Health authorities in New York State are racing to devise strategies to blunt a new federal law that will restrict access to government health insurance programs, including Medicaid, that cover more than half of New York City\u2019s residents.<\/p>\n
To keep as many New Yorkers as possible from being cut from the Medicaid rolls next year, state and city officials are looking for ways to prove that patients are afflicted with addictions or are medically frail, conditions that would exempt them from the new restrictions. And they are considering how to sign people up for volunteer work \u2014 such as helping other New Yorkers navigate Medicaid\u2019s new rules \u2014 which could satisfy the law\u2019s work requirements.<\/p>\n
\u201cWe\u2019re getting very creative,\u201d Dr. Alister Martin, the city\u2019s new health commissioner, said in a recent interview.<\/p>\n
When President Trump\u2019s signature domestic policy bill passed last year, state health officials feared that perhaps 1.5 million people in New York might lose health coverage. Those predictions have grown somewhat less dire as officials have come up with possible methods for keeping people insured and exempting them from the new work requirements. Those requirements and other restrictions are expected to start next year.<\/p>\n
Under the president\u2019s bill, many adults on Medicaid will be required to work at least 80 hours a month to keep their insurance, unless they are in school, pregnant or raising children younger than 14, or if they qualify for another exemption. The rules are intended to push more people into the work force and reduce what Republicans have characterized as waste and fraud in government programs. The regulations were introduced to help pay for<\/a> the Trump administration\u2019s tax cuts.<\/p>\n States must now verify twice a year that many Medicaid recipients remain eligible, a requirement that is expected to result in many people losing coverage periodically, especially if their work hours vary or they move between jobs, or have difficulty navigating the paperwork requirements.<\/p>\n Since 2010, when the Affordable Care Act was passed, the number of uninsured Americans has dropped substantially. In New York State, the share of adults and children without health insurance dropped from about 12 percent<\/a> to 5 percent<\/a>. Now, that number is expected to rise again.<\/p>\n The question is by how much.<\/p>\n \u201cThis is truly a seismic shift in Medicaid policy, the largest in the history of the program,\u201d Amir Bassiri, the state Medicaid director, said at a panel discussion hosted last month by the United Hospital Fund, a nonprofit.<\/p>\n Chris Pope, a health care analyst at the Manhattan Institute, a conservative think tank, said that he expected many states \u2014 especially those with Democratic leaders who wanted to expand the social safety net \u2014 to try to blunt the law by searching for exemptions. State officials have a substantial incentive for doing so: The federal government pays 90 percent of the health coverage costs for some Medicaid recipients, with the states paying the remainder.<\/p>\n \u201cMy assessment of the work requirements is there is the greatest possible incentive for states to find every possible loophole,\u201d Mr. Pope said. \u201cA blue state like New York, I think they\u2019re going to be looking to implement it in the loosest possible way.\u201d<\/p>\n Dr. Martin said that the effort to keep New Yorkers on Medicaid \u2014 which has not previously been reported \u2014 felt particularly urgent to him, like one of those sci-fi movies in which scientists had to save everyone on Earth from an approaching asteroid.<\/p>\n Still, some health care analysts expressed concern that not enough was being done, given that key provisions of the domestic policy bill were going into effect over the next year.<\/p>\n \u201cI\u2019m not seeing the kind of public planning process to reassure me they are ready or that they\u2019re going to be ready,\u201d said Bill Hammond, a health care policy analyst at the Empire Center for Public Policy, a think tank in Albany, N.Y.<\/p>\n The federal Centers for Medicare and Medicaid Services said in a statement that states would be \u201crequired to implement these provisions in accordance with the law, and C.M.S. will issue guidance to ensure exemptions are applied appropriately and that eligible beneficiaries are protected.\u201d<\/p>\n To reduce the number of people stymied by paperwork and red tape, New York State has been working to automatically certify residents who are already fulfilling the requirements, by accessing information not only from state databases but from payroll providers.<\/p>\n Elisabeth Benjamin, vice president of health initiatives at the Community Service Society, a nonprofit that supports anti-poverty policies, said that officials were confronting considerable challenges in their effort to prepare for the Medicaid changes.<\/p>\n \u201cThey\u2019re doing the best they can to figure out what they can automate, but people are still going to lose coverage \u2014 a lot of people,\u201d Ms. Benjamin said. \u201cMany of those people are already working, but proving it will be hard.\u201d<\/p>\n She predicted that agricultural laborers upstate and employees in industries with high turnover, intermittent hours or off-the-books payments \u2014 such as kitchen and construction workers \u2014 could be especially prone to losing their health insurance.<\/p>\n The Congressional Budget Office had estimated that 4.8 million people in the United States might eventually lose Medicaid coverage<\/a> because they cannot meet the work requirements, while others will lose their insurance because of administrative hurdles or difficulty providing the necessary documentation<\/a>.<\/p>\n In New York, health officials said that if people lost Medicaid coverage, they would forgo health care, leading to needless suffering<\/a>.<\/p>\n