New York Health Purchasing Alliance, Inc., d/b/a HealthPass

HealthPass is a nonprofit initiative that offers an array of insurance plans to small businesses.

With a planning grant from the New York Health Foundation’s “Expanding Coverage Options in the Small Group and Individual Market in New York State” program, HealthPass analyzed the feasibility of adding Healthy NY, a State-sponsored insurance plan that offers coverage to businesses with 50 or fewer employees, sole proprietors, and individuals, to the HealthPass menu of insurance plans. For those who met the income-based eligibility criteria, the State subsidized benefits, allowing Healthy NY to offer premiums at a lower cost. HealthPass believed that if Healthy NY could be brought into HealthPass, more small businesses would provide coverage to their low-income workers.

This grant was one of five organizations that received a planning grant from the 2008 NYHealth request for proposals (RFP), “Expanding Coverage Options in the Small Group and Individual Market in New York State.” The RFP grew directly out of the Foundation’s desire to generate ideas for expanding health insurance options for small businesses and sole proprietors.

Read an NYHealth special report that contains a summary of findings from this RFP.

Half of New York State’s uninsured workers work in businesses with fewer than 25 employees or are self-employed. Small businesses pay more for health insurance premiums, and their costs have grown faster than for other categories of employers by size. With a planning grant from the New York Health Foundation’s “Expanding Coverage Options in the Small Group and Individual Market in New York State” program, HealthPass, a nonprofit initiative that offers an array of insurance plans to small businesses, will analyze the feasibility of adding Healthy NY, a State-sponsored insurance plan that offers coverage to businesses with 50 or fewer employees, to its menu of insurance plans with the hope that more small businesses will provide coverage to their low-income workers.

Through this project, HealthPass will: 1) expand the options for small businesses who qualify for the Healthy NY program; 2) ease administrative complexities of offering a Healthy NY option under one unified program; 3) leverage the Healthy NY subsidies through wider distribution of the products; 4) encourage brokers to present the Healthy NY products to small businesses interested in HealthPass; and 5) expand upon the successes of HealthPass in reaching the working uninsured.

Joseph P. Addabbo Family Health Center

Southeast Queens is a community experiencing a serious shortage of primary care, and lack of primary care for these residents often leads to higher rates of nonurgent emergency room use and preventable hospitalizations.

These residents have low incomes, high poverty rates, and poor health statuses and by the end of 2008, the situation in this area worsened. The St. Dominic’s Family Health Center, a primary outpatient center of Mary Immaculate Hospital of Caritas Healthcare, was about to close as Caritas declared bankruptcy. With NYHealth’s support, Joseph P. Addabbo Family Health Center acquired St. Dominic’s from Caritas and incorporated St. Dominic’s into its Federally Qualified Health Center (FQHC) network in 2009. This initiative enabled St. Dominic’s to continue operations under new ownership, expand its services, and become self-sustaining.

The Joseph P. Addabbo Family Health Center (Addabbo) is a nonprofit, federally qualified health center (FQHC) with three clinical sites and one children’s day treatment center in Queens County. NYC Primary Care Initiative identified Southeast Queens as one of 11 communities citywide most in need of primary care investment. The bankruptcy of the Caritas health system threatens access to health care in central Queens and also provides an opportunity to reorganize health care delivery in that borough.Addabbo will take over and operate the St. Dominic Center as an addition to its FQHC network. The St. Dominic facility has the capacity to serve 35,000 to 50,000 patients, but has always operated far below capacity despite the well-documented level of need in the community. The clinic is at imminent risk of closure. If this occurs, the loss of this facility will displace some 4,000 patients and undermine the health status of area residents by reducing the availability of primary care services.

Addabbo is licensed by the State of New York as a Diagnostic and Treatment Center. It operates as an interdisciplinary group practice and maintains active affiliations with local hospitals, and community- and school-based outreach programs. The New York State Department of Health has granted emergency approval to Addabbo to begin operation of the St. Dominic facility and has committed $650,000 to support the acquisition.

William F. Ryan Community Health Center

In 2009, Columbia University announced its intent to close the Thelma C. Davidson Adair Community Health Center (Thelma Adair), located in the medically underserved community of Central Harlem.

Allowing Thelma Adair to close would have created a significant gap in health care capacity—current patients would lose their medical home and unmet community health needs would only have increased in this medically underserved area. The William F. Ryan Community Health Center (Ryan) is part of the Ryan Network—a group of Manhattan-based community health centers that was founded to provide community health care in the most underserved neighborhoods of New York City. Ryan was in a unique position to take over Thelma Adair. The center was located in Ryan’s catchment area, and Ryan had a strong reputation for managing community-based health centers. In December 2009, NYHealth awarded a grant to Ryan to help ensure the smooth transition of Thelma Adair into its operations.

This acquisition allowed Ryan to consolidate primary care services, operate the facility at full capacity, and add additional primary care services. The designation of Thelma Adair as an FQHC within the Ryan Network enabled it to receive higher reimbursement rates and achieve sustainability. Ryan has a proven track record of acquiring other hospital-operated ambulatory care centers in urban settings and restructuring them as FQHCs to meet the needs of underserved communities.

The Nelson A. Rockefeller Institute of Government

Under Medicaid’s rules, an individual’s income and assets are taken into consideration when determining his or her eligibility for long-term care coverage.

Those having either income or assets that exceed the annual limits are not eligible. Applicants who transferred their assets (to other family members or to a trust, for example) within five years of applying for Medicaid long-term care coverage are also not eligible. According to a March 2009 report published by the Nelson A. Rockefeller Institute of Government (Rockefeller Institute) and funded by the New York Health Foundation (NYHealth), there is substantial variation and difference in the magnitude of Medicaid denial rates of long-term care coverage across New York’s 62 counties. With a Phase 2 grant from NYHealth, the Rockefeller Institute conducted a study to uncover possible reasons for discrepancies in denial rates and provide actionable recommendations to standardize practices throughout the State.

To be eligible for Medicaid long-term care, applicants must meet income and asset rules, and not have transferred assets (e.g., to another person, a trust, or annuity) within five years of the application. According to the Phase 1 grant, statewide, the transfer of personal financial assets resulted in denying an average of 7% of Medicaid long-term care applications during the last 10 years. However, the study found wide variation in the rate of denials due to asset transfer with some counties denying close to 50% of applications and others denying less than 1%. Among the State’s larger counties, the study found higher-than-average rejection rates in Rockland (24.2%), Ulster (22.6%), Saratoga (14.6%), and Suffolk (14.5%) counties. In Westchester (0.5%), Dutchess (1.0%), Schenectady (1.2%), Rensselaer (1.3%), Orange (1.4%), and Erie (2.1%) counties, rejection rates were well below the statewide average. These disparities may stem from differences in how the rules are understood and applied across the counties. The Phase 2 grant will seek to identify the factors driving this variation, the potential cost impact to the State, and specific actions the State and counties can take to minimize variation in denial rates. Smoothing out county-level differences has large cost implications; Medicaid is the largest funding source for long-term care in New York State, and more than 40% of the $49 billion being spent on Medicaid in 2009 is for long-term care.

National Urban Fellows, Inc.

To maximize each fellow’s talents while also providing a rich learning experience, NYHealth assigns concrete projects and goals to allow fellows to focus their time and energy. Connecting the fellow’s interests and existing skill set with opportunities to grow, expand, and attain new competencies makes for a fulfilling experience for the fellow as well as for the mentoring organization.

The National Urban Fellows (NUF) Program trains a diverse cadre of potential leaders in public administration and health management. Each fellow—chosen from a national competition—receives full tuition and a living stipend to complete a Master of Public Administration degree at the City University of New York Baruch College, and to spend nine months as an intern in a nonprofit organization in the United States. Every year since 2006, a fellow has interned at NYHealth and this support will continue for 2009-2010.

Public Health Solutions

Approximately one million New Yorkers are estimated to be eligible for public health insurance but are not enrolled.

To help reach these people, New York State designates a network of “facilitated enrollers” (FEs) to identify and assist eligible individuals with signing up for public health insurance programs such as Medicaid, Child Health Plus, and Family Health Plus. Public Health Solutions (PHS) has been an FE since 2001 and is active in Kings County, New York County, and Queens County. Until recently, FEs had to rely on an entirely paper-based process that is time-consuming, error-prone, and redundant. For this grant, PHS was able to fully implement an electronic application process. As a result, the number of daily applications completed per FE increased from 4.8 to 5.9—a 24% increase.

New York State-designated “facilitated enrollers” currently navigate a complex, time-consuming, error-prone, and redundant paper-based system to enroll eligible individuals in public health insurance programs. This grant will allow Public Health Solutions (PHS) to establish a financially sustainable electronic application process resulting in a 40% increase in enrollment, and significant cost savings and efficiencies.

Approximately 1 million New Yorkers are estimated to be eligible for public health insurance but are not enrolled. Until recently, enrollment required applicants to enter the same information multiple times by hand, and enrollers to hand-deliver batches of applications to a central location. The New York City Human Resources Administration has started to accept and process electronic applications to address the inefficiencies of the paper-based system. To take advantage of this change, PHS will purchase the technology necessary to implement an automated application process, including certified software, laptops, scanners and printers. It will also provide a report on practical lessons learned during the transition in order to assist facilitated enrollers considering electronic automation.

Read the report associated with this grant, “Increasing Health Insurance Enrollment in Technology.”