New York State Family Health Plans

The New York State Family Health Plus program is the result of consensus among New York State government leaders and key consumer and advocate groups, labor organizations and healthcare providers. Under Governor Pataki’s leadership, the State legislature enacted this program as part of the Healthcare Reform Act of 2000. Family Health Plus is a public health insurance program for adults between the ages of 19 and 64 who do not have health insurance - either on their own or through their employers - but have income or resources too high to qualify for Medicaid. The program provides comprehensive coverage, including prevention, primary care, hospitalization, prescriptions and other services.

Program Details:

• Eligibility: single adults, couples without children, and parents with limited income who are between the ages of 19 and 64 and residents of New York State and are United States citizens or fall under one of many immigration categories
  • Adults who have health insurance – either on your own or through your employer, or are eligible for employer-sponsored health coverage through a federal, state, county, municipal or school district benefit plan - are not eligible to enroll
  • There are limits on the amount of assets or resources that adults can have and still be eligible to enroll in Family Health Plus.
  • Different family sizes are eligible at different levels of income and resources in 2006
• Health insurance: provided through participating managed care plans
• Costs: no cost to apply for the program and no deductibles once you are enrolled
  • Minimal co-payments for medical care/services
• Coverage: includes physician services, inpatient and outpatient hospital care; prescription drugs; smoking cessation products; lab tests and x-rays; vision, speech and hearing services; rehabilitative services; durable medical equipment; emergency room and emergency ambulance services; behavioral health and chemical dependence services; diabetic supplies and equipment; hospice care; radiation therapy; chemotherapy and hemodialysis; and dental services
• Application Process: includes personal interview to complete an application, provide proof of certain information, and select a health plan
  • Enrollment facilitators are available to ease the enrollment process and answer questions

Results:

• Within the first year of commencement, in 2002, enrollment in the Family Health Plus program increased from 6,691 in January to 27,272 in May.
• By March 2006, enrollment totaled 528,414 consisting of 320,784 adults with children and 207,630 adults without children enrolled.
• In 2002, Pataki increased funding for the program by $20 million to help 47 community-based organization conduct outreach to increase enrollment in the program. The state is using the model provided by the Child Health Plus program to increase enrollment. A previous state grant of $40 million to the Child Health Plus program allowed intensive community outreach efforts and an extensive mass media campaign, which increased enrollment from 90,000 in 1994 to more than 500,000 in 2002.
• As of 2002, 2,641 New York City residents had enrolled in the program

***For further information, please visit, http://www.health.state.ny.us/nysdoh/fhplus/.

Published: January 26, 2009