The Children's Aid Society

Proposed Funding Cuts to Facilitated Enrollment in New York State Public Health Insurance

March 1, 2004

estimony Before the New York State Legislature

Senate Finance Committee
Assembly Ways and Means Committee
February 3, 2004

by Kate Lawler, Program Director, Health Care Access Program (HCAP), The Children's Aid Society

I would first like to thank the Senate Finance and Assembly Ways and Means Committees for holding this hearing and for the Legislature?s ongoing leadership and commitment to New York?s public health insurance system.

As a facilitated enrollment lead agency working under contract with the New York State Department of Health, The Children?s Aid Society has seen the real-life impact that New York?s Family Health Plus, Medicaid, and Child Health Plus programs have had in the communities where we and our sub-contractors work, particularly in Central Harlem, Washington Heights, Manhattan?s Lower East Side and Chinatown.

We have seen growing numbers of families connecting to a regular source of preventive health care, rather than taking the ?wait and see? approach to health, for fear that a medical bill might mean not paying the rent. We have seen self-employed cab drivers, family day care providers, and hairdressers able to go to work each day with the peace of mind that comes from knowing that they have an active health insurance card in their wallet. We have heard the mother?s sigh of relief because with eyeglasses her son can now see the blackboard or with an asthma management plan, her daughter no longer stands at the sidelines of her gym class.

No matter how you look at it, this is progress for New York. By investing in a solid and accessible public health insurance system, New York reaps the immeasurable benefits of healthier families, healthier communities and a healthier workforce. We must build upon this investment and protect our public health insurance system from attempts to curb outreach, eligibility, enrollment or benefits. We fear that some of this year?s health care proposals would be a setback to the progress that New York has made over the past 5 years. We are particularly concerned about proposals to: 1) cut facilitated enrollment, 2) shift children from Medicaid to Child Health Plus B, and 3) rollback Family Health Plus eligibility and benefits. These cuts would hurt hardworking families and individuals who finally have a long-awaited source of affordable health care.

Cutting Facilitated Enrollment Will Decimate Enrollment in Underserved Communities
Facilitated enrollment was created in recognition of the many barriers that can keep eligible New Yorkers from enrolling in public health insurance through the traditional process at a Medicaid office. Facilitated enrollment has been enormously successful in ensuring that New York?s Medicaid, Child Health Plus, and Family Health Plus programs reach the families and individuals for whom they were created. Over the past four years, community-based facilitated enrollers have enrolled approximately 266,000 children and nearly 100,000 adults in health insurance. The Executive Budget?s proposal to reduce facilitated enrollment for children and eliminate facilitated enrollment for adults will bring enrollment to a screeching halt in many of the communities where we work. The same barriers that used to keep low income New Yorkers from accessing health coverage will once again stand in their way.

* Many Uninsured New Yorkers Cannot Miss Work to Apply for Health Insurance-- Three out of four uninsured New Yorkers work. Facilitated enrollment has offered hard working families and individuals a place to apply for health insurance during evening and weekend hours so that they don?t have to lose a day?s wages going to a Medicaid office. Conveniently located in communities where eligible families and individuals live and work, facilitated enrollment agencies have enabled people to apply for health insurance in schools, community centers and shopping districts that are already part of their everyday lives.
* Facilitated Enrollment has Opened the Door to Non-English Speakers and Other Underserved Populations ? Community-based facilitated enrollment agencies reach immigrant and other underserved communities who have historically been left out of public health insurance programs. Across the state, facilitated enrollment agencies speak over 40 languages and are reaching immigrant and rural communities that previously had minimal access to the public health insurance system. By opening this access point, facilitated enrollment is going a long way toward addressing the health disparities that exist in these underserved communities.
* Facilitated Enrollment is a Single-Entry Point into a Multi-faceted System Facilitated enrollment has given New York families and individuals a single-entry point into a multi-faceted public health insurance system that can feel like a maze without individualized assistance. If adult facilitated enrollment is eliminated, the only place where an entire family will be able to apply for health insurance together will be at a Medicaid office. This will make an already multi-faceted system feel fragmented and even harder to navigate. People will be at greater risk of being bounced around from office to office, creating frustration and inefficiencies for applicants and enrollment entities alike.

Shifting Kids from Medicaid to Child Health Plus B Can Lead to Loss of Coverage and Essential Services
The Executive Budget proposes to lower the Medicaid limit for children ages 6 to 18 from 133% of the federal poverty level (FPL) to 100% FPL. In effect, this means that tens of thousands of children and teens will have to move from Medicaid to Child Health Plus B. From firsthand experience, we know that despite everyone?s best efforts, such transitions between programs are not always seamless and kids can lose coverage in the process. The transfer from Medicaid to Child Health Plus B is particularly difficult because the Child Health Plus B coverage cannot begin until the Medicaid case is closed and yet the end date of a child?s Medicaid coverage is not always predictable. This can lead to gaps in coverage and can require tremendous staff resources and coordination between facilitated enrollment agencies, local districts and health plans.

Children and teens with special health care needs required to switch from Medicaid to Child Health Plus B will lose access to essential services that are covered more comprehensively by the Medicaid program. Limits on Child Health Plus B coverage for home health care, therapeutic services, and speech and hearing services can be particularly problematic for special needs kids.

Cuts to Family Health Plus will Hurt Low Income Adults
Finally, through the Family Health Plus program, hundreds of thousands of low-income adults in New York finally have a long-awaited option for affordable health coverage. Cuts to benefits or eligibility would be a tragic setback to this progress. First, the proposal to impose a Family Health Plus assets test would mean that low-income New Yorkers, with even modest savings, would no longer be eligible for health coverage, even if they are unemployed or working at or below minimum wage. Second, the proposal to exclude from Family Health Plus employees who work for companies of more than 50 people would hurt individual workers who have no control over whether or not their employer offers coverage. Lastly, the proposals to eliminate the Family Health Plus dental and vision coverage would leave low income New Yorkers with out-of-pocket expenses that they simply will not be able to afford.

In conclusion, we fear that proposals to curb outreach, enrollment, eligibility, and benefits within New York?s public health insurance system will significantly setback the progress that has been achieved in recent years. We fear that the communities where we and other facilitated enrollment agencies work throughout the state will be especially hurt by these changes. On behalf of these communities, we urge you not to cut the health care programs that are so vital to the health and well-being of low income New Yorkers.

Thank you again for the opportunity to present testimony at this important hearing.

For more information about the Health Care Access Program (HCAP), call Kate Lawler at (212) 503-6801.