With the release of New York’s FY2026-2027 Final Budget, HCFANY thanks the Governor and the Legislature for enacting proposals to help consumers and patients access affordable, quality health care, and hopes to see continued efforts as HR1 policies are implemented over the next several years. HCFANY is disappointed that the final budget fails to protect […]
With the release of New York’s FY2026-2027 Final Budget, HCFANY thanks the Governor and the Legislature for enacting proposals to help consumers and patients access affordable, quality health care, and hopes to see continued efforts as HR1 policies are implemented over the next several years. HCFANY is disappointed that the final budget fails to protect Essential Plan coverage for half a million New Yorkers who will lose it this July.
HCFANY’s response to this year’s budget falls under four categories: (I) Mitigating Losses from Federal Cuts to Health Care, (II) Protecting and Improving Health Coverage, (III) Enhancing Consumer Transparency, and (IV) Regulating Health Care Prices.
(I) Mitigating Losses from Federal Cuts to Health Care
On July 4, 2025, President Donald Trump signed HR1, also known as the “One Big Beautiful Bill Act”, which has drastically altered eligibility and funding for health insurance for New Yorkers. The New York Department of Health (NYSDOH) estimates that 1.5 million New Yorkers, citizens and immigrants alike, will become uninsured as the changes under HR1 are implemented over the next couple of years.
Action to preserve Essential Plan (EP) coverage for 1.3 million New Yorkers.
Last September, Governor Hochul requested to terminate the State’s Section 1332 Waiver, which would return the EP to the Basic Health Plan under Section 1331 of the Affordable Care Act. This March, New York State of Health announced that the Centers for Medicare and Medicaid Services (CMS) approved New York’s request and will complete this transition on July 1, 2026.
HCFANY is disappointed the final budget did not include funding to keep half a million New Yorkers covered.
In the State’s transition back to the Basic Health Plan, half a million New Yorkers will lose access to health insurance this July, including individuals on the Essential Plan with incomes between 200 to 250 percent of the Federal Poverty Level (FPL), with DACA and PRUCOL statuses, and lawfully present immigrants losing eligibility for premium tax credits. HCFANY fought hard to garner support from the Legislature to sign on to S9589/A10926, a proposal which would preserve coverage for this population, with significant help from the bill sponsors—Senator Rivera and Assemblymember Paulin. Amid devastating federal health care cuts, HCFANY hopes to see the State take action to provide coverage for the half a million New Yorkers losing health coverage starting this July in next year’s Budget.
Action to terminate continuous coverage for children ages 0-6 years
The federal government has made it clear that the State will be forced to discontinue its continuous coverage program for children up to age six, made possible through New York’s Medicaid 1115 Waiver. Although this waiver ends in March 2027, the final budget repeals this program this July.
(II) Protecting and Improving Health Coverage
Expanding continuity of care protections.
Continuity of care protects patients through network disruptions when (1) their provider leaves the plan’s network or (2) the patient switches plans and the current provider they see is no longer in network. The final budget made the following changes to these scenarios:
(Scenario 1: When their provider leaves your plan’s network) A patient is eligible to continue seeing their current provider at the same in-network costs for up to 90 days, or if applicable, through the end of the patient’s postpartum care.
(Scenario 2: When a patient switches health plans and their current provider is no longer in network) A patient is eligible to keep in-network costs with their current provider if the patient has a life-threatening condition, for up to 60 days, and starting January 1, 2027, up to 90 days, only if the provider agrees to the payment rate and rules of the new plan. If pregnant, the patient will be able to see their current provider through the end of postpartum care.
Protecting consumers from repetitive and redundant health plan utilization reviews for individuals with chronic conditions.
A utilization review is conducted to determine if a treatment, testing, or procedure is medically necessary for a patient. The final budget bans this review from being conducted more than once per year, unless the provider changes the patient’s course of treatment.
(III) Enhancing Consumer Transparency
The final budget implements many requirements for insurers who provide coverage on the New York State of Health Marketplace (NYSOH) to improve consumer transparency, many of which complement the recently released 2027 Plan Invitation.
Improving the Department of Financial Services (DFS) Consumer Guide.
The DFS Consumer Guide, which helps consumers pick health plans on NYSOH, will now provide information on grievances, approvals, adverse determinations, appeals, and other pre-authorization issues filed for each plan. HCFANY hopes the State continues to improve the Consumer Guide to serve more consumers, for example, by including DOH-regulated plans. Currently, the Guide does not report on plans that cover 80% of New Yorkers in the individual market.
Requiring public notice when contracts between hospitals and health plans end.
In the final budget, public notice is now required when contracts between hospitals and health plans are planned to end. This will help consumers stay informed when network disruptions occur.
Requiring health plans to make their formulary drug lists more accessible.
Health plans in New York are required to disclose to patients which prescription drugs are covered under their plan in a formulary drug list. Consumers will now be able to view this list without creating an account or password and will have an easier time determining which plan it applies to, if an insurer offers multiple plans.
Adding more covered services, including vision, dental, and nearby cancer centers, to the Essential Plan benefit package.
Next, the final budget will expand coverage of services in the Essential Health Plan Benefit package, including vision and dental care and services provided by cancer centers licensed by DOH within a nearby service area.
(IV) Regulating Health Care Prices
Weakened government oversight on health care transactions
Initially proposed in the Executive Budget, the final budget omitted the proposal requiring the DOH to conduct a more intensive review of health care transactions for cost, quality, access, health equity, and competition, and implementing additional requirements for written notices of such transactions.
Medicaid beneficiaries are now excluded from the independent dispute resolution (IDR) process.
The IDR process was implemented to protect consumers from surprise medical bills by establishing a third-party entity that reviews the payment offers from both the insurer and the provider to determine the cost of the out-of-network service.
