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Know Your Rights
Source: Gothamist
Subject: Health Justice & Access

Clock ticking for bill to expand healthcare to NY’s undocumented immigrants

A new version of a bill that aims to expand public health coverage to undocumented migrants is racing against time as health and immigrant organizations push lawmakers to get it to Gov. Kathy Hochul’s desk.

Supporters say the coverage could be entirely funded through billions of surplus dollars from an existing federally funded insurance program. But a version of the “Coverage for All” bill last year faced resistance from Hochul. A spokesperson for the governor said in April 2023 that it would introduce “significant financial uncertainty and risk,” since it was difficult to estimate the size of the undocumented population, and New York could be on the hook for unexpected costs. The 2023 version passed the state Senate but never got a vote in the Assembly.

A new version of the bill would let New York cap enrollment, which supporters say would allow the state to prevent costs from exceeding expectations and falling on New York. They also say Coverage for All would shift costs away from locally funded emergency health care. Last year, New York spent $575 million on Emergency Medicaid, a program that covers the cost of emergency care for those who are uninsured because of their immigration status, according to the state health department.

It’s not yet clear how many people the newly expanded insurance would reach, as it would be up to state officials to decide on any enrollment cap. But supporters from the nonprofit Community Service Society of New York estimate that the current version of the bill would cost a little more than $1 billion per year and serve about 150,000 undocumented residents.

The future of the bill is uncertain. The state legislative session ends on June 6 and Hochul has yet to indicate whether she would sign the updated legislation if it passes.

“The governor will review the legislation if it is passed by both houses of the Legislature,” Sam Spokony, a spokesperson for Hochul, said last week in response to questions about the bill. Her office didn’t respond to specific questions about new measures to control costs.

The state Senate passed the new version of the bill on May 15. Assembly Speaker Carl Heastie did not respond to questions last week about whether he would put it up for a vote, but advocates say they believe the bill has the support needed to pass.

“There’s got to be a final push to get it over the finish line,” said Assemblymember Jessica González-Rojas, who introduced the bill in her chamber. Still, she acknowledged, “at this point, we want to move bills that would have the governor’s support.”

The legislation would let New York seek the Biden administration’s permission to extend the existing, federally subsidized Essential Plan to residents who don’t otherwise qualify due to their immigration status. Supporters of the proposal — including some hospitals, health insurers and city officials — argue that it would ultimately save the state money and it’s necessary to fill one of New York’s last remaining gaps in health coverage: an undocumented population estimated to include hundreds of thousands of people who can’t normally qualify for public insurance.

Last year, when pushing for a bill that didn’t include the option for capping enrollment, advocates said they hoped to cover an estimated 255,000 undocumented New Yorkers. Many noncitizens, including green card holders and asylum-seekers, already qualify for some type of health insurance, while undocumented children under 19 typically qualify for a program called Child Health Plus.

As of this year, New York also extended Medicaid access to low-income, undocumented immigrants older than 65. About 28,000 people have enrolled so far, according to the state health department.

To serve additional undocumented migrants, advocates say the state can use federal surplus dollars generated through the Essential Plan, which offers health insurance to low-income residents who do not qualify for Medicaid. That program has historically received federal subsidies that far outstripped spending.

Cadence Acquaviva, a spokesperson for the state health department, said New York is sitting on about $9 billion accumulated through the program, though that tranche of money is currently frozen and being left to build up interest. But moving forward, the Essential Plan will continue generating extra funds that could be used for undocumented coverage, according to Elisabeth Benjamin, vice president of health initiatives at the Community Service Society.

“Why wouldn’t we offload the financing for people that really need coverage?” she said, adding that this would help “stabilize the health system,” since public and safety net hospitals already shoulder the costs of serving uninsured people.

Peter Semczuk, executive director of Montefiore Health System’s Moses and Wakefield Campuses, said at a Coverage for All rally in the Bronx this month that Montefiore supports the bill. “The Bronx is home to many, many immigrants, one of the largest immigrant communities in the entire United States,” he said. “Montefiore proudly stands with all of you to support all the legislation to make sure that, regardless of the ability to pay, people in this state are adequately insured.”

Ahead of this month’s Senate vote on the bill, some conservative lawmakers also said they worried that federal funding would be insufficient or fall through. They also noted that federal money comes from taxpayers, just like state money.

“Once again we’re going to use taxpayer dollars from people who have done everything right and followed all the rules to now provide a free service to someone who has broken the rules,” said Sen. Dean Murray, a Long Island Republican.