Historic Progress Made in Reforming Medicaid in New York State-Patient Centered Medical Home

New York spends more on Medicaid per capita than any other state in the nation, but we rank only 21st in program quality for patients. In most counties, Medicaid costs alone account for more than half of the entire county tax levy.

To reform the system, Governor Cuomo created a Medicaid Redesign Team. The Team — comprised of health care professionals, stakeholders, and legislators — was charged with reducing costs and improving patient care. The Team held open meetings throughout the state and reviewed more than 4,000 ideas from team members, outside health care professionals, and citizens.

Last week, the Team accomplished their goal, submitting an unprecedented consensus plan that meets the Governor’s budget target and saves over $2.3 billion. What’s more, under the plan, one million New Yorkers will now have access to an innovative “patient-centered” medical program, making New York the national leader in providing this type of personal care. Today, the legislation to enact the plan was submitted to the Legislature to be included as part of the Executive Budget.

If you would like more information on this historic plan, click here to read about the Medicaid report.

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New York and New Jersey Establish “High Risk Health Insurance Pools”

The federal Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act, which together comprise the new federal health care reform law, were signed into law by President Obama on March 23, 2010, and March 30, 2010, respectively. The health care reform law contains a provision for the establishment of a temporary statewide insurance pool for high risk individuals.  Coverage through this program will be available until January 2014 when more health insurance coverage options become available through a Health Insurance Exchange.

New York

This new program is called the Pre-Existing Condition Insurance Plan (PCIP) and will be available throughout the country. In New York State, the PCIP plan is called the NY Bridge Plan, and is administered by Group Health Incorporated (GHI), an EmblemHealth company.

The NY Bridge Plan provides health coverage to individuals who have a pre-existing medical condition, have not had insurance for six months, and who are legal residents.

The NY Bridge Plan covers a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs.  Eligibility is not based on income and the Plan does not charge a higher premium because of a pre-existing condition.  Coverage for a pre-existing condition begins right away, with no waiting period.

Applications are available now with coverage effective October 1, 2010. for more information go to NY Bridge Plan

New Jersey

NJ Protect is a new health insurance option for uninsured New Jerseyans with pre-existing medical conditions. Coverage through NJ Protect will generally cost less than comparable individual health insurance and offer superior benefits. Because the program is federally subsidized, treatment for pre-existing medical conditions will be covered as of the day a policy goes into effect, and preventive care will be covered at no out-of-pocket cost to the policyholder.

Applications for NJ Protect are now available.  Contact Horizon Blue Cross and Blue Shield of NJ to request the application.  Please be sure to explain you are asking about NJ Protect so the customer service representative can quickly provide information for the NJ Protect options.  More more information go to www.HorizonBlue.com/NJProtect

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