Nearly a third of New Yorkers on public insurance make too much money to qualify: report

Nearly a third of New Yorkers on state-run health insurance plans might be making too much money to qualify, driving rapid spending growth in an already-stretched Medicaid budget, a new report shows.

There are 8.5 million New Yorkers who get health insurance through Medicaid or the Essential Plan, the state’s federally funded health plan for people with incomes up to 250% of the poverty limit. But only 5.5 million of those enrollees appear to fall within income eligibility limits, raising questions about the approximately 3 million New Yorkers who do not qualify for coverage, according to an analysis of U.S. census data published last week by the Empire Center for Public Policy, a right-leaning think tank based in Albany.

Those 3 million enrollees are estimated to cost the state and federal governments $20 billion a year, increasing costs for taxpayers who prop up the state’s ballooning Medicaid budget, the report said. New York is projected to spend $113 billion on Medicaid and the Essential Plan in 2025, nearly doubling its costs from 10 years ago.          The state has lost proper control over the management of these programs,” said Bill Hammond, senior health policy fellow at the Empire Center and author of the report.

Cadence Acquaviva, a spokeswoman for the Department of Health, said that the state disagrees with the report’s estimate, adding that the agency uses a range of federal and state electronic data sources to confirm an applicant’s eligibility for Medicaid and all other state-run health insurance programs.
“As one of the hardest hit states during the pandemic, the state’s public insurance programs have become even more important,” Acquaviva said. “As we pursue innovative ways to expand eligibility, and provide new cost savings initiatives, we know that New Yorkers will continue to apply for programs that can lower coverage costs.”
New York has long tried to control spending in the Medicaid program, but skyrocketing public insurance enrollment has left costs largely out of the state’s control, Hammond said. New York contributed $38 billion to its Medicaid budget, up $10 billion from only three years ago, according to the report.  
Hammond said that growth can largely be attributed to state policy decisions that have eased insurance enrollment requirements. New York has taken advantage of federal rules that allow more people to get coverage through government plans, including by expanding Essential Plan eligibility to families who make up to 250% of the federal poverty limit – or $78,000 for a family of four – to become the highest income eligibility threshold in the country.
Those policies have led New York to enroll more people on public health plans than any other U.S. state, with 44% of residents enrolled in Medicaid and the Essential Plan. Enrollment is even higher in New York City, where 60% of the population gets coverage through Medicaid or the Essential Plan, the report said.
The state has implemented policies to get more New Yorkers on insurance coverage, but Hammond said that the widening gap between people who fall within the income eligibility requirements and total enrollment shows that oversight may be going awry. He said that swelling enrollment not only hurts taxpayers, but it also harms the private insurance market; when healthy individuals enroll in government-funded plans, that leaves sicker people on commercial plans and increases premiums.
But others say that increasing enrollment is needed to help New Yorkers pay for the state’s exorbitant health costs. New York has the second highest medical costs in the country, forcing even residents with insurance plans to struggle to afford insurance premiums and rising hospital prices, said Elisabeth Benjamin, vice president of health initiatives at the Community Service Society, a Midtown-based nonprofit that helps New Yorkers navigate insurance and medical costs.
“Coverage in New York is damn expensive,” Benjamin said. “If we care about the New York state Medicaid budget, we should be looking at the price of care.