New York City health officials are strategizing now on how to keep as many people as possible enrolled in Medicaid, before new work requirements for the public health insurance program take effect in January, potentially leaving hundreds of thousands without coverage.
The new city budget includes $3 million for the health department to hire community health workers to help people navigate the new federal work requirements and figure out if they qualify for one of many possible exemptions.
Health Commissioner Alister Martin said in an interview that discussions are also underway about other approaches to keeping people insured, such as creating volunteer opportunities in city government that would satisfy the federal requirements. At the health department, that could entail helping others avoid losing coverage, he said.
“There are conversations going on across different city agencies about how we can actually lean in here and potentially say, ‘Yes, this does suck. This is an ill-advised policy. And also, let's convert this into an opportunity for people,’” Alister said.
Medicaid insures 6.4 million low-income people statewide, and more than half of those live in the five boroughs, according to state data. The state Department of Health estimates that at least 475,000 people statewide will lose Medicaid coverage as a result of the new work requirements, although some of the policies that could affect eligibility are currently being challenged in court.
Under the new rules, non-exempt Medicaid enrollees ages 19-64 have to prove they are working or engaging in another eligible activity to maintain coverage. New Yorkers can meet the requirements by earning at least $580 a month, or by working, participating in work programs or doing community service for at least 80 hours a month. Being enrolled in an educational program at least half time also meets the requirement, as does engaging in some combination of these activities.
The Medicaid work requirements were enacted through the massive H.R.1 domestic spending bill passed by Republicans in Congress and President Donald Trump last year. The Trump administration released new rules last month with more details on how state Medicaid programs are supposed to implement the law.
The law exempts a wide range of groups from the work requirements, including former foster youth, pregnant people, those in rehab for drug or alcohol use and people who are “medically frail,” meaning they have serious illnesses or disabilities.
But New York and two dozen other states are suing the Trump administration over the rules released in June because they say the policies set too high a bar for people to qualify for the medical frailty exemption, putting the most vulnerable patients at risk of losing access to care.
The Trump administration’s rules state that it’s not enough to have a serious medical condition such as cancer or HIV, but that the individual also has to prove that condition prevents them from meeting the federal work requirements.
That means states won’t be able to use data such as insurance claims to automatically verify that people qualify for medical frailty exemptions, creating a much bigger hurdle for them to maintain coverage, according to the lawsuit.
Under federal law, states are responsible for verifying that residents qualify for Medicaid and are required, whenever possible, to use available data and documents to confirm someone’s eligibility without asking the person for additional information.
Even if the New York state health department uses those tools to the greatest extent possible, Martin said, his agency estimates that between 400,000 and 900,000 Medicaid enrollees in the five boroughs will still have to take some type of action to prove their eligibility once the work requirements take effect.
“If people are not careful, they’re going to have their Medicaid at risk,” Martin said. “If they’re not aware of what they have to do, there’s going to be trouble.”
Community health centers, which serve large numbers of low-income patients, are also coming up with ways to help keep their patients insured, said Rose Duhan, president and CEO of the Community Health Care Association of New York State.
But Duhan said that will entail working closely with the state Department of Health. She said health centers are hoping to gain access to additional state data, including information on when Medicaid patients’ coverage is up for renewal.
The state Department of Health will send out notices by Sept. 1 to New Yorkers on Medicaid who are subject to the new work requirements, explaining the steps to take to maintain coverage.
