The Family Health Plus (FHP) program was originally established by the NYS Health Care Reform Act of 2000. It was a Medicaid expansion program that provided comprehensive health insurance coverage to uninsured, low-income New Yorkers who were ineligible for Medicaid due to excess income.

With the implementation of the Affordable Care Act in January 2014, the NYS budget repealed the Family Health Plus program. No new applications were accepted after December 31, 2013.

FHP recipients will be converted to the Medicaid program or to the Affordable Care Act’s insurance affordability insurance products, that is the premium tax credit and the cost sharing reduction. See below, Transition Process for Family Health Plus Beneficiaries.

The Family Health Plus benefit will end December 31, 2014.


The Family Health Plus Premium Assistance Program

Individuals who are enrolled in their employer’s health plan or have COBRA coverage may be eligible for the Family Health Plus Premium Assistance Program (FHP-PAP), which pays for the employee’s share of the insurance premium and any out-of-pocket expenses, such as co-payments and co-insurance fees.

FHP-PAP will be phased out similar to the Family Health Plus program. No new applications will be processed for FHP-PAP effective January 1, 2014, with the exception of applications submitted on or before December 31, 2013, that are not processed prior to January 1, 2014, as well as applications submitted on or after January 1, 2014 that are ready to be processed by the district but MAGI-like budgeting is not yet available. Refer to Health Programs, Affordable Care Act, Modified Adjusted Gross Income (MAGI), for information on MAGI budgeting.

Once MAGI-like budgeting is available, if the case has income equal to or less than 138% FPL and it is determined to be cost effective to pay the premium for the employer-sponsored health insurance, the individuals on the case must be authorized for fee-for-service Medicaid and the premium amount reimbursed. If the premium is determined not to be cost effective the case is still enrolled in fee-for-service Medicaid since income is at or below 138% FPL. Individuals with incomes over 138% FPL are no longer eligible for FHP-PAP and must be denied or discontinued, as applicable.

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Health Programs

Benefits Plus - Solving the Public Benefit Puzzle – Community Service Society of NY