The NYS Essential Plan (EP) will have expanded eligibility levels starting April 1, 2024, under a recently approved federal 1332 Waiver program.  Until now, EP covered individuals who are over income for Medicaid (with incomes between 139%-200% of the FPL) and some lawfully present immigrants who are ineligible for federally funded Medicaid (with incomes between 0-200% of the FPL). 

In 2024, eligibility is expanding in two important ways:

1. Effective April 1, 2024 the upper income limit will increase from 200% to 250% FPL (annual limits in 2024 in this Fact Sheet (English)(Spanish)(click on "SELECT LANGUAGE" tab at the top of webpage for other languages.)
2. Effective August 1, 2024, immigrants with Deferred Action for Childhood Arrival (DACA) status with incomes between 0 - 250% of FPL will be eligible, as well as other lawfully present immigrants who are already eligible under the current program rules.

THIS ARTICLE HAS:

1. Information on the April 1, 2024 changes
2. What is the Essential Plan?
3. Where to Get Help

1.  Information on the April 1, 2024 changes -- 

• Click here for information about the changes starting April 1st. 

• Click here for a link to a webinar for assistors about the changes starting Aprl 1st and to download a PowerPoint about the changes. 

• April, 2024 income levels -- see Fact Sheet (English)(Spanish) click on "SELECT LANGUAGE" tab at the top of webpage for other languages..

• Transition of 70,000 People Enrolled in to the Essential Plan: 

In March, 2024,  70,000 people enrolled in Qualified Health Plans through the NY State of Health Marketplace with incomes between 201% - 250% will receive notices informing them that they will be transitioned from a Qualified Health Plan (for which they were paying a premium and likely had deductibles) to free EP effective April 1, 2024. 

NEW FAQs for consumers who will be transitioning into the Essential Plan can be found here, including:

Will I be able to keep my same doctors and other health care providers?”  DOH states that most health care providers who accept their Qualified Health Plan will likely accept the same insurer’s Essential Plan.  To make sure, they should call their health care provider to confirm they accept the new Essential Plan health insurance.  They can also  use the NYS Provider & Health Plan Look-Up tool to find Essential Plan options that work with their current health care providers. They also have the option to change their health plan.

 Will the cost-sharing payments I have already made in my QHP in 2024 count when I move to my new Essential Plan health insurance?”  DOH says yes, they will be.  This means that any out-of-pocket costs they paid, including copayments, coinsurance, and deductible, for their 2024 Qualified Health Plan will apply to their Essential Plan maximum out-of-pocket limit through March 31, 2025. 

2.  What is the Essential Plan? 

The Essential Plan is comprehensive health insurance for people age 19-64 who do not have employer health coverage or Medicare, and who are not eligible for Medicaid or Child Health Plus.   

• See https://info.nystateofhealth.ny.gov/EssentialPlan.  This is on the NYState of Health website, which is where you apply for the Essential Plan as well as MAGI Medicaid and Child Health Plus for those under 65.  At the above webpage is more info --

• Essential Plan At a Glance card - who is eligible, services covered, cost sharing, and out-of-pocket costs - many languages available here  - click on language selector at the top. 

• Essential Plan Fact Sheet   has current income limits as of April 2024.  SELECT OTHER LANGUAGES  at the top of https://info.nystateofhealth.ny.gov/essential-plan-fact-sheet  including:

  • (Espanol)

  • Информационный бюллетень по Основному плану на 2024 год – расширение на английском языке.pdf  (Russian)

  • 2024 অপরিহার্য পরিকল্পনা ফ্যাক্ট শীট - ইংরেজি expansion.pdf (Bengali)

• There is no asset limit for the Essential Plan. 

• The income limit as of April 1, 2024 will be 250% FPL. 

• Use the Plans by County Tool to learn what health plans are available in your county for the Essential Plan.

• Use the NYS Provider & Health Plan Look-Up tool when you are deciding which health plan to enroll in or when you are looking for a provider, for example a hospital or doctor, that works with your plan.

More on the Essential Plan:

• Section 1331 of the Affordable Care Act (ACA), created an option for states to offer a "Basic Health Program,"  with the goal of reducing rates of uninsured.  New York is one of just two states that offered a Basic Heath Program.  New York calls its Basic Health Plan the Essential Plan.  See 2016 issue brief by Kaiser Family Foundation.   Under the ACA, states offering a basic health plan like NYS receive significant federal funding for these programs. 

• NEW YORK LAW:  NY Social Services Law Sec. 369-gg.
• In 2023. New York sought to place its Basic Health Program on pause and filed a 1332 Waiver request to roll over NY’s BHP Essential Plan enrollees into a 1332 Waiver program. 
• The new 1332 Waiver program will expand income eligibility up to 250% of FPL (up from a cap at 200% of FPL) and will include more immigrants (the DACA population).
• EP enrollees who become pregnant  -- they will be able to remain in EP instead of being switched to Medicaid for pregnant people.  They will experience no cost sharing and will remain continuously covered for the first 12 months after birth.
• At the time of this writing (March 2024), the State is considering additional cost sharing improvements for EP enrollees. 

FOR HELP:

Contact Community Health Advocates 
https://communityhealthadvocates.org/contact-us/ 

•  (888) 614-5400 Monday to Friday, 9am to 4pm,
•  email cha@cssny.org.

This article was authored by the Evelyn Frank Legal Resources Program of New York Legal Assistance Group.