Enrollment in the Essential Plan, a low-cost health insurance option for low-income New Yorkers who are ineligible for Medicaid, is about to rise. Today marks the start of a long-planned eligibility expansion to people earning as much as 250 percent of the federal poverty line, or about $38,000 annually for an individual. Previously only New Yorkers earning up to 200 percent of the federal poverty line qualified. Over 1.2 million people were enrolled in the Essential Plan as of March 1, according to state data. Under the expansion, nearly 100,000 more New Yorkers are expected to join the plan’s membership rolls. That includes an estimated 70,000 people who are enrolled in qualified health plans on the state’s insurance marketplace — at least some of whom will be moved automatically to the Essential Plan. The transition to the more affordable coverage option will save them about $2,300 in monthly premium expenses and another $2,400 in out-of-pocket spending, per New York State of Health estimates. The $13 billion-a-year program is authorized under a state innovation waiver under Section 1332 of the Affordable Care Act, which federal officials approved on March 1. The expansion was folded into the state budget last year and originally slated to roll out on Jan. 1. Under the waiver, New York will spend $5.8 billion in pass-through federal funding to increase provider reimbursement rates and continue a quality incentive pool for plan issuers. The funds will also support a $25 million annual grant program for social determinants of health and behavioral health, to be rolled out later this year, and $49 million to compensate insurers for foregone premium revenue this year as a result of qualified health plan enrollees shifting to the Essential Plan. To further increase affordability using those pass-through funds, New York plans to implement cost-sharing subsidies for enrollees in qualified health plans earning up to 400 percent of the federal poverty line starting next year, New York State of Health Executive Director Danielle Holahan said in an interview.
| 
