Public Health Solutions

Since the opening of the New York State of Health Marketplace in 2014, more than 2.8 million New Yorkers have gained access to health insurance coverage.

Although enrollment has been largely deemed a success, signs of dysfunction and gaps in the system regarding consumer education have been reported. Many of those enrolled are new to insurance and may be confused about using health insurance and its benefits, including provider networks or how to handle denied claims. Consumer education for insurance is limited and hard-to-find, and it is increasingly clear that there is room to better address the needs of insured New Yorkers. In 2016, NYHealth awarded Public Health Solutions (PHS) a grant to assess the existing state of post-enrollment resources for consumers in New York and provide recommendations to meet their health navigation needs.

Under this grant, PHS developed a blueprint of recommendations to improve the current system of consumer assistance services and post-enrollment support in the State. This blueprint examined the existing consumer assistance structure and how it addressed consumer post-enrollment needs; identified potential actions to make the system more efficient and effective; leveraged existing community-based consumer assistance systems’ knowledge and resources; and made actionable recommendations for policies, strategies, and funding allocation. Recommendations identified improvements to help New Yorkers’ ability to resolve health care confusion, inquiries, or disputes effectively.