Hochul Inches Toward Health Insurance for Undocumented Immigrants

While the governor awaits guidance from the federal government, thousands of undocumented New Yorkers can’t afford to go to the doctor.

Sam Mellins   ·   May 19, 2023
Governor Kathy Hochul speaks before a screen with a Shirley Chisolm quote, reading: "You don't make progress by standing on the sidelines... You make progress by implementing ideas."
Governor Kathy Hochul presents her executive budget proposal on February 1, 2023 in Albany. | Mike Groll / Office of Governor Kathy Hochul

Governor Kathy Hochul just got one step closer to fulfilling a year-old promise: Her administration sent a letter to federal health officials last week, asking for guidance on potentially using federal funds to provide undocumented residents with public health insurance coverage. It’s the latest development in New York’s slow movement toward a major expansion of health coverage for undocumented people — but the finish line is still a considerable way off. Even if the federal government greenlights an application, it will likely take months for New York to draft it and get federal approval.

Legislators pushing for the expansion characterized Hochul’s letter as a half-measure. In April 2022, the governor pledged that New York would seek federal funds to extend health coverage to undocumented residents. She’d most likely do this through the federally funded but state-run Essential Plan, which often ends up with surplus funding — currently around $9 billion. But in the leadup to this year’s budget process, she backtracked.

The final budget, passed earlier this month, included a waiver application expanding income eligibility for state-funded health plans, but it left undocumented immigrants out. Senator Gustavo Rivera, who sponsors a bill to extend coverage to undocumented New Yorkers, said that negotiations over this issue were “the most frustrating part for me during the entire budget process.”

“The best that they could come up with was, ‘Well, we might not get it,’” said Rivera. “That’s not a good answer.”

On top of Hochul’s letter, 64 legislators sent their own ask to federal health officials on Friday, inquiring whether New York can get a waiver to provide health coverage to undocumented immigrants — an attempt to increase political pressure for the coverage expansion.

Like anyone who’s uninsured, undocumented immigrants without coverage can go long stretches without seeing doctors. They often don’t seek medical care due to cost, and they face the added fear of attracting attention from immigration authorities.

“I have pressure in my chest constantly after having Covid,” Selene Aguilar, a housecleaner in Queens who contracted the virus twice, told New York Focus through an interpreter. “It was impossible for me to go to a doctor. It just costs too much money.”

Both houses of the legislature supported the expansion in negotiations over this year’s state budget, as did many prominent New York politicians, including US Representatives Jerry Nadler and Alexandria Ocasio-Cortez, New York City Mayor Eric Adams, and New York City Comptroller Brad Lander.

New York would not be the first state to implement such changes. Colorado recently got a federal waiver to do the same, and Washington also got approval for a similar measure.

“It was impossible for me to go to a doctor. It just costs too much money.”

—Selene Aguilar, Queens housecleaner

“New York has a fantastic chance to get what Colorado and Washington have already,” said Elisabeth Benjamin, vice president of health initiatives at the nonprofit Community Service Society. “What I hope and expect the Department of Health and Human Services to say is, ‘Look at these two other state waivers and give us a proposal.’”

Referring to Colorado and Washington as examples, the federal Centers for Medicare and Medicaid Services suggested that New York could expand government-funded health care to undocumented immigrants in a statement to New York Focus. “A state could elect to cover the undocumented through a Section 1332 waiver plan,” the statement noted, referring to a section of the Affordable Care Act that allows states to apply for federal health care funding.

This year’s state budget process led to an informal agreement that the Hochul administration would send a letter to the federal Department of Health and Human Services requesting guidance on the using of federal dollars to provide coverage to undocumented immigrants, as she recently did.

Hochul’s office and the Department of Health declined to share the text of the letter with New York Focus. A Hochul spokesperson said that if the federal government denies New York a chance to get federal funds, the administration will look for other ways to provide the coverage.

Rivera called the letter “a good start,” but supporters of the measure are concerned that it may allow the Hochul administration to stall. “We don’t want this to be a delay tactic or not done in good faith,” said Assemblymember Jessica González-Rojas, who sponsors Rivera’s bill in the Assembly. “We could have done this without a letter.”

The most likely avenue for extending coverage to undocumented immigrants, the state-run Essential Plan insurance program, provides low-cost coverage to nearly 1.2 million New Yorkers, but is currently only open to lawful residents. About 250,000 people would become eligible if that changed, though experts estimate that only a fraction of those would enroll in the program.

Some health policy experts argue that the expansion would actually save New York about $500 million annually, since the state already pays for undocumented immigrants’ medical care through its emergency Medicaid program. If undocumented New Yorkers were eligible for the federally funded Essential Plan, those costs could be shifted to the federal government.

The Hochul administration has disputed this argument. A Hochul spokesperson claimed that without guaranteed additional federal funding, New York could face significant financial risks from increased Essential Plan enrollment.

Since it started in 2016, the Essential Plan has regularly run a surplus, which the state keeps. Currently the state has over $9 billion in unused Essential Plan funds. The funds weren’t originally approved to provide coverage for undocumented immigrants, but if the federal government allows it, that sum or future years’ surpluses could be used for that purpose.

Hochul’s administration is also seeking another expansion of the Essential Plan. On May 12, the state health department requested that the federal government provide funds to broaden the income eligibility levels for the Essential Plan, making another 100,000 New Yorkers eligible for the plan. The application also notes that the state is “seeking new federal solutions to support the coverage of undocumented New Yorkers.”

Aguilar, the housecleaner, said she was “very disappointed” when immigrants were excluded from the Essential Plan expansion. “We have been fighting for a long time for us to be able to go to the doctor,” she said.

Update: May 22, 2023 — This story was updated to include a statement from the Centers for Medicare and Medicaid Services.

Sam Mellins is senior reporter at New York Focus, which he has been a part of since launch day. His reporting has also appeared in The San Francisco Chronicle, The Intercept, THE CITY, and The Nation. 
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