Chapter Listing

Overview of COVID-19 Impact

Health Benefits: Changes Under COVID-19

Summary

This section will address the changes and resources available on health-related programs and services as a result of COVID-19 for:

  • Medicaid
  • Medicare
  • Medicare Savings Program (MSP)
  • Medicare Part D
  • Qualified Health Plans
  • Other Health Plans
    • Child Health Plus
    • Essential Plan

Medicaid

SUMMARY

Eligibility requirements for both MAGI and Non-MAGI Medicaid applicants have not changed as a result of COVID-19. However, the application procedures for Non-MAGI Medicaid and program requirements have been modified under COVID-19. For HRA’s FAQ for non-MAGI applicants/recipients, visit: https://www1.nyc.gov/site/hra/help/dss-covid19-faqs.page.

If you are a Benefits Plus Online subscriber and want additional information on Medicaid, refer to Benefits Plus Online, Health Programs, Medicaid.

Eligibility guidelines for non-MAGI Medicaid and Medicare Savings Programs were increased effective January 1, 2023. In addition, easements in place as a result of COVID-19 are ending as a result of legislation passed in December 2022.

For subscription information visit: https://bplc.cssny.org/home/subscription_options.

CHANGES IN NON-MAGI APPLICATION PROCEDURES

Applicants applying for Medicaid as MAGI households continue to submit an application via the NY State of Health at https://nystateofhealth.ny.gov or by calling 1-855-355-5777, there is no change.

To learn more about non-MAGI vs. MAGI Medicaid, refer to Benefits Plus Online, Health Programs, Medicaid, MAGI Medicaid vs. Non-MAGI Medicaid.

Application Procedures

Additional guidance is found at https://health.ny.gov/health_care/medicaid/covid19/factsheets/eng_guide_med_cons_enrolled_thru_ldss.htm.

Local Medicaid Offices

Most Medicaid offices have reopened for in-person assistance. To find open locations, visit: https://www1.nyc.gov/site/hra/locations/medicaid-locations.page.

Medicaid Application

The Medicaid application is the DOH-4220, Access NY Health Care and the DOH-5178A, Supplement A. Effective January 1, 2021, Supplement A, is required for all non-MAGI Medicaid applications, not only for those applying for Community Based Long Term Care Services or Institutional Medicaid.

Submitting an Application Via Fax

During the COVID-19 emergency, non-MAGI Medicaid applicants are able to submit a Medicaid application via fax to 917-639-0732. In addition, young adults under age 26 who were formerly in foster care may submit an application via fax.

Individuals who have an immediate need for home care, can fax their application and home care request to 917-639-0665.

Submitting an Application via Facilitated Enrollers

Non-MAGI Medicaid applicants may also contact a facilitated enroller (FE) to apply for Medicaid via telephone. The FE, community-based organizations contracted by NYS to assist the aged, blind and disabled population with application/ recertification assistance, must send the individual a copy of the Medicaid application to use during the required telephone interview, as well as the DOH form 5147, Submission of Application on Behalf of Applicant, which allows the FE to sign the application on the applicant’s behalf. Both these forms can be sent by standard mail or by email, if acceptable to the applicant.

The applicant must sign and return both documents prior to conducting the interview. The form can be scanned and emailed back to the FE ABD agency.

Applicants can attest to all elements of eligibility except immigration status and identity, if the immigration document does not also prove identity, see below, Documentation.

Beginning June 2023 in NYC, and July 2023 in the rest of NY, documentation “easements” are ending and applicants will be required to provide all documentation when applying for Medicaid;

A listing of Facilitated Enrollers in NYC can be found here. The following agencies serve as facilitated enrollers in NYS:

DOCUMENTATION

Missing Documentation

During the COVID-19 emergency, if an applicant has missing information, their local district will attempt to contact them via phone or e-mail (the district does not need to receive the information in writing and can accept information verbally).

If the local district is unable to contact the individual, the local district will send a written request for the missing information with a due date of no less than 10 days.

Self-Attestation

Local districts must allow for self-attestation for all eligibility criteria, except for immigration status and identity, if the immigration document does not also prove identity. Applicants that need to prove immigration status/identity should submit the required copies of documentation. However, if an applicant is not able to submit documentation due to the COVID-19 emergency, the application should still be submitted and processed. Applicants will be granted a 90-day reasonable opportunity to provide the required documents. If the COVID-19 emergency has not ended and supporting documents have not been received at the end of the reasonable opportunity period, coverage should be extended for a second 90-day period.

Applicants whose citizenship status is not verified through data sources will be given an opportunity to submit documents later.

Self-attestation applies to both initial applications or for a request for an increased coverage and redetermination.

Beginning June 2023 in NYC, and July 2023 in the rest of NY, documentation “easements” are ending and applicants will be required to provide all documentation when applying for Medicaid.

Self-Attestation for Nursing Home Level of Care

In addition, individuals applying for Medicaid coverage of nursing home care can attest to income and resources during this emergency, including attesting to any transfer of assets in the look-back period.

The use of the Asset Verification System (AVS) provides the agency with bank account and real property information. Documentation is only required when information is not available in AVS or for incapacitated individuals that cannot consent to AVS.

WAIVING OF APPLICATION REQUIREMENTS

Application for Other Benefits

During the COVID-19 emergency, applicants will not be required to apply for Medicare or Social Security; in addition, referrals for Veterans benefits have been suspended. This requirement is waived for the period of the COVID-19 emergency.

Child Support Requirements

Medicaid recipients are not required to comply with child support requirements to apply for or maintain Medicaid coverage. Clients can call 929-221-7676 or email dcse.cseweb@dfa.state.ny.us, or write to the NYC Office of Child Support Services, PO Box 830, Canal Street Station, New York, NY 10013 and state their willingness to comply. Clients should provide their name, case number and contact information. Demonstrated compliance is suspended until further notice.

Third Party Health Insurance

Applicants will not be required to provide third party health insurance information and local districts are not required to make new cost-effective determinations for possible reimbursement.

Application Signatures

If a signature on the Access NY Application and/or Supplement A cannot be signed by the applicant (or the applicant’s spouse) and the applicant is in a hospital or nursing home, the application can be signed by someone acting on behalf of the individual. The individual who is signing on behalf of the application must complete Submission of Application on Behalf of Applicant (DOH-5147 for NYS (http://coverage4healthcare.org/insurance_over_65/authorized_representative.pdf); MAP3044 for NYC) and must note the applicant cannot sign the form due to access issues/COVID-19 emergency.

If the applicant can sign the application, then the applicant must sign the DOH-5147 themselves to authorize another person or the facility to apply on behalf of the individual.

CHANGES IN MEDICAID RENEWALS

NYS’ Medicaid GIS on Medicaid Eligibility Processes During the Emergency Period: https://health.ny.gov/health_care/medicaid/publications/docs/gis/20ma04.pdf.

Renewal Extensions

All cases due to expire during the months of March 2020 through March 31, 2023, are extended for 12 months. Cases will NOT be closed for failure to renew or for failure to provide documentation unless the individual voluntarily cancels their Medicaid or moves out of NYS.

This provision applies regardless of any changes in circumstances that would otherwise have resulted in coverage termination. Individuals do not need to take any action to keep their coverage. However, if an individual informs the district of a change that results in an increase in Medicaid coverage, the district is required to process the change.

Any case that is closed will be re-opened and coverage restored to ensure no gap in coverage. If a renewal, notice or other correspondence is returned to the district with no forwarding information, the district must maintain coverage for the case for the duration of this emergency.

The renewal extension applies to all renewal cases including Office of Mail Renewal, Medicaid Spenddown cases, Managed Long Term Care, Nursing Home Eligibility, Medicare Savings Program, and Medicaid Buy-In for Working People with Disabilities.

Starting in March and April 2023, and lasting for 12 months, all Medicaid beneficiaries will need to renew to assess continued eligibility. Those with coverage through the LDSS (HRA in NYC) should receive renewal packets in the mail. (Those with non-MAGI Medicaid who wish to be rebudgeted under the higher 2023 income limits prior to receiving the renewal packet in the mail can request to be rebudgeted by following the instructions received in the mail.)

Turning 65

Medicaid recipients on the NY State of Health Marketplace who turn 65 will maintain their coverage on the Marketplace for the duration of the emergency, see more information below, Medicaid, Transition of Cases to and from NY State of Health Marketplace (NYSOH).

Spenddown Cases

Local districts should not increase an individual’s spenddown liability, as this is considered a reduction in coverage.

Individuals must continue to meet their surplus requirement if they want to have Medicaid coverage. MAP-3183 (dated 09/02/2021) was sent to all Surplus beneficiaries to this effect.

Individuals who have a spenddown and have been unable to submit a bill or payment due to the COVID-19 emergency should contact their local district; in NYC they should call the MICSA Surplus Helpline at 929-221-0835. The individual should include the following information:

  • Name
  • CIN
  • Phone number
  • If submitting a bill, provide the name of the provide, the date of the service, and the amount of the bill
  • If submitting a payment, indicate the amount of the payment.

Clients will receive a call back if additional information is needed. If the requested information is provided, coverage will be extended for 6 months.

With the increase in income and resource limits for non-MAGI Medicaid beginning January 2023, those who wish to be rebudgeted under the higher 2023 income limits prior to receiving their renewal packet in the mail can request to be rebudgeted by following the instructions received in the mail.

Transition of Cases to and from NY State of Health Marketplace (NYSOH)

WMS TO NY STATE OF HEALTH

Effective April 2020, upstate transitions from WMS to NYSOH are suspended. For NYC, individuals who are transitioned to NYSOH but who do not gain Medicaid coverage through NYSOH will have their case re-opened on WMS.

NY STATE OF HEALTH TO WMS

The monthly referrals of WMS for those individuals turning 65 with an active Medicaid case on NYSOH were suspended as of March 19, 2020. However, referrals for those turning 65 to NYSOH may still be sent to local districts because another identifier triggered the transition to WMS, such as receipt of community-based long term care services, see immediately below.

MEDICAID MANAGED CARE ISSUES

Prior to the COVID-19 crisis, anyone with Medicare could not remain in a Mainstream Medicaid Managed care plan (MMC), HIV Special Needs Plan (SNP) or a Health and Recovery Plan (HARP). (All these plans cover long-term care services and supports.) At this time, individuals with Medicaid who become Medicare eligible are maintaining their Medicaid coverage through NY State of Health.

With a new process called Default Enrollment, some plan enrollees are enrolled in the same Medicare Advantage Dual Special Needs Plan or Medicaid Advantage Plus plan as their Medicaid insurer.

If you are a Benefits Plus Online subscriber, for additional information on Default Enrollment, refer to Health Programs, Medicaid,Medicaid Managed Care Provisions. For subscription information visit: https://bplc.cssny.org/home/subscription_options.

SOURCE MATERIALS

https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/20ma04.pdf
https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/20ma05.pdf
http://www.wnylc.com/health/news/86/

Medicare

SUMMARY

Standard coverage and cost-sharing rules still apply for both inpatient (Medicare Part A) and outpatient (Medicare Part B) care. Medicare has allowed an expansion of the use of telehealth services, reduced coverage requirements for skilled nursing facility (SNF) care, opened up their enrollment procedures, and Medicare Advantage plans must allow beneficiaries to receive health care services with out-of-network providers, among other changes.

If you are a Benefits Plus Online subscriber, for additional information on Medicare, refer to Health Programs, Medicare. For subscription information visit: https://bplc.cssny.org/home/subscription_options.

CHANGES IN REQUIREMENTS FOR ACCESSING BENEFITS

Coronavirus Testing – Lab-Based Molecular PCR and Antigen tests

Medicare Part B covers the full cost of a Molecular PCR test and rapid antigen when the test is performed by a laboratory, pharmacy, doctor, or hospital, and when a doctor or other authorized health care professional orders it. A Medicare beneficiary can also get up to one lab-performed test a year without an order, with no out-of-pocket cost.

In addition, beneficiaries can get tested at “parking lot” test sites operated by pharmacies and other entities consistent with state requirements. Medicare is also covering certain antibody tests.

Those in Medicare Advantage plans have no out-of-pocket costs for these services, similar to Original Medicare.

Go to https://www.cms.gov/newsroom/press-releases/trump-administration-issues-second-round-sweeping-changes-support-us-healthcare-system-during-covid for more information.

Everyone, regardless of insurance, is able to order 8 free at-home rapid antigen covid tests at https://special.usps.com/testkits.

Coronavirus Testing – At-Home Rapid Antigen Tests

Effective April 4, 2022, Medicare Part B covers up to 8 at-home rapid antigen covid tests per Medicare beneficiary per calendar month for the duration of the Public Health Emergency. The cost of the test is covered in full, meaning that the Medicare beneficiary has no deductible or co-insurance for these tests, and providers are not permitted to balance bill the beneficiary for any costs. The coverage applies to people in Original Medicare as well as in Medicare Advantage plans; all beneficiaries should use their red, white and blue Medicare card when obtaining these tests, even if enrolled in a Medicare Advantage plan.

Medicare beneficiaries MUST use participating pharmacies or health care providers and Medicare will pay the providers directly; Medicare will not reimburse beneficiaries for any tests they purchase. National pharmacy chains are participating in this initiative, including: Albertsons Companies, Inc., Costco Pharmacy, CVS, Food Lion, Giant Food, The Giant Company, Hannaford Pharmacies, H-E-B Pharmacy, Hy-Vee Pharmacy, Kroger Family of Pharmacies, Rite Aid Corp., Shop & Stop, Walgreens and Walmart. For more locations, visit https://www.medicare.gov/medicare-coronavirus#300 or call 1-800-Medicare.

For FAQ, visit https://www.cms.gov/files/document/4422-frequently-asked-questions-medicare-coverage-otc-covid-tests.pdf.

Coronavirus Vaccine and Booster

The COVID vaccine and boosters are covered under Medicare Part B for those with Original Medicare, and by the plan for those in Medicare Advantage plans. There is no cost-sharing (deductible, coinsurance, or copayment) for the vaccine or boosters.

Skilled nursing facility (SNF) CARE

Medicare Part A generally only covers SNF care if someone was a hospital inpatient for three consecutive days before entering the SNF. During the COVID-19 emergency, Medicare has removed the three-day hospital stay requirement for beneficiaries who are affected by this emergency, including beneficiaries who:

  • Need to be transferred to a SNF, for example, due to nursing home evacuations or to make room at local hospitals
  • Need SNF care as a result of the COVID-19 emergency, regardless of whether they were previously in the hospital.

Medicare is also changing other SNF coverage requirements. Typically, Medicare Part A covers up to 100 days of SNF care each benefit period. During the COVID-19 emergency, beneficiaries who cannot start a new benefit period can get another 100 days of covered SNF care without having to begin a new benefit period. For more information about benefit periods, refer to Health Programs, Medicare, Medicare Covered Services, Covered Services – Medicare Part A, Benefit Period.

Caution: The flexibilities regarding SNF coverage during the Public Health Emergency specify that it can be used only by people who experience “dislocations or are otherwise affected by COVID-19.” See page 19 of this CMS document for more information.

Telehealth Services

Medicare had generally only covered telehealth services in limited situations. During the COVID-19 emergency Medicare expanded coverage and access and will cover hospital and doctors’ office visits, behavioral and mental health counseling, preventive health screenings, and other visits via telehealth services for all beneficiaries. Limited telehealth services can also be delivered using only audio. These services include counseling and therapy provided by an opioid treatment program, behavioral health care services, and patient evaluation and management. Medicare permanently expanded the use of telehealth for mental health services.

CMS is waiving limitations on the types of clinical practitioners that can offer Medicare telehealth services; other practitioners, such as physical therapists, occupational therapists, and speech language pathologists, can now provide such services.

Standard Medicare cost-sharing may apply, but a provider can choose not to charge for the cost-sharing for these services. If a beneficiary has a Medicare Advantage Plan, they should contact their plan to learn about its costs and coverage rules.

Medicare Part D

Among other changes, Medicare Part D plans must cover formulary drugs at out-of-network providers, cover up to a 90-day supply of prescription drugs, and make other needed changes to ensure beneficiaries can access their medication.

The following rules apply to all Part D plans, whether standalone plans that work with Original Medicare or Medicare Advantage plans that include Part D coverage, must cover 90-day refills of prescriptions (except in cases of a safety concern). Part D plans are required to do this during a Public Health Emergency. See this link and this link for more information on this provision.

If you are a Benefits Plus Online subscriber, for additional information on Medicare Part D, refer to Health Programs, Medicare, Medicare Part D. For subscription information visit: https://bplc.cssny.org/home/subscription_options.

Part D plans must:

  • Cover formulary Part D drugs filled at out-of-network pharmacies
    • Part D plans must do this when beneficiary cannot be expected to get covered Part D drugs at an in-network pharmacy.
  • Cover up to 90-day supply of the prescription (or the length of the prescription, whichever is shorter) at the beneficiary’s request
    • During the emergency, all Medicare Advantage and Part D stand-alone plans must cover up to a 90-day supply of a drug, as long as they have a prescription for that amount, when a beneficiary asks for it.
    • Plans cannot use quantity limits on drugs that would prevent a beneficiary from getting a 90-day supply, if they have a prescription for that amount.
    • However, some safety limits are still in place to prevent unsafe doses of opioids.
  • Make other needed changes to ensure beneficiaries can access their medication without interruption
    • Plans have different options for how to do this, such as lifting restrictions that prevent a beneficiary from filling a prescription too soon.
      Medicare has also given plans the flexibility to make optional changes. These optional changes include:
  • Removing prior authorization requirements for certain services
  • Relaxing restrictions on home or mail delivery of prescription drugs
  • Relaxing restrictions on refilling prescriptions too soon
  • Making mid-year changes that would provide more generous coverage (lower cost-sharing) or adding additional benefits
  • Not disenrolling beneficiaries who:
    • Fail to pay premiums
    • Live outside of plan service area for more than six months
    • No longer qualify for specialized type of plan known as Special Needs Plan (SNP)

Every Medicare Advantage and Part D stand-alone plan is different. Beneficiaries should contact their plan directly to learn about how it covers services related to coronavirus.

Changes for Medicare Advantage Plans

During the COVID-19 emergency, Medicare Advantage Plans must work to maintain access to health care services and prescription drugs for plan members. Medicare Advantage Plans must:

  • Allow beneficiaries to receive health care services at out-of-network doctor’s offices, hospitals, and other facilities
  • Charge in-network cost-sharing amounts for services received out-of-network
  • Waive referral requirements
  • Suspend rules requiring the beneficiary tell the plan before getting certain kinds of care or prescription drugs, if failing to contact the plan ahead of time could raise costs or limit access to care.

This requirement applies whenever there is a declaration of a disaster, emergency or public health emergency. This CMS memo reinforces these requirements.

Medicare Savings Program (MSP)

SUMMARY

Medicare Savings Programs help to pay for costs associated with Medicare Part A and Part B coverage. While most aspects of the program remain the same, it is important to note the easements in place due to the public health emergency.

Eligibility guidelines for Medicare Savings Programs were increased effective January 1, 2023. In addition, easements in place as a result of COVID-19 are ending as a result of legislation passed in December 2022.

If you are a Benefits Plus Online subscriber, for additional information on the Medicare Savings Program, refer to Health Programs, Medicare – Programs to Assist with Cost Sharing, Medicare Savings Program – QMB, and QI. For subscription information visit: "https://bplc.cssny.org/home/subscriptionoptions":https://bplc.cssny.org/home/subscriptionoptions.

ELIGIBILITY

MSP applicants are usually required to collect Social Security benefits as a condition of applying (with the exception of those who are working full time). This requirement is suspended due to the public health emergency.

APPLICATION

People can apply for the Medicare Savings Program (MSP) by mail, fax, at a Medicaid office, or with a facilitated enroller. With Medicaid office staffing limited, it may be most effective to apply over the phone with a facilitated enroller.

Clients are asked to only visit a Medicaid office if necessary. Individuals can call the Medicaid helpline at 1-888-692-6116 with questions.

DOCUMENTATION

At this time, applicants are allowed to self-attest to all eligibility requirements, with the exception of identity and citizenship/immigration, if immigration document does not also prove identity. Copies of documents that prove immigration and/or identity status should still be submitted.

If applicants are unable to submit this documentation due to the COVID-19 Emergency, the application should still be submitted. Clients will be given an opportunity to submit the documents later. Clients whose citizenship status is not verified through data sources will also be given an opportunity to submit the documents later.

Beginning June 2023 in NYC, and July 2023 in the rest of NY, documentation “easements” are ending and applicants will be required to provide all documentation when applying for a Medicare Savings Program.

RENEWAL EXTENSIONS

All cases due to expire during the months of March 2020 through March 31, 2023, are extended for 12 months. Cases will NOT be closed for failure to renew or for failure to provide documentation unless the individual voluntarily cancels their Medicare Savings Program or moves out of NYS.

This provision applies regardless of any changes in circumstances that would otherwise have resulted in coverage termination. Individuals do not need to take any action to keep their coverage. However, if an individual informs the district of a change that results in an increase in MSP coverage, the district is required to process the change.

Any case that is closed will be re-opened and coverage restored to ensure no gap in coverage. If a renewal, notice or other correspondence is returned to the district with no forwarding information, the district must maintain coverage for the case for the duration of this emergency.

The renewal extension applies to all renewal cases including Office of Mail Renewal, Medicaid Spenddown cases, Managed Long Term Care, Nursing Home Eligibility, Medicare Savings Program, and Medicaid Buy-In for Working People with Disabilities.

Beginning in March and April 2023, those with MSP will be rebudgeted to assess ongoing eligibility. With the increase in income and resource limits for MSP beginning January 2023, those who wish to be rebudgeted under the higher 2023 income limits prior to receiving their renewal packet in the mail can request to be rebudgeted by following the instructions received in the mail.

Advocacy Tip: Individuals with an MSP are deemed eligible for Full Extra Help for Part D. Since MSP eligibility is being automatically extended, clients should maintain Full Extra Help coverage. Those with MSP in any months between July – December 2022 will have Full Extra Help for the remainder of 2022 and for the duration of 2023. Those with MSP in any month in 2023 will have Extra Help through 2023.

Qualified Health Plans on NYS of Health marketplace

SUMMARY

The NY State of Health opened a special enrollment period allowing individuals who are uninsured to enroll in a Qualified Health Plan, as well as allowing a grace period to pay for a health plan’s monthly premium.

If you are a Benefits Plus Online subscriber, for additional information on Qualified Health Plans, refer to Health Programs, Affordable Care Act, Plans on the Marketplace & Who Qualifies, Qualified Health Plans. For subscription information visit: https://bplc.cssny.org/home/subscription_options.

OPEN ENROLLMENT

Typically, open enrollment in NYS runs from November 1st through January 31st of the following year. However, New York State created an “exceptional circumstances” special enrollment period for anyone who is uninsured during the COVID pandemic. The 2022 open enrollment period was expected to last from November 16, 2021 – January 31, 2022, however it has been extended indefinitely as a result of the continued renewal of the federal Public Health Emergency. See this press release from NY State of Health.

Individuals apply for coverage through NY State of Health on-line at https://nystateofhealth.ny.gov, by phone at 855-355-5777, or by working with Navigators: https://info.nystateofhealth.ny.gov/ipanavigatorsitelocations.

For additional information on special enrollment periods visit: https://info.nystateofhealth.ny.gov/resource/questions-and-answers-coronavirus-special-enrollment-period-english.

NO COST SHARING FOR COVID-19 TESTING

There is no cost-sharing for COVID-19 testing for individuals enrolled in qualified health plans.

Effective January 15, 2022, Qualified Health Plans must cover either at-home antigen covid tests per member per month at no cost to the member. If the plan has a network in place for these tests, the plan will pay up to $12/test (i.e., $12 for one test, $24 for a pack of 2 tests). If they don’t have a network in place to supply the tests, they will have to reimburse the full cost of the tests (i.e., if they charge $35 for a box of 2, that will be covered). Plans can pay for the cost up-front or reimburse you.

There is no limit to the number of tests (at-home or lab-based) that a plan will cover per month if they are ordered by a health care provider following an assessment.

WHEN HOUSEHOLD CIRCUMSTANCES HAVE CHANGED

Households should update their account within 60 days of the change on the NYS of Health Marketplace. Anyone who has experienced a change in income, employment or other major life event, may qualify for more financial help that could lower their health insurance costs.

PAYMENT OF PLAN PREMIUMS

Individuals enrolled in subsidized or unsubsidized coverage in NYS may have more time to pay their health insurance premiums during the COVID-19 emergency. For more information on this grace period visit the Department of Financial Services at https://www.dfs.ny.gov/press_releases/pr202003301 and the NYS of Health Marketplace at https://info.nystateofhealth.ny.gov/resource/questions-and-answers-coronavirus-special-enrollment-period-english.

For a fact sheet visit: https://info.nystateofhealth.ny.gov/sites/default/files/NYSOH%20COVID-19%20Grace%20Period%20and%20SEP%20QAs%205-11-20.pdf

Premium Tax Credit (PTC)

Temporary improvement as a result of the American Rescue Plan:

  • To qualify for the PTC, typically households must have income below 400% of the federal poverty level (FPL). The American Rescue Plan Act increased the amount of the premium tax credit for those with incomes up to 400% FPL. In addition, the ARPA expands the availability of the premium tax credit to eligible individuals whose income is above 400% FPL for 2021 and 2022. These households will not have to pay more than 8.5% of their modified adjusted gross income towards the cost of health insurance premiums. The Inflation Reduction Act extended these premium subsidies through 2025.

NY STATE OF HEALTH FACT SHEETS

https://info.nystateofhealth.ny.gov/sites/default/files/Fast%20Facts%20on%20NYSOH%20Insurance%20Changes%20During%20the%20Coronavirus%20Emergency.pdf..

https://info.nystateofhealth.ny.gov/sites/default/files/Fast%20Facts%20on%20NYSOH%20Insurance%20Options%20During%20the%20Coronavirus%20Emergency.pdf

IMPACT OF COVID-19 CASH AID ON THE PREMIUM TAX CREDIT AND COST SHARING REDUCTION SUBSIDY

For details on how the CARES Act Economic Impact payments (EIP), the American Rescue Plan Act payments, and Pandemic Unemployment Compensation affects benefit eligibility, see here.

Other Health Benefits

CHILD HEALTH PLUS

Qualifying for And Enrolling in Child Health Plus

Eligibility and enrollment procedures for Child Health Plus have not changed as a result of COVID-19. Children eligible for Child Health Plus can enroll year-round, as usual. Go to https://www.dfs.ny.gov/reports_and_publications/press_releases/pr202003161 for more information.

For assistance with applying on the Marketplace, contact the Community Service Society of New York, which is a Navigator agency, at 888-614-5400.

Renewal Procedures

For New Yorkers currently enrolled in Child Health Plus and have a coverage end date of March 31, 2023, their coverage will be extended for an additional 12-month period.

Impact of COVID-19 Cash Aid on Eligibility

For details on how the CARES Act Economic Impact payments (EIP), the American Rescue Plan Act payments, and Pandemic Unemployment Compensation affects benefit eligibility, see here.

No Cost Sharing for COVID-19 Testing

There is no cost-sharing for COVID-19 testing for individuals enrolled in Child Health Plus.

Effective January 15, 2022, CHP insurers must cover either at-home antigen covid tests per member per month at no cost to the member. If the plan has a network in place for these tests, the plan will pay up to $12/test (i.e., $12 for one test, $24 for a pack of 2 tests). If they don’t have a network in place to supply the tests, they will have to reimburse the full cost of the tests (i.e., if they charge $35 for a box of 2, that will be covered). Plans can pay for the cost up-front or reimburse you.

There is no limit to the number of tests (at-home or lab-based) that a plan will cover per month if they are ordered by a health care provider following an assessment.

ESSENTIAL PLAN

Qualifying for And Enrolling in Essential Plan

Eligibility and enrollment procedures for the Essential Plan have not changed as a result of COVID-19. Individuals eligible for the Essential Plan can enroll year-round, as usual. Go to https://www.dfs.ny.gov/reports_and_publications/press_releases/pr202003161 for more information.

For assistance with applying on the Marketplace, contact the Community Service Society of New York, which is a Navigator agency, at 888-614-5400.

Renewal Procedures

For New Yorkers currently enrolled in the Essential Plan and have a coverage end date of March 31, 2023, their coverage will be extended for an additional 12-month period, as long as they remain age-eligible and do not have Medicare.

MEDICAID BUY-IN FOR WORKING PEOPLE WITH DISABILITIES (MBI-WPD)

Lost Job during COVID-19 Emergency

Typically, MBI-WPD recipients must maintain a job to stay in the program. However, MBI-WPD recipients have traditionally been allowed a six-month grace period if they became unemployed through no fault of their own and have the intent to return to work. During the COVID-19 emergency an additional six-month period will be provided, if needed, to look for new employment.

Impact of COVID-19 Cash Aid on eligibility

For details on how the CARES Act Economic Impact payments (EIP), the American Rescue Plan Act payments, and Pandemic Unemployment Compensation affects benefit eligibility, see here.

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