: 12 Jul, 2010
by Valerie Bogart (New York Legal Assistance Group)
Updated: 21 Mar, 2016
by Amanda Gallipeau (Empire Justice Center)

New York State  Official Website on Exchange --- http://healthbenefitexchange.ny.gov/.

Open enrollment on the New York State Health Exchange ended on 3/31/14, with an extension through April 15th to complete applications that were filed before that date.   However, it is not too late to enroll for certain people and certain coverage:

  • Individuals and families can enroll in coverage if they qualify for a "special enrollment period" ("SEP"). Click here to learn more. And see more info about the Special Enrollment Periods - FAQs, webinars, directives that allow some people to enroll in a Qualfied Health Plan and in premium and co-insurance subsidies any time during the year -- here  http://info.nystateofhealth.ny.gov/news/special-enrollment-periods-webinar-training-assistors
  • MEDICAID -- Individuals eligible for Medicaid or Child Health Plus and American Indians/Alaskan Natives can enroll at any time during the year.  People who do not have Medicare may apply online on the Exchange, and may contact a Navigator for help.  People with Medicare must apply for Medicaid at their local Medicaid office. 
  • Small Business Owners and Employees interested in the Small Business Marketplace -- enrollment in the small business marketplace is available all year long.  

As of April 15, 2014, 1,319,239 New Yorkers have completed their applications and 960,762 have enrolled for coverage since the launch of the Marketplace on October 1, 2013. More than 70 percent of those who have enrolled to date were uninsured at the time of application. The Marketplace is well on its way to meeting or exceeding its enrollment goal of 1.1 million people by the end of 2016.

Background on the Affordable Care Act and the New York State Exchange.  New York is is one of a small group of states to establish its own health insurance Exchange.  Health reform consists of two laws. The first and larger of the two is the Patient Protection and Affordable Care Act (PPACA) signed on March 23, 2010, and the second is the Health Care & Education Reconciliation Act, signed on March 30, 2010. Federal health reform contains many provisions which affect both public health insurance programs, such as Medicaid and Medicare, and private health insurance including the health insurance many people either get through their employer or purchase directly. The provisions of the health reform laws go into effect on a staggered basis, with some provisions going into effect immediately, but most going into effect in 2014.

CMS published proposed regulations to implement all aspects of health reform, including the enrollment processes, appeals of denials of the various subsidies, etc.  In February 2013, numerous organizations in NYS and nationally submitted comments on the regulations  in February 2013 including the Empire Justice Center,  the National Health Law Program, and Selfhelp Community Services.

Many organizations have produced extensive materials explaining and interpreting these laws and how they will be implemented.  

In July 2013, DOH released the listing of organizations who will serve as In-Person Assistors/Navigators.  These organizations will provide in-person enrollment assistance to individuals, families, small businesses and their employees who apply for health insurance through the Exchange.

Here are some suggested resources:

  • New York State  Official Website on Exchange -- http://healthbenefitexchange.ny.gov/.   This is successor to earlier health reform website launched in July 2010 --  http://www.healthcarereform.ny.gov -
  • Official U.S. website on federal health reform -- http://www.healthcare.gov/

    • On June 24, 2013 HHS relaunched https://www.healthcare.gov/ with an emphasis on providing information related to eligibility and open enrollment.    This site will help individuals get ready for October 1 and link them to available coverage now.  For individuals in New York and other states with state-based marketplaces (SBMs), the site provides a link to the SBM’s website. For states using the federally facilitated marketplace (FFM), healthcare.gov will be the on-line portal.

      By October, healthcare.gov will allow consumers to create accounts, complete an online application, and shop for qualified health plans.  Between now and the start of open enrollment, the Marketplace call center will provide educational information and, beginning Oct. 1, 2013, will assist consumers with application completion and plan selection.

      For Spanish speaking consumers, CuidadoDeSalud.gov will be updated to match healthcare.gov’s consumer focus.  “Resources in Other Languages” at the bottom of healthcare.gov links to 12 “taglines” that provides the phone number for the federal call center so limited English proficient consumers can receive information directly in their non-English languages. More languages should be added soon and the call center can provide interpreting services in over 150 languages.

    • The federal health reform laws  mandated that the U.S. government launch this site  -- which it did on July 1, 2010.  It includes all public and private options in all states -- users will be able to enter certain demographic and other information to identify their own local options.   It will include price estimates for all insurance plans and the relative amounts each insurance company spends on medical care vs. administrative costs (called the "medical loss ratio").

    • This Fact Sheet on Immediate Benefits for New York from Health Reform was posted in 8/10, with statistics on numbers of New Yorkers affected by different provisions, such as the fact that 246,000 New Yorkers hit the doughnut hole in 2009.

    • CMS Guidance.  released the first in a series of letters providing guidance regarding the Medicaid changes and improvements that are included in the health reform laws.  The April 9, 2010 letter is available at this link:  New Option for Coverage of Individuals under Medicaid

      The letter provides initial guidance on section 2001 of the Affordable Care Act, Medicaid Coverage for the Lowest Income Populations, which establishes a new Medicaid eligibility group and the option for states to begin providing medical assistance to individuals eligible under this new group as of April 1, 2010.  For the first time since the Medicaid program was established, States will be able to receive Federal Medicaid funding to provide coverage under their State Medicaid plan for adults with income up to 133% of the federal poverty level, without regard to disability, parental status or most other categorical limitations.  Single adults and childless couples with incomes up to 100% of the federal poverty level are already eligible for public health insurance coverage in New York State under the federal waiver program, Family Health Plus.  New York faces a series of important implementation decisions going forward in order to maximize eligibility and federal contributions to the costs of coverage.

      According the to CMS guidance, states may elect to phase-in coverage for this new eligibility group at any time, but for an effective date of April 1, 2010, states had to submit amendments to their state plans by June 30, 2010.  States will not begin to receive an enhanced match for the expansion population until January 2014.  The enhanced match established in the American Recovery and Reinvestment Act (ARRA) does not apply to these individuals.

  • Earlier info posted on New York State website on federal health reform  -- http://www.healthcarereform.ny.gov - site created July 2010.  Includes:

  • See info about suspension of enrollment effective 2013 in the NY Bridge Plan which had began accepting applications on August 20, 2010, with coverage available beginning October 1, 2010.  This "Pre-Exisiting Condition Insurance Plan" (PCIP) was part of implementation of  the Patient Protection and Affordable Care Act. New York State has designated GHI to administer PCIP in New York.  This is the insurance pool for uninsured high risk individuals, who are people with pre-existing medical conditions that are expensive to treat.

    See more info here.

  • Advocacy Organizations:

This site provides general information only. This is not legal advice. You can only obtain legal advice from a lawyer. In addition, your use of this site does not create an attorney-client relationship.  To contact a lawyer, visit http://lawhelp.org/ny. We make every effort to keep these materials and links up-to-date and in accordance with New York City, New York state and federal law. However, we do not guarantee the accuracy of this information.  To report a dead link or other website-related problem, please e-mail us.

Also read
item NYS Bridge Plan coverage ends on June 30, 2013
item Medicaid Expansion in Federal Health Care Reform: The Gift of the MAGI
item Health Plan Appeal Rights in New York After the Affordable Care Act
item New York Medicaid Expansion under the ACA ... and other 2013 budget changes
item Empire Justice Center Reports on Immigrant Access to Health Care in NY's Health Insurance Exchange
item "MAGI" Medicaid Eligibility under the Affordable Care Act - Rules for Most People Under age 65 Without Medicare

Also listed in
folder Medicaid
folder Uninsured

External links
http://www.wnylc.com/health/client/images/icons/article_out.svg https://nystateofhealth.ny.gov/individual

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"MAGI" Medicaid Eligibility under the Affordable Care Act -...       NYS Bridge Plan coverage ends on June 30, 2013

This site provides general information only. This is not legal advice. You can only obtain legal advice from a lawyer. In addition, your use of this site does not create an attorney-client relationship. To contact a lawyer, visit http://lawhelpny.org. We make every effort to keep these materials and links up-to-date and in accordance with New York City, New York state and federal law. However, we do not guarantee the accuracy of this information. To report a dead link or other website-related problem, please e-mail us.