Expanding Health Care Coverage

Project Title

Optimizing Consumer Protections in Health

Grant Amount


Priority Area

Expanding Health Care Coverage

Date Awarded

January 5, 2012








Under the Affordable Care Act (ACA), nearly 2.2 million New Yorkers will be able to access affordable, quality health care coverage through a newly established “exchange.”

These exchanges will serve as a central marketplace where individuals and employers can access all public and subsidized private insurance options. Yet, with the influx of consumers expected to seek insurance through the exchange and the newness of the system itself, the potential for errors, omissions, and conflicts is high. The Community Service Society of New York (CSS) developed a consumer-friendly and consumer-protective system that assists enrollees with accurate navigation and fair, transparent participation throughout this exchange.

Under this grant, the Community Service Society of New York (CSS) designed a model consumer protection, notification, and dispute resolution system for individuals and small employers seeking coverage through the exchange. Building these protections at the outset can ensure a more successful health care coverage program. CSS also conducted a national review of best practices with regard to eligibility and enrollment in health programs and apply such guidelines to New York State. Other specific activities of this project included: legal analysis of existing and prospective rules pertaining to Federal and State health coverage programs; a review of existing consumer protection and dispute resolution mechanisms in New York; and the dissemination of actionable recommendations to stakeholders, such as State policymakers.

Read the report associated with this grant, “Making the Affordable Care Act Work for New York’s Consumers”.