Over 6.6 million New Yorkers browse and enroll in health coverage through New York’s official health plan Marketplace, New York State of Health (NYSOH). As of January 2026, 4.1 million were enrolled in Medicaid, 210,000 in Qualified Health Plans, 551,000 in Child Health Plus, and 1.7 million in the Essential Plan. Every year, the New […]
Over 6.6 million New Yorkers browse and enroll in health coverage through New York’s official health plan Marketplace, New York State of Health (NYSOH). As of January 2026, 4.1 million were enrolled in Medicaid, 210,000 in Qualified Health Plans, 551,000 in Child Health Plus, and 1.7 million in the Essential Plan. Every year, the New York Department of Health (DOH) issues a plan invitation that outlines requirements and guidelines that health insurers must follow to participate in the Marketplace. HCFANY is thankful for the continued efforts of the State to ensure that consumers have an easier time navigating, affording, and accessing health insurance coverage in New York, amid federal cuts to health care.
New Yorkers who receive coverage through NYSOH have been greatly impacted by federal health care cuts, enacted by HR1. Those previously on Qualified Health Plans have already lost enhanced premium tax credits, which expired last year. With the termination of New York’s Section 1332 Waiver, cost-sharing initiatives that helped around 62,000 individuals save $50 million in health care costs will end. Lastly, half a million will lose their Essential Plan coverage starting July, unless the State acts now and implements bill S9589|A10926 in the final budget.
From this year’s 2027 NY State of Health Plan Invitation, HCFANY is pleased to see the following recommendations adopted:
Enforcing greater network adequacy standards:
- Specialists, or non-primary care providers, must meet the 30-minute or 30-mile time-and-distance standards.
Improving consumer transparency through network disruptions and provider directories:
- Plans are now required to submit disruption analysis reports earlier to NYSOH, at least 30 days before any consumer notices are scheduled to go out.
- Plans need to provide hospital network contracting status and anticipated contract end dates on a bi-annual basis for NYSOH to proactively monitor network stability for consumers.
- Plans must indicate and give consumers advance notice within their online provider directories when a provider, group, or facility will be leaving the network.
- The Department of Health will start collecting data and metrics on consumer complaints with provider directories.
Protecting consumers during substantial network changes:
- A special enrollment period will be created for members who experience a mid-year network disruption that materially affects access to covered services to allow consumers to change plans.
Expanding the Consumer Guide:
- NYSOH will collaborate with Department of Financial Services (DFS) to improve the consumer guide for individual market consumers by including DOH-regulated plans.
Enhancing information access to mental health and substance use disorder services:
- Plans must now establish and maintain a publicly accessible webpage that provides enrollees with information about behavioral health resources.
HCFANY is grateful that DOH and DFS continue to prioritize consumer protection and transparency. Stay tuned, as HCFANY will review the final State budget in the coming weeks.
