Expanding Health Care Coverage

Grantee Name

Medicare Rights Center, Inc.

Funding Area

Expanding Health Care Coverage

Publication Date

May 2016

Grant Amount


Grant Date:

December 2010 – September 2012

The Affordable Care Act outlined Medicaid expansion guidelines for states to include nondisabled, single adults under 65 years old with incomes up to 138% of the federal poverty level.

States that adopted the Medicaid provision began using a modified system to determine eligibility for and expand coverage to those persons who would now qualify. However, for approximately 700,000 Medicaid enrollees in New York State who are also eligible for Medicare—known as dual eligibles —federal health reform left intact more complicated eligibility rules that can exclude them from accessing seamless coverage available on the NY State of Health Marketplace, the State’s health benefit exchange. In 2010, NYHealth awarded Medicare Rights Center a grant to ensure that the needs of dual eligibles were considered as the new Marketplace was planned.

Outcomes and Lessons Learned

  • Analyzed the State’s ability to extend coverage for dual eligibles through the Marketplace;
  • Developed proposed regulations for how the Marketplace and the State Medicaid office could simplify and coordinate enrollment for dual eligibles;
  • Participated on the Medicaid Redesign Team and proposed recommendations for enrolling dual eligibles in Medicaid; and
  • Developed and distributed recommendations through the report, “Lessons from New York: Building a Better Medicaid Eligibility and Enrollment System for Duals.”

Two key recommendations for dual eligibles subsequently were included in the State’s 2012–13 budget, and the State committed funding in its 2012–13 and 2013–14 budgets to build a single eligibility and enrollment system through the Marketplace. Additionally, the State invested in an asset verification system, which enabled New York to electronically verify assets for all Medicaid applicants, including dual eligibles. As a result of these policy successes, Medicare Rights Center assisted other states as they developed their own exchanges. Medicare Rights Center also shared recommendations for dual eligibles with federal agencies during the development of the federal exchange.

Co-Funding and Additional Funds Leveraged: N/A