Nearly two years after New York enacted legislation to provide medical coverage to uninsured residents who make too much money to qualify for Medicaid, Gov. George Pataki has announced that the state's "Family Health Plus" plan will begin taking applicants in September 2001.
While supporters of the long-awaited plan say they are happy to be one step closer to the plan's launch, they are dismayed that there is still no concrete application procedure or, in fact, an application form. "It's kind of like having a new car, but we don't have the keys to start it," says Nicole Fenichel, project director for The Long Island Progressive Coalition (LIPC), a grassroots organization that promotes economic and social justice.
| "It's kind of like having a new car, but we don't have the keys to start it." |
Family Health Plus will cover and estimated 600,000 New Yorkers who aren't eligible for Medicaid and aren't offered employer-sponsored health insurance. The plan builds on the state's Child Health Plus program that provides health insurance for children. Family Health Plus will insure certain low-income adults as well as children. It is anticipated the program will cost more than $1 billion over the next three and a half years. Fifty percent of that money will come from the federal government, while state and local governments will make up the other half.
Implementation of the plan has been held up pending federal approvals and waivers, according to the New York State Department of Health. Those last stumbling blocks were removed as of May 30, 2001, when Pataki appeared with Tommy Thompson, United States Secretary of Health and Human Services, to reintroduce the program to both the press and New Yorkers. "This could truly be the most important health care program in America," said Thompson, who noted that New York is the first state to allow a government health insurance program to also insure single adults who do not have children.
Although the program's designers must smooth out the plan's final outreach and application procedures, the plan's benefit design and eligibility requirements have been worked out. Those who join must be ineligible for Medicaid, or eligible only because of their high medical costs. However, unlike Medicaid, there are no asset or financial resources tests.
Maximum annual income for Family Health Plus |
| Family size |
Single or married adult
(not living with children under 21) |
Parent
(living with at least one child under 21) |
1 |
$8,590 |
|
2 |
$11,610 |
$13,932 |
3 |
|
$17,556 |
| 4 |
$21,180 |
5 |
$24,804 |
| Source: New York State Department of Health |
1. Who can join?
Adults, age 19 to 65, who do not have health insurance.
2. What does it cost to join?
Nothing. Funding will be provided by the Medicaid program, with costs shared between the federal, state, and local governments.
3. What services are covered?
- Physician services.
- Inpatient and outpatient health care.
- Prescription drugs.
- Laboratory test and X-rays.
- Vision, speech, and hearing services.
- Emergency room and emergency ambulance services.
- Drug, alcohol, and mental health treatment as determined by the Commissioner of Health. There are limits on days of service.
- Diabetic supplies and equipment.
- Radiation therapy, chemotherapy, and hemodialysis.
4. Who will provide the care?
Managed care plans that currently provide either Child Health Plus or Medicaid managed care may also apply to provide Family Health Plus.
5. What if there is no Medicaid managed care or Child Health Plus provider in my county?
According to the Department of Health, in counties where an approved managed care plan is not available, "similar insurance coverage providing the same benefits will be made available to enrollees."
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