Lance's Corner

NYSOH Issues List of 2025 Dental Plans

Oct 7, 2024

Per the notice below, the New York State of Health (NYSOH), the health benefits exchange for New York State, has issued its list of dental plans available for 2025 through NYSOH.

State Health Department's NY State of Health Announces Approval of State's Innovation Waiver Amendment In Time for 2025 Enrollment Period

New York's Amended State Innovation Waiver Will Save 117,000 New Yorkers Over $300 Million in Out-of-Pocket Costs in 2025

Waiver Reduces Deductibles, Copayments for Moderate-Income New Yorkers, Individuals with Diabetes, and Pregnant or Postpartum People

Open Enrollment for 2025 Begins November 1, 2024

The State Department of Health's NY State of Health, the State's official health plan Marketplace, today announced that the U.S. Department of Health and Human Services and the U.S. Department of the Treasury approved New York's State Innovation Waiver amendment, cutting an estimated $307 million in out-of-pocket costs annually for over 117,000 New Yorkers.  The waiver's amendment approval comes at a critical time for New Yorkers making their care choices for 2025.  The Open Enrollment Period begins November 1 and ends January 31.  If an individual enrolls by December 15, then coverage will start January 1, 2025.  Otherwise, coverage will begin February 1, 2025.  In addition, beginning October 1, consumers can browse 2025 plan options on the Marketplace to prepare for Open Enrollment.  The waiver amendment approval is effective from January 1, 2025, through December 31, 2028.

"This is a significant milestone in ensuring New Yorkers have access to high-quality health care when needed," State Health Commissioner Dr. James McDonald said.  "I want to thank Governor Hochul for her steadfast support of innovative healthcare initiatives that address health disparities in all communities and protect New Yorkers from excessive out-of-pocket costs that hinder many from accessing quality care."

"We are thrilled that the approval and implementation of the 1332 waiver will provide more New Yorkers with enhanced options for their care," Executive Director of the NY State of Health Marketplace Danielle Holahan said.  "As New Yorkers decide on their 2025 coverage during the Open Enrollment Period, the amended waiver will result in significant savings for the consumer and will allow us to lower costs for Qualified Health Plan populations meaningfully."

"This administration has been focused every day on improving health care for all New Yorkers, including waiving cost sharing for insulin and improving access to mental health services," Department of Financial Services Superintendent Adrienne Harris said."  The expanded health care insurance subsides for low-income New Yorkers approved by CMS will make insurance more affordable and ensure all New Yorkers receive the health care they deserve."

The approved waiver amendment provides cost-sharing subsidies for enrollees with diabetes, who are pregnant or in their 12-month postpartum period, and all individuals and families with incomes up to 400 percent of the Federal Poverty Line (FPL) or $60,240 for an individual and $124,800 for a family of four.  On March 1, 2024, the federal government approved New York's Essential Plan (EP) expansion waiver for populations with incomes 250 percent of FPL who would otherwise be ineligible for the Essential Plan.  Over 1.5 million low-income consumers are enrolled in EP coverage.  Under the amended waiver, New York will extend cost-sharing subsidies to Qualified Health Plan program enrollees starting in 2025.  New York State's application for the 1332 waiver was approved by the U.S. Department of Health and Human Services and the US Department of the Treasury on March 4, 2024.  In addition to the affordability improvements projected to result from New York's initially approved waiver, the estimated savings for Qualified Health Plan enrollees approved under this amendment will result in aggregate savings of $307 million in 2025 and $1.3 billion from 2025-2028 for an estimated annual average of 117,687 enrollees.  At an individual level, the amendment will result in estimated annual savings of:

  • $3,500 for 80,000 consumers with income between 250-350 percent of FPL.
  • $730 for 20,000 consumers with income between 350-400 percent of FPL.
  • $1,600 for 17,000 consumers with diabetes.
  • $2,800 for 1,600 consumers who are pregnant or postpartum.
  • An estimated 5,000 consumers will benefit from more than one cost-sharing subsidy.

More information about the cost-sharing initiatives for 2025 can be found here.  NY State of Health Marketplace is a one-stop shop platform that allows New Yorkers seeking coverage to compare and buy insurance.  Consumers can enroll by:

The Marketplace offers an array of tools that make comparing and buying insurance easy:

  • Compare Plans and Estimate Cost Calculator.
  • Comprehensive list of plans by county.
  • Search for Certified Enrollment Assistors in your community.
  • Web Chat is available to help consumers complete their applications.

In New York State, over 6.6 million individuals have enrolled in the NY State of Health Marketplace, including 1.5 million Essential Plan enrollees and nearly 230,000 Qualified Health Plan enrollees, 145,000 benefitting from enhanced tax credits.  These enhanced premium tax credits, initially authorized under the American Rescue Plan Act of 2021, have led to record enrollments in Qualified Health Plans and have provided critical funding for New York's State Innovation Waiver.  Due to expire at the end of 2025, these tax credits are essential to keeping Marketplace health insurance coverage affordable in New York and provide New Yorkers with additional incentives to take advantage of lowered health care coverage.  For more information on the benefits to New Yorkers of these tax credits, see the Congressional District fact sheets: 2024 Congressional District Report.pdf (ny.gov).  NY State of Health is also announcing the health and dental insurance plans that will be offered through the Marketplace for the 2025 coverage year.  New Yorkers looking for affordable and comprehensive health insurance can experience the ease of a one-stop shopping experience by comparing Qualified Health plan options to prepare for the 2025 Open Enrollment Period, which begins on November 1, 2024.

Qualified Health Plans

Consumers can enroll (starting November 1, 2024) or renew (starting November 16, 2024) in a 2025 Qualified Health Plan, and are encouraged to enroll before December 15, 2024, for coverage starting January 1, 2025.  All Qualified Health Plans cover preventive care, such as routine doctor visits and screenings, and pre-existing conditions at no additional cost.

Essential Plan, Medicaid, and Child Health Plus

The Essential Plan, Medicaid, and Child Health Plus are open for enrollment year-round.  All these programs offer comprehensive benefits, including vision and dental benefits for all enrollees with no monthly premium, no deductible, and low-cost sharing.

Small Business Marketplace

Eligible small employers can lower the cost of offering employee coverage with the federal Small Business Healthcare Tax Credit when purchasing Small Business Marketplace-certified plans approved through NY State of Health.  There are currently more than 18,900 employers signed on with the Small Business Marketplace (SBM).  Employers can only access small employer tax credits by completing a short application at nystateofhealth.ny.gov/employer.  In 2025, Oscar Insurance Corporation will no longer offer plans on the SBM.  Consumers in the counties served by these insurers will continue to have a choice of two or more insurers offering SBM-certified plans.

Dental Plans

Dental coverage is available for adults and families in certain Qualified Heath Plans or through a stand-alone dental plan (SADP) on the individual Marketplace.  New for 2025, there will be no waiting periods permitted for dental services other than for orthodontia for on-exchange SADPs.  More information on 2025 Plans can be found here.  More Information on Plans by County can be found here.

USDOL Issues Comprehensive Employer Guidance on Long COVID

The United States Department of Labor (USDOL) has issued a comprehensive set of resources that can be accessed below for employers on dealing with Long COVID.

Supporting Employees with Long COVID: A Guide for Employers

The “Supporting Employees with Long COVID” guide from the USDOL-funded Employer Assistance and Resource Network on Disability Inclusion (EARN) and Job Accommodation Network (JAN) addresses the basics of Long COVID, including its intersection with mental health, and common workplace supports for different symptoms.  It also explores employers’ responsibilities to provide reasonable accommodations and answers frequently asked questions about Long COVID and employment, including inquiries related to telework and leave.

Download the guide

Accommodation and Compliance: Long COVID

The Long COVID Accommodation and Compliance webpage from the USDOL-funded Job Accommodation Network (JAN) helps employers and employees understand strategies for supporting workers with Long COVID.  Topics include Long COVID in the context of disability under the Americans with Disabilities Act (ADA), specific accommodation ideas based on limitations or work-related functions, common situations and solutions, and questions to consider when identifying effective accommodations for employees with Long COVID.  Find this and other Long COVID resources from JAN, below:

Long COVID, Disability and Underserved Communities: Recommendations for Employers

The research-to-practice brief “Long COVID, Disability and Underserved Communities” synthesizes an extensive review of documents, literature and data sources, conducted by the USDOL-funded Employer Assistance and Resource Network on Disability Inclusion (EARN) on the impact of Long COVID on employment, with a focus on demographic differences.  It also outlines recommended actions organizations can take to create a supportive and inclusive workplace culture for people with Long COVID, especially those with disabilities who belong to other historically underserved groups.

Read the brief

Long COVID and Disability Accommodations in the Workplace

The policy brief “Long COVID and Disability Accommodations in the Workplace” explores Long COVID’s impact on the workforce and provides examples of policy actions different states are taking to help affected people remain at work or return when ready.  It was developed by the National Conference of State Legislatures (NCSL) as part of its involvement in USDOL’s State Exchange on Employment and Disability (SEED) initiative.

Download the policy brief

Understanding and Addressing the Workplace Challenges Related to Long COVID

The report “Understanding and Addressing the Workplace Challenges Related to Long COVID” summarizes key themes and takeaways from an ePolicyWorks national online dialogue through which members of the public were invited to share their experiences and insights regarding workplace challenges posed by Long COVID.  The dialogue took place during summer 2022 and was hosted by USDOL and its agencies in collaboration with the Centers for Disease Control and Prevention and the U.S. Surgeon General.

Download the report

Working with Long COVID

The USDOL-published “Working with Long COVID” fact sheet shares strategies for supporting workers with Long COVID, including accommodations for common symptoms and resources for further guidance and assistance with specific situations.

Download the fact sheet

COVID-19: Long-Term Symptoms

This USDOL motion graphic informs workers with Long COVID that they may be entitled to temporary or long-term supports to help them stay on the job or return to work when ready, and shares where they can find related assistance.

Watch the motion graphic

A Personal Story of Long COVID and Disability Disclosure

In the podcast “A Personal Story of Long COVID and Disability Disclosure,” Pam Bingham, senior program manager for Intuit’s Diversity, Equity and Inclusion in Tech team, shares her personal experience of navigating Long COVID symptoms at work.  The segment was produced by the USDOL-funded Partnership on Employment and Accessible Technology (PEAT) as part of its ongoing “Future of Work” podcast series.

Listen to the podcast

HHS OIG Issues Annual Report on State MFCUs

Per the notice below, the Office of the Inspector General (OIG) of the United States Department of Health and Human Services (HHS) has issued its annual report on the performance of state Medicaid Fraud Control Units (MFCUs).

Medicaid Fraud Control Units Fiscal Year 2023 Annual Report (OEI-09-24-00200) 

Medicaid Fraud Control Units (MFCUs) investigate and prosecute Medicaid provider fraud and patient abuse or neglect. OIG is the Federal agency that oversees and annually approves federal funding for MFCUs through a recertification process. This new report analyzed the statistical data on annual case outcomes—such as convictions, civil settlements and judgments, and recoveries—that the 53 MFCUs submitted for Fiscal Year 2023.  New York data is as follows:

Outcomes

  • Investigations1 - 556
  • Indicted/Charged - 9
  • Convictions - 8
  • Civil Settlements/Judgments - 28
  • Recoveries2 - $73,204,518

Resources

  • MFCU Expenditures3 - $55,964,293
  • Staff on Board4 - 257

1Investigations are defined as the total number of open investigations at the end of the fiscal year.

2Recoveries are defined as the amount of money that defendants are required to pay as a result of a settlement, judgment, or prefiling settlement in criminal and civil cases and may not reflect actual collections.  Recoveries may involve cases that include participation by other Federal and State agencies.

3MFCU and Medicaid Expenditures include both State and Federal expenditures.

4Staff on Board is defined as the total number of staff employed by the Unit at the end of the fiscal year.

Read the Full Report

View the Statistical Chart

Engage with the Interactive Map

GAO Issues Report on Medicaid Managed Care Service Denials and Appeal Outcomes

The United States Government Accountability Office (GAO) has issued a report on federal use of state data on Medicaid managed care service denials and appeal outcomes.  GAO found that federal oversight is limited because it doesn't require states to report on Medicaid managed care service denials or appeal outcomes and there has not been much progress on plans to analyze and make the data publicly available.  To read the GAO report on federal use of state data on Medicaid managed care service denials and appeal outcomes, use the first link below.  To read GAO highlights of the report on federal use of state data on Medicaid managed care service denials and appeal outcomes, use the second link below.
https://www.gao.gov/assets/d24106627.pdf  (GAO report on federal use of state data on Medicaid managed care service denials and appeal outcomes)
https://www.gao.gov/assets/d24106627_high.pdf  (GAO highlights on federal use of state data on Medicaid managed care service denials and appeal outcomes)

CMS Issues Latest Medicare Regulatory Activities Update

The Centers for Medicare and Medicaid Services (CMS) has issued its latest update on its regulatory activities in the Medicare program.  While dentistry is only minimally connected to the Medicare program, Medicare drives the majority of health care policies and insurance reimbursement policies throughout the country.  Therefore, it always pays to keep a close eye on what CMS is doing in Medicare.  To read the latest CMS update on its regulatory activities in Medicare, use the link below.
https://www.cms.gov/training-education/medicare-learning-network/newsletter/2024-03-14-mlnc