Expanded Eligibility Under Federal State Innovation Waiver Ensures More New Yorkers Are Now Covered Under State’s Essential Plan
New Enrollees in Essential Plan Will Save Over $6,100 Per Year
New York Receives Nation’s Largest State Innovation Waiver Award to Date
Funding Received Through Affordable Care Act
Governor Kathy Hochul announced today that New York State received a final commitment of $10 billion from the federal government to provide high-quality, affordable health insurance to approximately 1.5 million New Yorkers. Following sustained advocacy by the Governor, New York secured this funding through the federal State Innovation Waiver. The $10 billion commitment received today marks the nation’s largest State Innovation Waiver award to date.
“By securing this nation-leading investment, we’re expanding affordable health insurance for New Yorkers and continuing to address the cost of living in communities statewide,” Governor Hochul said. “I’ll never stop fighting to ensure New Yorkers get the affordable, quality care they need.”
This funding commitment follows through on the Governor’s previous announcement that New York expanded eligibility levels for the Essential Plan, a public health insurance program offered through the NY State of Health. The expanded eligibility ensured that more than 200,000 additional New Yorkers are newly covered under the Essential Plan this year, making a total of approximately 1.5 million covered statewide.
New enrollees in the Essential Plan are estimated to save over $6,100 each year compared to what they would have paid for commercial coverage.
Statewide enrollment includes:
Statewide Enrollment in the Essential Plan by Region
Region | Number of Essential Plan Enrollees |
NYC Metro | 919,107 |
Long Island | 198,602 |
Northern Metro | 76,107 |
Mid-Hudson | 46,156 |
Northeast | 45,878 |
Utica-Adirondack | 34,778 |
Central | 43,273 |
Finger Lakes | 43,041 |
Western | 90,907 |
Grand Total | 1,497,849 |
The $10 billion in federal funding for 2024 includes approximately $1 billion made possible because of the federal Inflation Reduction Act (IRA). The IRA extended the availability of enhanced premium tax credit subsidies, which are set to expire in 2025 if Congress does not act. IRA-enhanced premium subsidies have been a critical funding source, enabling New York to expand affordable coverage and achieve record enrollment.
On April 1, 2024, New York expanded eligibility levels for the Essential Plan, a public health insurance program offered through the NY State of Health. The Essential Plan is now available to New Yorkers with incomes up to 250 percent of the Federal Poverty Level, $37,650 annual income for an individual in 2024. This expansion resulted from New York’s Section 1332 State Innovation Waiver application, approved by the U.S. Department of Health and Human Services and the U.S. Department of Treasury on March 1, 2024. Thanks to the waiver, approximately 1.5 million New Yorkers across the State are getting health plan coverage with $0 premiums and low or no cost-sharing. New York has received interim payments in April and August that allowed an on-time launch of the program’s expansion in April 2024.
Section 1332 State Innovation Waivers allows states to pursue innovative strategies for providing residents access to high-quality, affordable health insurance. New York’s waiver was approved for five years, from 2024 through 2028. Funding amounts for 2025 through 2028 will be determined on a year-by-year basis.
Complementing New York’s recently approved 1115 Medicaid Demonstration waiver, this 1332 waiver New York also seeks to address social determinants of health for Essential Plan enrollees. Waiver funding will support grants that address food insecurity, including through food pharmacies and medically tailored meals, and will support enrollees with persistent asthma by providing them with air conditioners to protect their health and reduce the number of Emergency Department visits. This waiver will also support grants to insurers to increase access to behavioral health providers and services, including mobile crisis units, crisis diversion centers and crisis respite centers.
New York’s high coverage levels are also a result of the State’s fully integrated marketplace model, across public and private health insurance products, which allows the State to maintain higher coverage levels because individuals can seamlessly change programs when their incomes or family circumstances change.
Find information about Section 1332 State Innovation Waivers on the Centers for Medicare and Medicaid website. Details about New York’s Section 1332 waiver are available.
Information about Essential Plan Benefits and Cost Sharing Grid can be found here.
About the NY State of Health
New York opened its Health Plan Marketplace, NY State of Health, in October 2013. The Marketplace’s one-stop health insurance shopping experience offers high-quality comprehensive health plans. NY State of Health, a division of the New York State Department of Health, is the only place where consumers can qualify for help paying for coverage through premium discounts or tax credits. Eligible New Yorkers can also enroll in Medicaid, Child Health Plus and the Essential Plan through the Marketplace all year. Find more information about the NY State of Health Marketplace, please call Customer Service at 1-855-355-5777, TTY: 1-800-662-1220 or find an enrollment assistant.
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