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Know Your Rights
Source: Albany Watch
Subject: Health Justice & Access

Health coverage for undocumented adults? Late push for measure in NY as session ends

Silvia Carina Mendez had lived with heavy menstrual bleeding for three years with no idea what was making it so severe.

But the bleeding was getting worse, and in January the 46-year-old Rockland County mother felt so weakened she went to a hospital emergency room, then returned the next day and the day after that. Doctors eventually diagnosed her with uterine fibroids and gave her medication to help, but told her she would need surgery to be cured.

That’s out of the question for now. Mendez, who had been working as a housekeeper but had to stop when her condition worsened, has no insurance to cover the surgery cost and can’t afford it on her own. She doesn’t qualify for public health insurance for one reason: she’s an undocumented immigrant.

A renewed push to help immigrants like Mendez is coming to a head in Albany. With just one week left in New York’s 2024 legislative session, immigrant advocacy groups are pressing the Assembly to pass a bill already approved by the Senate that would allow undocumented adults to get medical coverage in New York through a federally funded program.

Supporters say it could help roughly 150,000 low-income New Yorkers ages 19 to 64, the last big population group that remains uninsured as public coverage has expanded in recent years. The state began offering Medicaid coverage to undocumented adults 65 and older in January, and undocumented children already were covered under the state’s Child Health Plus program.

Insuring the remaining adults through the state’s federally funded Essential Plan would cost the state nothing, and could actually save it money, immigrant advocates say. Becca Telzak, deputy director of the group Make the Road New York, said the coverage would spare New York roughly $400 million a year in emergency Medicaid expenses for immigrants cared for in emergency rooms.

Telzak said the “Coverage for All” bill — which cleared the Senate but not the Assembly on the last day of the 2023 session — was amended this year to make sure that the state would never be forced to absorb costs that the federal government doesn’t pay.

2023 push:Will NY provide health coverage for undocumented adults? What we know as budget deadline looms

Mendez, who came the U.S. from Guatemala 17 years ago and lives in Spring Valley with her family, said having no health insurance means she seeks medical treatment only when absolutely necessary, and pays out of pocket when she does.

The severe pain caused by her chronic bleeding brought her to one of those rare crises.

“It’s been about three years,” Mendez said of her condition, speaking in Spanish through an interpreter from Proyecto Faro, a Rockland County immigrant support group that she’s involved with. “It then got progressively worse, so that now I crawled in pain, because it’s unbearable.”

Being uninsured also endangers her livelihood. Mendez said she hasn’t been able to work regularly since December because of her untreated condition, which has in turn made it harder for her to find housekeeping jobs.

Coverage for All: How would it work? Who would pay?

The pending bill would have New York seek the federal government’s approval to expand eligibility for the Essential Plan, which covers those earning too much to qualify for Medicaid but less than 250% of the federal poverty level. That waiver would allow undocumented adults under 65 to enroll as well.

Supporters say it makes sense to let the feds cover medical costs that might otherwise fall to the state or hospitals.

“This pot of money is already sitting there waiting to be claimed,” Assemblywoman Amy Paulin and Theo Oshiro of Make the Road wrote in an April op-ed column.

The Essential Plan program has built up a $9.1 billion surplus, a tempting prospect for those seeking to cover undocumented adults.

But the surplus is off limits, state officials say. Because of another recent waiver that raised the income threshold, “this accumulated balance is suspended for the life of the Waiver and will not be available to support Essential Plan costs,” the Department of Health said in an emailed response to the USA Today Network.

That still leaves the new excess funding the state gets from Washington that theoretically could be used.

Gov. Kathy Hochul’s office declined to comment on the bill, saying only that she’ll review it if it both chambers pass it.

Last year, her administration voiced misgivings, telling the USA Today Network that trying to use the Essential Plan to cover undocumented New Yorkers “carries significant financial uncertainty and risk.” The statement raised doubts both about getting federal consent and estimating the size of the undocumented population and its medical expenses.

Bill Hammond, senior fellow for health policy at the Empire Center for Public Policy, added another uncertain factor: the “fluke” that allows the state to collect more Essential Plan funding than it needs — for now.

“The question is, are the feds going to let that continue,” he said.

Hammond also pointed out that offering Essential Plan coverage would still require taxpayer money, only from Washington instead of Albany.

“It’s not ‘free money,'” he said. “It’s just coming from a different source that state officials aren’t responsible for.”

The Senate passed the bill on May 15 in a party-line vote of 40-21, with Democrats in support and Republicans in opposition. The Assembly has yet to take it up. The last scheduled session day is June 6.

Chris McKenna covers government and politics for The Journal News and USA Today Network. Reach him at