Expanding Health Care Coverage

Grantee Name

Affinity Health Plan, Inc. (Coalition of New York State Public Health Plans)

Funding Area

Expanding Health Care Coverage

Publication Date

April 2015

Grant Amount


Grant Date:

April 2011 – April 2012

Under the recent implementation of health care reform in the United States, more than 1 million New Yorkers were expected to gain health insurance coverage.

Based on their new eligibility, individuals are able to qualify for and select from an expanded Medicaid program or low-cost public and private plans available through the NY State of Health Marketplace (the Marketplace). For those who experience income fluctuations—coupled by shifting eligibility for subsidized coverage plans—it is vital to ensure continuity of coverage and health care. In 2011, NYHealth awarded Affinity Health Plan, a member of Coalition of New York State Public Health Plans (the Coalition), a grant for the Coalition to conduct research and develop a policy brief to identify existing barriers to coverage and inform key decisions to improve coverage continuity through the Marketplace.

Outcomes and Lessons Learned

  • Produced the final report, “Achieving Continuity of Insurance Coverage for Lower-Income New Yorkers in 2014,” which:
  • Found that 30% of non-elderly individuals who earn below 400% of the federal poverty level and are enrolled in Medicaid or subsidized private market coverage would experience year-to-year fluctuations that could alter their eligibility for Medicaid, subsidized health plans, or other insurance assistance programs;
  • Identified barriers to continuity of coverage, such as the misalignment in eligibility and enrollment rules among plans, differentiation in covered benefits among plans, and variation in administrative practices among the Marketplace, New York’s Medicaid Managed Care Plan, and the State’s Qualified Health Plans (QHPs); and
  • Included 34 recommendations to directly inform how New York State could achieve seamless transitions across several coverage programs on the Marketplace.

The recommendations have been widely disseminated to federal and State policymakers, payers, providers, and consumer groups. The State has moved forward with several of the recommendations from the report, including:

  • Designing and building interfaces to allow for electronic verification of eligibility;
  • Creating health plan shopping functionality to allow consumers, regardless of income, to select Medicaid, Child Health Plus, or QHPs on the Marketplace website;
  • Addressing Prepaid Health Services Plans (PHSPs) participation in the QHP market. Recognizing the importance of insurer participation across the Medicaid, Child Health Plus, and QHP markets for promoting continuity, the Marketplace has worked collaboratively with PHSPs to address unnecessary barriers to their participation as QHPs. As a result, four PHSPs offered QHP products for the 2014 coverage year; and
  • Assessing the implementation of the Basic Health Program (BHP), which states may choose to establish as an additional option to provide coverage for low-income individuals. Recently enacted State legislation would allow the BHP to move forward in New York if it makes financial sense.