This article briefly explains how uninsured people -- those without Medicare, Medicaid, or private health insurance -- may obtain help with hospital, prescription drug and other medical bills. First is a brief explanation of New York's Hospital Financial Assistance or Charity Care law, with a longer article at this link. Second are explanations of certain targeted insurance programs for special populations, with links to more information. Third is information about sliding-scale services provided by New York City public hospitals and clinics.
HEADS UP: In January 2024, undocumented immigrants age 65 and over will be eligible for full Medicaid. Stay tuned about news here. This was postponed from January 2023.
Essential Plan (EP) -
NYS's program that exercises an option under the Affordable Care Act to establish a "Basic Health Program). 42 U.S.C. 18051, 45 C.F.R. 156.420. These programs are for people under 65 with income above the Medicaid limit. Originally the income limit was 200% FPL and will be going up to 250% FPL in 2024. The EP is designed to reduce health care costs for lower income people for whom enrolling in a Qualifed Health Plan on the NYS of Health would be expensive.
Also the EP allows NYS to obtain a federal subsidy to provide health care to legal immigrants who are "PRUCOL" - many PRUCOL immigrants switch from Medicaid to the Essential Plan because it is partly federally funded. See this article about PRUCOL Medicaid.
Federal law requires BHPs to cover "essential health benefits." 42 USC 18022.
Essential Plan: NY Soc. Serv. L. Sec. 369-gg
Patient Access to Hospital Charity Care Funds - NYS Hospital Financial Assistance Law
Effective January 1, 2007, all general hospitals must establish written policies and procedures for the provision of financial assistance to reduce the hospital bills of low income New Yorkers who are uninsured or underinsured.
The patient financial assistance section in New York’s Charity Care law establishes a sliding fee scale rate for all patients living at or below 300% of the federal poverty level. Under this provision hospitals cannot charge more than $150 to patients with incomes at or below the FPL and charges for patients with income up to 300% of the FPL cannot exceed the Medicaid rate for services received. N.Y. Pub. Health L. § 2807-k(9-a).
In addition to limiting charges, the patient financial assistance law requires the following:
SDOH has posted the requirements of the law and information on hospitals on its New York State Hospital Profile webpage.
See more in this article on this website.
Targeted Insurance Programs
EPIC is a prescription drug benefit plan for New York residents who are over the age 65. The EPIC program has modest co-pays. A single person must have income less than $75,000 a year to qualify. Couples must have income less than $100,000. See our article about EPIC and how it works with Medicare Part D and other information. To get an application or ask questions about EPIC, call 1-800-332-3742 or visit their website at http://www.health.state.ny.us/nysdoh/epic/faq.htm.
Prescription Drug Discount Cards and Patient Assistance Programs
These are options to assist with the cost of prescription drugs for those without insurance, or who are under-insured. See more in our article that focuses on these programs.
ADAP has four programs for uninsured or underinsured persons living with HIV:
To be eligible for ADAP, the household income must be at or below 435% FPL - see limits here. The resource limit for all households is $25,000.
Medicaid Cancer Treatment Programs (MCTP)
MCTP expands Medicaid eligibility for individuals diagnosed with breast, cervical, colorectal and prostate cancer or with precancerous conditions. Individuals must enroll through designated entities called Cancer Services Program Partnerships, which are listed by county on the DOH website. Applicants should call their local center and make an appointment for an interview and to fill out an application, which is then processed centrally by SDOH. The income limit for the program is 250% of poverty and there is no resource limit. Applicants cannot have any other insurance coverage. All other Medicaid eligibility requirements apply. Eligibility for the breast and cervical cancer programs is limited to those 18 years of age or older; eligibility for the prostate and colorectal programs is limited to those under 65. Individuals enrolled in the program have full Medicaid eligibility; their coverage is not limited to cancer care. Applicants do not have to have a new diagnosis of cancer in order to get care, even if they have already received treatment, as long as they do not currently have creditable insurance coverage and meet the other eligibility requirements. More information about the program is available at http://www.health.state.ny.us/nysdoh/bcctp/bcctp.htm.
Public Hospitals and Clinics – New York City
Public hospitals and community based clinics often provide discounted or free medical care and medication. Many of these providers treat uninsured individuals for free or at a reduced rate, called a sliding fee scale. In New York City, the public hospital system is run by the New York City Health + Hospitals Corporation (H+H). There are H+H facilities throughout the city.
HHC offers a sliding fee scale program for uninsured and underinsured patients called NYC Care. This program offers reduced fees for in-patient and out-patient services. The sliding fee scale is at this link https://www.nychealthandhospitals.org/financial-assistance/ (scroll down to WHAT DO I PAY? Heading). The fee scale is also on PAGE 12 of the new member handbook.
HHC also has a Home Care Agency which should provide home care to the uninsured, including undocumented immigrants. See information on NYS DOH website here. Note that in January 2023, undocumented immigrants age 65 and over will be eligible for full Medicaid. Stay tuned about news here.