Covering Undocumented Immigrants in New York Updated Presentation for HCFANY Winter Meeting Elisabeth R. Benjamin, MSPH, JD, VP Health Initiatives Community Service Society of New York January 8, 2016 Photo credit: Philip Greenburg without author s permission
New York has a high number of uninsured immigrants New York State ranks fourth among states in unauthorized immigrants (867,000 people*) Most (73% or 643,000) of New York s unauthorized immigrants live in New York City More than half (457,000) of New York s unauthorized immigrants are estimated to be uninsured 264,000 undocumented adults are uninsured Lack of coverage associated with poorer health outcomes, financial burdens** * Migration Policy Institute (2015). Profile of the Unauthorized Immigrant Population: New York http://www.migrationpolicy.org/data/unauthorized-immigrant-population/state/ny **Sommers, B. D. (2010). Targeting in Medicaid: The costs and enrollment effects of Medicaid s citizenship documentation requirement. Journal of Public Economics, 94, 174-182. 2
New York s current public coverage climate for immigrants Covered! Children Medicaid or CHIP Pregnant women Medicaid up to 200% of FPL Adults LPRs, Lawful & PRUCOLs (including DACA) get full Medicaid Undocumented adults get Emergency Medicaid if below 138% FPL Who is Uncovered? Undocumented adults Residual PRUCOL immigrants > Medicaid limits (Mostly DACA/DAPA) withut author s permission. All errors 3
Coverage for immigrant New Yorkers: CSS s four policy proposals 1. High-deductible Bronze plan to supplement Emergency Medicaid for low-income undocumented adults below 138% of FPL 2. Young Adult Coverage ( Dreamer ) for undocumented and PRUCOL adults between the ages of 19 and 30 up to 400% of FPL 3. State-funded Essential Health Plan (formerly known as Basic Health Program (BHP)) 4. Essential Plan Clean up option (cover the residual PRUCOLs) 4
Comparison of Program Benefits and Population Served 5
Option 1: Comprehensive, higher deductible commercial insurance product for undocumented Emergency Medicaid adult enrollees What is the goal? Augment coverage for lowincome (below 138% of FPL) immigrants who only have ER benefits How will it work? Enrollee will get a free Bronze plan ($3500 deductible) supplemented by ER Medicaid Free for consumers State pays premiums Feds/State jointly fund the costs of providing ER Medicaid as a wrap What are the Benefits? Free care Preventive care free (per ACA) ER, cancer, renal (no deductible) All other care subject to $3500 deductible, 50% coinsurance for care between $3500 - $6850 6
Option 2: Comprehensive, subsidized coverage for undocumented and PRUCOL young adults, age 19-30 What is the goal? Comprehensive coverage that mimics NYSOH subsidies to young adults How will it work? Young adult goes to NYSOH portal to determine their eligibility for State-only funded sliding-scale financial assistance, equivalent to federal tax credits and costsharing reductions What are the benefits? YA enrolls in a Child Health Plus-like plan 7
Option 3: Comprehensive coverage for low-income undocumented and PRUCOL adults through State-funded EP What is the goal? Comprehensive EP coverage (.95/1.00 AV) to immigrant adults below 200% FPL who are not Medicaid eligible How will it work? NY EP started 2016 Federal financing will result in $645M in State Medicaid savings from covering legal immigrants Little to no cost for enrollees $0 up to for enrollees below 150% FPL $20 per month for enrollees 150-200% FPL Low cost-sharing What are the benefits? EP wraps EM < 138% FPL 8
Option #4: Essential Plan Clean Up What is the goal? Eliminate the cliff for legal immigrants who are eligible for Medicaid, but not EP or federal subsidies on the NYSOH Marketplace. How will it work? Offer state-only funded EP to immigrants who are ineligible for federally-funded EP or federal subsidies because of immigration status. What are the benefits? EP benefits 9
Summary: Take-Up and Costs of CSS Coverage Proposals (Without DACA/DAPA Expansion, Medium take up for all options) Program Actuarial Value Number Eligible Estimated # of Enrollees Total Gross State Costs State Cost per Enrollee PMPM Annual State Cost Per Enrollee 10
Thank you! The Community Service Society of New York would like to thank the following funders for their support of this project: The Altman Foundation The New York Community Trust The New York State Health Foundation The United Hospital Fund We would also like to thank our colleagues at: Manatt Health Solutions Gorman Actuarial The New York City Department of Health and Mental Hygiene The Steering Committee of Health Care for All New York 11