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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: 19 Nov, 2021
by Valerie Bogart (New York Legal Assistance Group)

New York State  of Health  Exchange ---  https://nystateofhealth.ny.gov/

MEDICAID -- Individuals eligible for Medicaid or Child Health Plus and American Indians/Alaskan Natives can enroll at any time during the year  on the New York State of Health website.   This is for people under age 65 who do not have Medicare (with some exceptions for Medicare beneficiaries who live with dependent children, grandchildren or certain other family).   They may qualify for "MAGI Medicaid" under the Affordable Care Act.   Contact a Navigator or Community Health Advocates for help. 

  •  People with Medicare  or who are age 65+ must apply for Medicaid at their local Medicaid office using a paper application. During the pandemic, NYC HRA is accepting applications by fax.   See more here (NYC)(outside NYC)

Qualified Health Plans -- Open enrollment began Nov. 16, 2021 and goes through Dec. 31, 2021. See here

  • This is for people whose income is above the Medicaid level, but who may still be eligible for premium and co-insurance subsidies based on their income.  

  • Individuals and families can enroll in coverage  outside of this open enrollment period 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

  • Small Business Owners and Employees interested in the Small Business Marketplace -- enrollment in the small business marketplace is available all year long.  

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.

See links to information on MAGI Medicaid under the Affordable Care Act here and NYS directives here. 

Here are some suggested resources:

  •  New York State of Health   Exchange --  https://nystateofhealth.ny.gov/   
  • Official U.S. website on federal health reform and federal marketplace -- http://www.healthcare.gov/ - for states that do not sponsor their own health Exchange.

    • 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").

    • CMS Guidance - see links here - 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.

  • Advocacy Organizations:

    • Empire Justice Center -- Federal Health Care Reform: The Impact on NYS Programs

    • Kaiser Family Foundation -- http://healthreform.kff.org -- tools including an interactive timeline showing when health reform provisions take effect, all the latest polling data, short videos with Foundation experts answering specific questions about the law on a variety of health policy topics, links to other information resources, the latest headlines on health reform from Kaiser Health News, and FAQs about the new law.

      • Health Reform Hits Main Street, a new animated short video from the Kaiser Family Foundation, features the YouToons explaining the health reform law to an American public still confused by how it works. Have you seen it? The short movie has three major sections: explaining problems in the current health care system, short-term changes that will take place between now and 2014, and major provisions that will take effect in 2014. View it online and share it with colleagues, friends and family: http://healthreform.kff.org/the-animation.aspx .  Narration by Cokie Roberts, ABC News and NPR news commentator and a member of the Foundation's Board of Trustees

    • National Health Law Program - Health Reform webpage- includes a three- part comprehensive analysis of the reform laws, including changes in private insurance, Medicaid, and other areas.

    • Medicare Rights Center -- http://www.medicarerights.org/issues-actions/health-reform-and-medicare.php

    • National Senior Citizens Law Center -    Materials from WEBINAR: Health Care Reform & Low Income Older Adults  -- This webinar presented an overview of how the PPACA will affect older individuals, with a focus on the Medicaid long-term services and supports provisions, the provisions relating to long-term care facilities, and the changes that will have a particular impact on dual eligibles, such as certain changes to Medicare Part D and Medicare Advantage.


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 Income and Resource Limits for New York State Public Health Insurance Programs
item Applying for Medicaid Personal Care Services and CDPAP Outside NYC - 2016 Changes
item NYS Medicaid Application Form (updated 2015) for Age 65+ or Disabled or Blind - New Supp A NYC 2021
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 Applying for Medicaid Personal Care or CDPAP Services in New York City - 2021 Changes
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 NYS Directives on Medicaid changes under the Affordable Care Act
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
folder Medicaid -> Applying For and Keeping Medicaid

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 -...       Medicaid Expansion in Federal Health Care Reform: The Gift of...


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.