New York State has the Opportunity to Expand Access to Health Coverage to Low-Income Immigrants

By Assemblymember Amy Paulin and Theo Oshiro | April 13, 2024

As a growing number of asylum seekers have arrived in our state, New York’s leaders have made an increasing number of requests for Washington to provide resources to make it easier to care for New York’s newest immigrants.

But there’s one solution that hasn’t been mentioned, one that would both provide support to new arrivals and low-income immigrants who have lived in our state for years, all while saving our state money in the long term: using available federal dollars to expand health insurance coverage for low-income undocumented New Yorkers. While Washington is unlikely to come through with other significant funding, this pot of money is already sitting there waiting to be claimed.

Current law bars most undocumented adults in New York State from getting access to public health insurance, beyond emergency coverage. While it may seem denying undocumented New Yorkers health coverage would save the state money, in reality, it’s exactly the opposite.

Just like everybody else, undocumented New Yorkers face unexpected health issues – and when they arise, the only option is to visit an emergency room. In cases where individuals are facing severe, life-threatening issues, the state pays for coverage, including for undocumented individuals. However, for all other care, our hospitals pay out of pocket, and this puts our health institutions at financial risk. Health insurance would allow those who are undocumented and living in New York to seek easier and lower-cost interventions at an earlier stage.

Coverage for All, a bill that’s currently before the New York Legislature, would make it possible for low-income immigrant New Yorkers to get access to affordable health insurance, allowing those New Yorkers to go to primary care doctors rather than relying on more expensive emergency care. And New York has already begun taking steps towards universal coverage. Currently, undocumented children can get access to low and no-cost health insurance via Child Health Plus, and two years ago, the State Legislature passed and Governor Hochul approved an expansion of Medicaid to cover undocumented seniors aged 65 and older and to provide 12 months of post-pregnancy coverage through Medicaid for everyone who meets the income requirements, regardless of immigration status.

Yet there are still more than 240,000 New Yorkers across the state who are ineligible for any health insurance coverage because of their immigration status — a number that’s growing by the day.

There’s an easy way to secure coverage for such New Yorkers — and with no fiscal hit to our state budget. New York State can seek federal funding through a 1332 waiver from the US Department of Health and Human Services to expand the Essential Plan to all low-income New York residents, including undocumented immigrants — a step that would save New York millions of dollars in emergency healthcare spending.

There is significant precedent for the federal government covering the costs of health insurance for undocumented residents. Last year, in a letter to the state, the Centers for Medicaid and Medicare Services confirmed that federal funding could be used for immigrant health coverage, including for those who are undocumented. And Colorado and Washington have already used the 1332 waiver option to provide coverage options for undocumented immigrants in their respective states. Now, New York has a chance to follow.

The Coverage for All bill (A3020B / S2237B) would direct Governor Hochul to seek approval from the federal government to expand New York’s Essential Plan to cover undocumented adults, at zero cost and with no risk to the state.

And not only is Coverage for All smart from a fiscal perspective, but it will also help healthcare providers, who will spend less on uncompensated care and be paid Essential Plan rates, which are much higher than the rates for emergency health coverage.

Coverage for All is a win-win for New York. Following the inclusion of this legislation in both the Senate and Assembly one-house budgets, we have the opportunity to take a step towards creating a healthier New York. And with New York facing additional pressure on its budget, we simply can’t afford to leave money on the table. The time to pass Coverage for All is now.

Amy Paulin is the Assembly Chair of the Committee on Health and New York State Assemblymember representing District 88. Theo Oshiro is the Co-Executive Director of Make the Road New York.