New York's Health Insurance Program Descriptions

The Health Insurance Training Center for New York State Health Insurance Programs (HITC) assists the New York State Department of Health's Office of Health Insurance Programs, Division of Health Reform and Health Insurance Exchange Integration (Department), in providing for the development and delivery of education, training materials, and technical assistance on New York's health insurance programs. The target audiences for these trainings are Local Departments of Social Services' (LDSS) staff and any other entities, as determined by the Department, that assist individuals in enrolling for health insurance. These health insurance programs include the following:

Medicaid

New York Medicaid is health insurance designed to provide comprehensive medical health care coverage to eligible low-income New York residents. This program is the cornerstone of all of New York State's public health insurance programs and is available to individuals and families who meet requirements for income limits, and if applicable resource limits, and citizenship or immigration status. Medicaid is a large program with many eligibility categories providing coverage to a wide range of individuals and circumstances. The most common general eligibility categories consist of children under 21, parents and other caretaker adults, pregnant women, single adults and couples without children, certified blind or disabled persons of any age, and the elderly. Financial eligibility rules for Medicaid vary depending on the eligibility category. Financed by a combination of state, federal, and local funds, Medicaid covers approximately 4.6 million New Yorkers. Medicaid Managed Care is an approach for delivering Medicaid benefits to enrollees. This approach focuses on preventive health care, providing enrollees with a medical home for themselves and their families. Several different health plans and health care systems offer Medicaid Managed Care plans that coordinate the provision, quality, and cost of care for its enrolled members. Enrollment in a Medicaid Managed Care program is available at any local department of social services.

Child Health Plus

In New York State, the State Children's Health Insurance Program is known as Child Health Plus (CHPlus). CHPlus is designed to provide comprehensive health care coverage to uninsured children under the age of 19 who are not Medicaid eligible due to family income or immigration status, do not have health insurance, and do not have access to the New York State Health Insurance Plan (NYSHIP). The program is available to New York State residents regardless of income or immigration status, but families with incomes below 400% of the federal poverty level have all or most of the cost of CHPlus subsidized by New York State and federal government. For children with household incomes over the limit for subsizied coverage, families can purchase coverage at the full premium amount which varies by health plan. Some children who had employer-based coverage may be subject to a waiting period before they can enroll in the program. This will depend on the family household income and the reason for the loss of employer-based coverage. Approximately 400,000 children currently are enrolled in CHPlus. Although it is financed jointly by state and federal governments and is supervised at the State level, CHPlus is administered by participating Managed Care Plans that have a contractual relationship with the Department. These plans focus on preventive health care and provide enrollees with a medical home.

Medicaid for Pregnant Women

Medicaid for Pregnant Women provides comprehensive prenatal care to low-income women and teens, including routine prenatal check-ups, lab work, and access to specialists and hospital care, during pregnancy and delivery and for up to two months after delivery. In addition, their infants receive health care services for at least one year after birth. This coverage is available to all pregnant women, with incomes above traditional Medicaid standards. Pregnant women can be eligible with income at or below 223% of the the Federal Poverty Level (FPL). Pregnant women only need to show proof of residency, income and identity. No verification is required for citizenship, immigrations status or social security number.

Family Planning Benefit Program

The Family Planning Benefit Program (FPBP) is a Medicaid program for low income males and females that covers family planning services who are not already enrolled in Medicaid and meet certain income, and citizenship or immigration status requirements. Individuals with private health insurance may also enroll in FPBP if they need confidential services and meet the eligibility requirements. Enrollees may access services at any provider that accepts Medicaid and provides family planning services. The goal of FPBP is to increase access to confidential family planning services and to enable teens, women, and men of childbearing age to reduce unintended pregnancies.

Family Planning Extension Program

The Family Planning Extension Program (FPEP) provides 24 months of family planning services to women who were pregnant while in receipt of Medicaid (regardless of how that pregnancy ended), but who are no longer eligible for Medicaid, Family Health Plus or the Family Planning Benefit Program (FPBP) after their 60 day post-partum period. Women and teens are automatically enrolled in this program, and may access covered services through all Medicaid-enrolled providers with their existing Medicaid cards. Financed entirely by New York State, this program does not consider income or immigration status.