The New York Health Plan Association is questioning the legality of Gov. Andrew Cuomo's emergency move on Monday to deny insurers entrance into Medicaid and other markets if they withdraw their Affordable Care Act plans in the state.
At the governor's direction, the Department of Health will ban all insurers who withdraw from offering qualified health plans on the state marketplace from contracting with the state in such programs as Medicaid, Child Health Plus and the Essential Plan.
"New York is home to one of the most robust health marketplaces in the country," the governor said by statement, "and insurers who do not comply will lose access to such profitable programs."
Cuomo also mandated that plans cover 10 essential health benefits.
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Insurers must comply with the new regulations as a requirement of their license in New York, the governor said.
Regulations the governor is calling a first-in-the-nation mandate that commercial plans cover all medically necessary abortion services without copays, coinsurance, or deductibles, unless the plan is a high deductible plan.
"We will not stand idly by as ultra-conservatives in Washington try to roll back the progress we have made to expand access quality, affordable health care, putting our most vulnerable New Yorkers at risk," Governor Cuomo said. "As long as I am governor, New Yorkers will not be subject to price discrimination based on age, gender, or pre-existing conditions, and essential health benefits will continue to be the rule, not the exception. These aggressive actions will make certain that no matter what happens in Congress, the people of New York will not have to worry about losing access to the quality medical care they need and deserve."
The governor's actions have the potential to create more uncertainty for plans than what's being discussed in Washington to replace the ACA, said New York Health Plan Association President and CEO Paul Macielak.
"We believe most -- if not all -- these coverage requirements exist in current law or regulation, so we do not understand the 'emergency' here," Macielak said by statement. "There are issues about the legality and timing of the directive to ban plans that don't participate on the exchange from the Medicaid, Child Health Plus and Essential Plan markets, and the impact it might have on the overall marketplace in New York."
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Cuomo directed the New York State Department of Financial Services to promote new emergency regulations mandating health insurance providers do not discriminate against residents who have preexisting conditions, or based on age or gender, in addition to safeguarding 10 essential benefits of the ACA.
Student accident and health insurance policies must cover the same categories of essential health benefits and be subject to the same benchmark plan rules that currently apply through the Affordable Care Act.
The 10 mandated essential health services include ambulatory patient services, such as office visits, ambulatory surgical services, dialysis, radiology services, chemotherapy, infertility treatment, abortion services, diabetic equipment, supplies and self-management education.
It includes emergency room and urgent care services, hospitalization, such as pre-admission testing, inpatient physician and surgical services, hospital care, skilled nursing facility care, and hospice care.
It includes maternity and newborn care, mental health and substance use disorder services, prescription drug coverage and orally administered anti-cancer medication.
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It includes rehabilitative services and devices such as durable medical equipment, medical supplies, prosthetic devices, hearing aids, chiropractic care, physical therapy, occupational therapy, speech therapy, and home health care; laboratory services, such as diagnostic testing; preventive and wellness services and chronic disease management, such as well child visits, immunizations, mammography, gynecological exams including cervical cytology screening, bone density measurements or testing, and prostate cancer screening; and pediatric services, including oral and vision care; dental care and prescription lenses and frames.
The Department of Financial Services will also mandate under existing New York law that health insurers provide coverage for all contraceptive drugs and devices and cover at least one form of contraception in each of the FDA-approved contraceptive delivery methods without co-pays, coinsurance, or deductibles, regardless of the future of the Affordable Care Act.
The GOP American Health Care Act that has passed the House and is expected to be modified or redone in the Senate, would allow states to waive coverage of essential benefits.