With New York’s Medicaid coverage already broader than federal law requires, the state expects to add about 75,000 more people to the program next year under the health care overhaul, plus another 425,000 who are already eligible but don’t know it.
Medicaid, the government health insurance program for the poor, currently covers 5.1 million New Yorkers, more than one-fourth of the state’s residents. The income threshold to qualify for most programs is already above the federal poverty line.
“There are 1 million who are eligible but not enrolled. The hope is that roughly half will come in as a result of the new welcome mat effect,” said Elisabeth Benjamin, vice president for health initiatives at the Community Service Society of New York, an advocacy group.
Separately, New York plans to begin enrollment Oct. 1 in a new health insurance marketplace known as an exchange. That’s expected to enroll another 1.1 million New Yorkers who have no health insurance but make too much money to qualify for Medicaid. They would pay premiums and could qualify for subsidies depending on their income. The exchange is expected to reduce costs that individuals pay for insurance.
New York officials are putting together a marketing plan to help increase the number of residents who have insurance coverage. They expect to sign up more than half of the 2.7 million uninsured among the state’s 19 million residents.
Benjamin said New York probably has the best public health insurance programs in the U.S., including Child Health Plus, now available to all its children under age 19. It won’t change.
The program provides health coverage on a sliding fee scale up to 400 percent of the federal poverty line, with full premiums after that at about $150 a month. Health Department officials estimate 90 percent of New York children have coverage.
The 2010 federal Affordable Care Act calls for expanding Medicaid eligibility and establishing state insurance exchanges with help from federal subsidies.
New York now provides Medicaid for single adults up to the poverty line, about $12,000 a year for an individual. That will rise in 2014 and is expected to add 75,000 people to the program.
Under Family Health Plus, its Medicaid-expansion program, the state now covers parents up to 150 percent of the poverty line, or $37,000 for a family of three. That is expected to drop to 138 percent next year as that program ends, but a Cuomo administration proposal will grandfather in about 36,000 adults enrolled at the higher threshold.
Benjamin said there are probably another 36,000 people in that income group who are not enrolled and who could be left out next year.
“The big issue is affordability,” where the insurance exchange may still be too expensive for lower-income residents in this high-cost state, she said.
At the same time, New York is expected to get up to $2.5 billion more in federal reimbursement for the overhaul.
Total federal, state and county Medicaid spending is tentatively budgeted to rise from nearly $54 billion this year to $57.6 billion for the 2013-14 fiscal year.