COD E R E D

New York passed the Health Care Reform Act of 2000, which included significant coverageexpansions and market reforms to increase the availability of health insurance for uninsuredindividuals and small businesses (less than 50 employees) in the state. One of these newcoverage options is Healthy New York. The Healthy New York plan has a streamlined benefitspackage and must be offered by all HMOs in the state to people who qualify (other types ofinsurers have the option of whether to participate). The only choice in the benefit plan iswhether to pay extra for prescription drug coverage or not. The program is a state-subsidizedreinsurance program that reimburses health plans for 90 percent of claims that they paybetween $5,000 and $75,000 in a calendar year for each member. 211Small employers, sole proprietors, and individuals have a list of criteria to meet in order toqualify to buy Healthy New York, including such things as having not been insured in the last 12months (with exceptions), a family member being employed in the last 12 months, and ahousehold income below 250 percent FPL. Small employers have income limits on apercentage of their employees, and must contribute at least half of the premiums for employees(they do not have to contribute to the premiums for employees’ families). Premiums arecommunity-rated and do not vary by eligibility category but can vary by county and HMO. 212As of December 2004, Healthy New York had 76,700 enrollees: 60 percent of these wereworking individuals, 20 percent were sole proprietors, and 20 percent were small-groupemployees. The state budgeted $49.2 million for Healthy New York for 2004, some of which isfunded by tobacco taxes. 213Covering Parents under SCHIP—New Jersey and OthersThe Centers for Medicare and Medicaid Services issued guidelines in 2000 on how states couldapply for 1115 waivers to allow their SCHIP programs to cover uninsured parents of SCHIPeligiblechildren. New Jersey, Rhode Island, Minnesota, and Wisconsin were the first states toobtain waivers for SCHIP parents (in 2001), and six more states had done so by 2002. The firstfour states had already been covering low-income parents through Medicaid waivers, Section1931 expansions, and state-only funds, but obtaining the SCHIP 1115 waivers allowed them toreceive the higher SCHIP matching rate for this population. It was easier for these first fourstates to apply for the waiver than it might be for other states because they were alreadycovering a substantial number of low-income parents through other programs, thus they werenot adding a large new population to the public insurance rolls. They also had not spent all oftheir SCHIP allotments at the time they applied for waivers, so they likely would have lostSCHIP money, unlike other states who already spend most or all of their SCHIP funds onchildren and thus do not have any left to cover parents. 214 It is important to note that sincefunding for each state is capped under SCHIP, it is not necessary to show that the expansionwill be revenue-neutral.The New Jersey SCHIP parent program (part of the New Jersey FamilyCare program, whichalso includes Medicaid recipients), was closed to new parent enrollment in June 2002 asenrollment exceeded expectations, causing funding problems. The state’s waiver applicationstated they would cap enrollment at 125,000, and in 2002 enrollment was 180,000. In order tobe able to keep these additional parents enrolled, as well as enroll the 12,000 people whoapplied after the enrollment freeze, the state applied for and received an 1115 HIFA waiver in2003 in order to standardize the benefit packages of parents with incomes under 133 percentFPL who are covered by a Medicaid 1931 to be the same as the benefits package for theparents from 133 percent to 200 percent FPL, which is equivalent to the most widely soldC-6