New York’s legislative session ended Friday without lawmakers passing a bill to extend subsidized health coverage to some 255,000 undocumented immigrants who are currently excluded. With members of the Assembly now talking about returning for a special session in the coming weeks, advocates said there’s still hope but that Gov. Kathy Hochul remains a wild card.
The state Senate voted 41-21 in favor of the so-called “Coverage for All” bill just before lawmakers were officially dismissed. The bill already made it through the Assembly Health Committee and has 63 sponsors. It needs at least 76 votes to pass on the Assembly floor.
“Essentially we just ran out of time,” Assemblymember Jessica González-Rojas, who introduced the bill in her chamber, told Gothamist Monday. “I’m very hopeful we’ll get it done during the special session.”
But that’s not all that’s needed for the program to move forward. In addition to signing the legislation, Hochul would need to get approval from the Biden administration to use federal funds to extend coverage to this new population. People who are undocumented are typically excluded from federal health insurance subsidies.
The U.S. Department of Health and Human Services has voiced its support for the extension, so if Hochul and the Assembly come through, all the big roadblocks are ostensibly clear. Most importantly, according to health care providers and immigrant rights activists, moving undocumented patients to the Essential Plan would allow them to access more preventive care, rather than waiting until they have to go to the emergency room.
“We are eager to work with Speaker [Carl] Heastie and members of the Assembly to ensure that New York takes this crucial step to achieve health equity and strengthen both the state’s economy and its healthcare system,” the Coverage for All Coalition, which includes immigrant advocacy organizations and labor groups, wrote in a statement Monday.
The potential path to Coverage for All
Advocates argue that, with the proper permissions, New York could secure coverage for undocumented immigrants at no cost to the state, using only federal dollars. The amended version of the Coverage for All bill that passed the Senate would make the program contingent on receiving the necessary federal approval.
But Hochul’s office did not respond to questions Monday about whether she is willing to seek the necessary approvals to make the plan for undocumented coverage a reality.
The state’s Essential Plan, which provides coverage for low-income residents who don’t qualify for Medicaid, typically costs less money to administer than it receives from the federal government, and New York is able to put the extra funds in a trust.
New York City Mayor Eric Adams and Congresswoman Alexandria Ocasio-Cortez joined the call earlier this year for Hochul to seek permission to use that surplus to extend Essential Plan coverage to undocumented immigrants in her request for a special health insurance waiver. Instead, she submitted that waiver request with a proposal to expand eligibility to those with higher incomes — but not to people who are undocumented.
Hochul would have to revise and resubmit the special waiver if the Coverage for All bill becomes law. In April, the governor’s office raised concerns that, even with federal subsidies, some of the cost of providing this coverage could still fall on the state, particularly if more people sign up for the plan than anticipated.
But in a letter to New York lawmakers on June 6, the U.S. Department of Health and Human Services confirmed that it would be possible to use federal funding to support the program, noting that Colorado and Washington state have obtained similar waivers to do so.
“We appreciate New York’s longstanding commitment to providing affordable health insurance coverage to its residents, and look forward to continuing to work with the State on this matter,” Chiquita Brooks-Lasure, administrator for the U.S. Centers for Medicare and Medicaid Services, added in the letter.
Some members of the state Senate expressed concerns about the initiative in a debate ahead of last week’s vote. Sen. Dean Murphy, a Long Island Republican, asked bill sponsor Sen. Gustavo Rivera what would happen if the cost of providing coverage to undocumented people exceeded federal subsidies.
Rivera responded that the state could simply restrict who was eligible. The legislation indicates that those with the lowest incomes should be prioritized. The commissioner could also prioritize people who are waiting for an organ transplant or have other serious health needs, according to the legislation.
“There might be some parts of the population we would not be able to cover,” said Rivera, who chairs the Senate Health Committee. “The language in the bill actually allows the commissioner some flexibility so we would not be on the hook for those individuals.”
Rivera and other advocates have argued that expanding Essential Plan coverage would save the state about $500 million annually that is currently spent on Emergency Medicaid, a program that covers the cost of emergency care for people who are undocumented.
Notably, those who are not citizens but who are here legally, including people applying for asylum in the U.S., are eligible for traditional Medicaid.
Murray countered that, even if every undocumented New Yorker could be covered through federal funds, the bill still sends the wrong message.
“We have a legal process for immigrants to come to this country, and if they don’t do it that way legally through that process, then they’ve broken the law,” Murray said. “When we continue to say, ‘Well, you shouldn’t have done it but we’re going to give you this or give you that,’ I can’t help but say we’re encouraging more activity like this.”
Health care providers, immigrant groups and New York City Health Commissioner Dr. Ashwin Vasan are among those who wrote letters urging state officials to amend the waiver request to the federal government to include undocumented immigrants during the public comment period earlier this year.
The Healthcare Association of New York State stated in its letter that the measure would allow clinicians to get paid adequately for their services when they do see those who are undocumented.
