By CARA MATTHEWS
Gannett Albany Bureau
ALBANY -- A report released Tuesday shows that 1.5 million New Yorkers could experience gaps in health-insurance coverage due to fluctuations in their incomes and eligibility for certain programs and subsidies.
Thirty percent of non-elderly residents who are below 400 percent of the federal poverty level - which comes to $76,360 annually for a three-person family - could be affected, according to the Coalition of New York State Public Health Plans.
New Yorkers with incomes that are just above the cutoff for Medicaid eligibility will be most impacted, the report said.
The release of the study follows Gov. Andrew Cuomo's executive order last week for New York to set up a health-insurance exchange by Jan. 1, 2014, as required under the federal Affordable Care Act.
The exchange, a marketplace for individuals and small businesses to purchase coverage, will expand options available to New Yorkers with annual incomes less than 400 percent of the federal poverty level.
It will provide new options for the state's roughly 2.6 million uninsured.
The Coalition of New York State Public Health Plans is urging state officials to make changes to state law so New Yorkers who are in special programs or receive subsidies won't be without health insurance. "Churning" on and off of coverage can hurt continuity of care and management of chronic diseases, the group said.
"Given the large number of New Yorkers who will experience income fluctuations that affect their eligibility, it is essential to mitigate any potential losses of coverage," said James Knickman, president and CEO of New York State Health Foundation, which gave the coalition a grant for the study.
Families that live within 130 percent and 185 percent of the federal poverty level ($19,090 for a family of three) are most vulnerable to "recurrent ups and downs" in their income, the report said.
People are eligible for Medicaid if their income is less than 139 percent of the federal poverty level. There are subsidized programs for low-income families with income that is too high for Medicaid, including Family Health Plus and Child Health Plus.
The coalition represents 10 plans that serve 2.8 million people -- roughly 75 percent of enrollees in Medicaid managed care, Family Health Plus and Child Health Plus.
Cuomo issued an executive order because the GOP-led Senate would not agree to legislation to create the exchange. The federal government will set up the exchanges for states that haven't made significant progress by early next year.
The U.S. Supreme Court recently heard arguments in a lawsuit challenging the Affordable Care Act. It has not issued a decision yet.
Tuesday's report recommends a series of changes that would reduce the likelihood of people losing coverage, said David Sandman, senior vice president of the Health Foundation.
"State officials absolutely do understand the issue and they've made it very clear that continuity and seamlessness are key parts of the coverage strategy," he said.
One of the proposals is for the state to create simple methods for reporting a change in income and finding out whether it affects eligibility.
The state could extend eligibility for Medicaid and Child Health Plus members who are transitioning to coverage in a health plan through the exchange so there wouldn't be a lapse, the study said.
"I think this is exactly the kind of analysis we need that will help the Department of Health as it moves forward in creating the exchange," said Elisabeth Benjamin, vice president of health initiatives for the Community Service Society in New York City.
There are a million "micro details" that state officials have to decide, she said.
The state loses a large chunk of people on public-insurance programs because annual recertification is so complicated, Benjamin said. Purchasing private coverage is difficult. The exchange will be a centralized venue for everyone, she said.
"The promise of health reform is they're setting up all these standardized health systems," she said. "The exchange is the medium for delivering those standardized health plans.
The exchange is expected to reduce the cost of insurance for individuals and small businesses because the risk will be spread out over a larger universe of people, Benjamin said.
"It's buying at wholesale instead of retail," she said.
By CARA MATTHEWS