BILL NUMBER: S2237B
SPONSOR: RIVERA
 
TITLE OF BILL:
An act to amend the social services law, in relation to coverage for
certain individuals under the 1332 state innovation program
 
PURPOSE OR GENERAL IDEA OF BILL:
To improve access to care by expanding eligibility for certain publicly
subsidized programs for individuals who currently face barriers to
health care coverage due to their immigration status.
 
SUMMARY OF SPECIFIC PROVISIONS:
This bill would direct the Commissioner of Health (COH) to modify their
1332 waiver program to seek coverage for certain undocumented individ-
uals that are residents of the state. The bill would authorize the COH
to implement limitations on enrollment of this population and authorize
them to provide coverage to individuals beyond that number if 1332 waiv-
er funds are available to support it. Any limitations on enrollment
would target coverage opportunities to lower income populations, but
would allow the COH to make exceptions for particular subsets of the
population that are at-risk.
This bill would authorize the COH to seek approval from the federal
government for additional pass through funding as a result of the
reduction in emergency medicaid expenses..
This bill would also expand the 1332 waiver program reporting require-
ments to include information on: any enrollment limitations and any
savings to the state due to coverage of undocumented individuals.
 
JUSTIFICATION:
Since the enactment of the Affordable Care Act Marketplace in 2010, New
York has drastically reduced the number of uninsured individuals from 3
million to 1 million. However, more than 400,000 immigrant New Yorkers
have not benefited from new coverage options or public coverage through
the New York State of Health Marketplace because of their immigration
status. Numerous studies have found that people without coverage are
more likely to delay seeking preventative care for serious and chronic
health conditions, avoid seeking care for fear of costs, and are at
higher risk of incurring medical debt or bankruptcy. Studies have also
shown that those who have gained coverage have reduced mortality and
morbidity.
Additionally, in many instances these individuals end up being covered
by Emergency Medicaid to address their medical issues, which can often
be a costly alternative to routine preventative care. Emergency Medicaid
is already supported under the current budget of the state, so this bill
would support the delivery of more comprehensive and preventative
services to avoid unnecessary hospitalizations. Recent data shows a
total in excess of $1 billion being spent on Emergency Medicaid. If this
program was implemented, estimates show that state and local governments
would generate a combined savings in excess of $400 million. Addi-
tionally, this potential coverage option would likely lead to a similar
savings in excess of $400 million to the federal government, which makes
the 1332 waiver application even more likely to succeed. Based on the
Department of Health's actuarially reviewed 1332 waiver document, even
with the coverage of additional individuals, the waiver trust fund
balance could continue to grow every year over the next five years.
The SFY 2022-23 budget contained provisions expanding Medicaid eligibil-
ity to individuals aged 65 or older that are otherwise eligible except
for their immigration status. This bill will provide more adult immi-
grants with access to health insurance coverage that is equivalent to
the coverage offered to their citizens or lawfully present counterparts
who are eligible for the Essential Plan or Medicaid. The program builds
upon New York's success covering children (including immigrant children)
through the Child Health Plus program. It extends coverage to eligible
adult immigrants ensuring that all New Yorkers have access to affordable
health coverage, averting the health insurance cliff many young immi-
grants now face when they turn 19 after years of state investment in
their health. Extending this coverage to all adults would create
savings for the state and improved health outcomes for all New Yorkers.
The lack of coverage for significant numbers of New Yorkers causes prob-
lems for the broader health care system because payers and providers
charge more to the insured population to offset their losses related to
providing care to the uninsured. Even with this cost shifting, the costs
associated with uncompensated care threaten the financial sustainability
of many safety net hospitals and clinics. The program will invest
hundreds of million into the healthcare system, further stabilizing the
state's healthcare economy.
By expanding eligibility for coverage, this bill will provide essential
services to hundreds of thousands of individuals, make New York health
care providers more financially sound, save state and local governments
hundreds of millions in costs, and ensure a healthy fiscal outlay for
the continued operation of the waiver program.
 
PRIOR LEGISLATIVE HISTORY:
2023: S2237A (Rivera) - Passed Senate
2022: S1572A (Rivera) - Reported to Finance
2021: S1572 (Rivera) - Referred to Health
2020: S3900 (Rivera) - Referred to Health
2019: S3900 (Rivera) - Referred to Health
 
FISCAL IMPLICATIONS:
Emergency Medicaid reductions would lead to significant State and Local
savings, with some estimates showing a combined savings in excess of
$400 million. Because the funding to support this coverage expansion
utilizes excess federal 1332 waiver program revenues, there is zero
financial cost to the state.
 
EFFECTIVE DATE:
The bill takes effect in the same time and manner as section 3 of part H
of chapter 57 of the laws of 2023.

Statutes affected:
S2237: 369-gg social services law, 366 social services law, 366(1) social services law
S2237A: 369-ii social services law
S2237B: 369-ii social services law