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An estimated 100,000 additional New York residents could soon enroll in the state’s Essential Plan—which provides health insurance to lower-income individuals who earn too much to qualify for Medicaid—thanks to a federal government-backed eligibility expansion, Governor Kathy Hochul announced Monday.
The US departments of Health and Human Services and Treasury approved New York’s request to extend eligibility for the public health insurance program to individuals with incomes up to 250% of the federal poverty line (FPL), or about $37,650 annually. The expansion—up from 200% of FPL, or a $30,000 annual income for one person—will take effect April 1 and continue through 2028.
The governor’s office said the expanded eligibility is expected to save newly eligible New York residents an average of $4,700 per year compared to coverage they would have purchased through qualified health plans offered on the state’s health insurance exchange. Hochul called the move “an important step toward building a better healthcare system statewide.”
With the expansion, an estimated 100,000 more New York residents will be eligible for the Essential Plan, including nearly 70,000 enrollees in qualified health plans, 20,500 uninsured people, and 12,000 individuals with Deferred Action for Childhood Arrivals (DACA) status who are enrolled in Medicaid or Child Health Plus, a state health insurance plan for kids.
Danielle Holahan, executive director of NY State of Health, which administers the Essential Plan, noted that the public insurance option, which was introduced in 2015, “has served as a critical haven for New Yorkers unable to qualify for Medicaid but still struggling to stay afloat with the cost of health insurance.”
“We are excited to build upon the success of this program to extend affordable, comprehensive health insurance coverage with no monthly premium to more low-income New Yorkers, including the [DACA] population,” she said in a statement.
More than 1 million New York residents are enrolled in the Essential Plan, which also comes with no deductible, low cost-sharing, free preventive care, and adult vision and dental services with no cost-sharing.