BILL NUMBER: S8619
SPONSOR: HELMING
 
TITLE OF BILL:
An act to amend the legislative law, in relation to requiring fiscal
notes for bills imposing mandated benefits under insurance plans and
under the Medicaid fee-for-service program
 
PURPOSE:
To ensure transparency and fiscal responsibility by requiring that any
legislation imposing new or expanded mandated benefits or services on
any public or private insurance plan, Medicaid managed care, or Medicaid
fee-for-service include a fiscal note estimating the financial impact of
such mandates.
 
SUMMARY OF PROVISIONS:
Section 1: Paragraph 1 amends the legislative law by adding a new
section 50-a to require that any legislative bill which enacts or amends
any provision of law that imposes a new mandated insurance benefit or
service, or that expands an existing mandated insurance benefit or
service shall contain an actuarial fiscal note stating the estimated
annual cost to the insurance premium on policyholders affected by such
enactment or amendment and the source of such actuarial estimate.
Paragraph 2 provides that this is applicable to all bills that will
impact insurance plans of the state of New York or of any of its poli-
tical subdivisions, and also to all bills that will impact every insur-
ance plan offered by an insurer doing business in this state as an
authorized insurer, and includes all types of health insurance, the
Essential Plan, Child Health Plus or Medicaid managed care.
Paragraph 3 specifies that the fiscal note shall contain an actuarial
analysis of the potential insurance premium impact of imposing such new
mandated insurance benefit or service, or expanding such existing
mandated insurance benefit or service, as well as an analysis of its
potential impact on all segments of the insurance market. Paragraph 4
provides that an omission of the fiscal note shall invalidate the bill.
Section 2: this section of the bill amends the legislative law by adding
a new section 50-b related to requiring fiscal notes on any legislative
bills related to Medicaid fee-for-service benefit expansions.
Paragraph 1 in Section 2 provides that any bill which amends the social
services law or any other provision of law in a manner that adds,
expands, or requires coverage of any benefit or service under the Medi-
caid fee-for-service program shall contain a fiscal note stating the
estimated annual cost to the state and to local social services
districts resulting from such amendment. Paragraph 2 of
Section 2 of the bill requires the fiscal note to be prepared in consul-
tation with the NY state department of health and the NY state division
of the budget. Paragraph 3 of Section 2 of the bill provides that an
omission of the fiscal note shall invalidate the bill.
Section 3: this section of the bill provides for an immediate effective
date.
 
JUSTIFICATION:
New York lawmakers frequently consider legislation expanding or creating
new health insurance benefits across commercial plans, the Essential
Plan, Child Health Plus, and Medicaid managed care. These proposals
often aim to improve access to care and address emerging clinical needs,
but they also carry fiscal implications for consumers, employers, coun-
ties, and the State. Unlike private-market mandates, which undergo actu-
arial review as part of the rate-setting process, legislative proposals
affecting public insurance programs are not required to include clear,
nonpartisan fiscal information at introduction. As a result, the Legis-
lature is often asked to evaluate significant coverage changes without
transparent analysis of their budget, premium, or administrative
impacts.
For Medicaid in particular, the State's financing structure creates
unique challenges for local governments. Although counties' direct share
of Medicaid benefit costs is capped, counties continue to experience
substantial operational impacts from State-level program changes,
including increased eligibility processing, renewals, service authori-
zation work, fair hearings, care management responsibilities, and admin-
istrative staffing needs. Counties have repeatedly expressed concern
that the State's Medicaid policy changes impose unfunded administrative
burdens that fall outside the cap. A standardized fiscal statement would
allow both the State and counties to better anticipate resource needs
and prevent cost shifts through administrative mandates.
Additionally, Medicaid fee-for-service supports some of the highest-need
individuals and most specialized services in the program, including
long-term care residents, medically fragile children, people with intel-
lectual and developmental disabilities, and individuals receiving trau-
matic brain injury and NHTD waiver services. Expansions or modifications
affecting these populations require stable and predictable funding to
ensure continuity of care. Timely, transparent fiscal information
allows the Legislature to responsibly plan for these needs, ensure
adequate appropriations, and avoid the unintended consequence of enact-
ing new benefits without resources to support them.
This bill does not limit, restrict, or discourage benefit expansions.
Rather, it provides lawmakers with necessary fiscal clarity, comparable
to what is already standard in the commercial market, so that coverage
decisions can be made responsibly, sustainably, and with full informa-
tion about their budgetary and administrative implications.
 
LEGISLATIVE HISTORY:
This is a new bill.
 
FISCAL IMPLICATIONS:
None to the state outside of normal administrative responsibilities for
preparing fiscal notes.
 
EFFECTIVE DATE:
This act shall take effect immediately.