Background

HISTORY

Family Health Plus (FHP) was established by the NYS Health Care Reform Act of 2000. Family Health Plus is a Medicaid expansion program intended to provide comprehensive health insurance coverage to uninsured, low-income New Yorkers who are ineligible for Medicaid solely due to excess income or resources. Prior to this legislation, many working, low income New Yorkers went without medical coverage because they did not have access to health insurance through employment and could not afford to purchase it.

In 2007 NYS created an important extension to FHP, the Family Health Plus Premium Assistance Program, which helps low income workers pay for health care coverage offered through their employer. This legislation was intended to save State money by requiring workers to enroll in their employer health insurance rather than applying for FHP. Through this Family Health Plus Premium Assistance Program, NYS pays for eligible workers out-of-pocket expenses related to their employer’s health insurance.

Also in 2007, NYS enacted a hybrid public/private insurance program of its own: the Family Health Plus Employer Buy-In program. Under the law, employers and union benefit funds allows all New York State employers to purchase the FHP benefit package for their employees.

ADMINISTRATION AND FUNDING

FHP is administered at the state level by the New York State Department of Health, Office of Medicaid Management. In New York City it is administered by the Human Resources Administration (HRA), Medical Assistance Program (MAP). Costs are shared by New York State, as well as NYC, and the counties of NYS.

Summary of Family Health Plus

Family Health Plus is an expansion of the Medicaid program enabling parents of minor children, single individuals and childless couples access health coverage though a managed care system, although the benefit package is less comprehensive than Medicaid. Income limits are set higher than Medicaid limits and there is no resource test. FHP covers adults without children (21 and over) with incomes up to 100% of the Federal Poverty Level (FPL), as well as adults with children, and 19 and 20 year olds, are covered up to 150% of the poverty level.

Individuals apply for Family Health Plus at local Medicaid offices or facilitated enrollers, community based organizations contracted with the State to provide application assistance with not only Family Health Plus, but also Medicaid, and Child Health Plus. At the time of application, individuals must select a managed care plan. Participants do not pay a premium, but are responsible for copayments for certain services.

Other Benefits under the Family Health Plus Program

FAMILY HEALTH PLUS PREMIUM ASSISTANCE PROGRAM

Individuals who have health insurance from an employer may be eligible for the Family Health Plus Premium Assistance Program. Such individuals are typically ineligible for FHP because they have employer health insurance. However, such individuals, if otherwise eligible for FHP, that is, meet all of the other eligibility requirements of FHP, may be eligible for the Family Plus Premium Assistance program. This program will pay for the employee’s share of the insurance premium, any out-of-pocket expenses, such as co-payments and co-insurance fees, as well as medical services not covered by the employer’s plan. . See below, Family Health Plus Premium Assistance Program.

FAMILY HEALTH PLUS EMPLOYER BUY-IN

The Family Health Plus (FHP) Employer Buy-In allows New York State employers to purchase the FHP benefit package for their employees. Employers are responsible for paying a minimum of 70% of the plan’s premium rate and employees can pay no more than 30% of the premium. Employees who meet the FHP eligibility requirements qualify to have the state pay their share of the FHP Employer Buy-In premium, if any. Further, employees who meet the FHP eligibility requirements pay the same co-pays as all other FHP members, whereas other employees will pay higher co-pays. See below, Family Health Plus Employer Buy-In.

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Health Programs

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