| Photo by Marek Studzinski on Unsplash
NEW YORK — The New York State Essential Plan (EP) expansion recently approved by the US Department of Health and Human Services and the US Department of Treasury covers 12,600 Deferred Action for Childhood Arrivals (DACA) individuals currently enrolled in Medicaid/CJPlus.
The EP is a public health insurance program offered to New Yorkers through the New York State of Health. It covers over 1 million low-income New Yorkers and provides comprehensive benefits with $0 monthly premiums, no deductible, and low-cost sharing. It also includes free preventive care, adult vision, and dental care without cost-sharing.
Through the State Innovation Waiver, the EP was expanded on April 1, 2024, to cover New Yorkers with incomes up to 250 percent of the Federal Poverty Level (FPL) — $37,650 annual income for an individual. Once fully implemented, the high-quality, affordable program with a zero-cost monthly premium will be available to an additional 100,000 New Yorkers.
According to New York State officials, it includes nearly 70,000 New Yorkers enrolled in Qualified Health Plans who will now be eligible for significantly more affordable coverage through the Essential Plan, 12,000 DACA individuals currently enrolled in Medicaid/CHPlus, and approximately 20,500 presently uninsured New Yorkers.
The Health & Welfare Council of Long Island (HWCLI) announced that beginning August 1, 2024, individuals who are considered DACA will be able to enroll in EP coverage.
Consumers who are DACA recipients and currently enrolled in Medicaid through the NY State of Health will be automatically transitioned into an EP 3 or 4 plan with the same insurer, and no action will be needed. These consumers will receive notices and may also receive emails and text reminders.
Suppose a consumer is DACA, enrolled in Medicaid through the NYS Department of Health, and is pregnant or eligible for Medicaid postpartum coverage. In that case, they will remain in Medicaid through the end of their twelve-month period of continuous coverage.
They will receive a renewal at the end of the 12-month postpartum period and, if otherwise eligible, may become eligible for EP.
EPme children may remain eligible for Medicaid or Child Health Plus because they are ineligible for EP dEP to their age.
In addition, starting November 1, 2024, DACA recipients will be considered lawfully present for Qualified Health Plan (QHP) eligibility. This change applies to all QHP eligibility with or without financial assistance. HWCLI will provide more information on how and when to help a DACA consumer eligible to enroll in a QHP later this year.]
HWCLI expects this expansion of DACA eligibility will now provide coverage to many currently uninsured consumers and many consumers with employer-sponsored insurance that does not meet the affordability threshold.
New York State already has the authority to provide coverage to DACA recipients who are not eligible for EP aEP or otherwise meet eligibility requirements for Medicaid and Child Health Plus.
If you have any questions about this information, please call our Healthcare Access line at 516-505-4426.
