New York 40K QHP Mystery Solved! Answer: The NY Child Health Plus Program

Eureka! I just received an explanation from the New York Dept. of Health of the mysterious 40,000 QHP enrollment discrepancy between the February HHS report and the New York State of Health press releases--apparently the additional 40K are newly-added enrollees in NY's Child Health Plus program, which is privately operated (and thus not included under Medicaid/CHIP) but is also technically not an official "Qualified Health Plan" by the technical definition.

According to the NY DOH, the higher NYSoH enrollee numbers include both the technical QHPs as well as enrollment in the state's CHild Health Plus program. This program covers kids up to 19 years old, with subsidies given for families up to 400% of the FPL. Therefore, children who fit this criteria get enrolled in Child Health Plus instead of actual QHPs.

They've specifically confirmed that "over 40,000 additional children have been enrolled in Child Health Plus through the Marketplace."

As for how to categorize these 40,000 enrollees, I'm still listing them under the QHP side because they're privately paid for (without using Medicaid dollars, as Arkansas' program does) and have increased by that number specifically due to the launch of the ACA exchange. While subsidies of up to 100% are provided depending on the enrollee's income, this isn't any different from a QHP enrollee who receives a heavy tax credit, so it's still a lot closer to the QHP category than the Medicaid one:

There is no monthly premium for families whose income is less than 1.6 times the poverty level. That's about $600 a week for a three-person family, about $724 a week for a family of four. Families with somewhat higher incomes pay a monthly premium of $9, $15, $30, $45, or $60 per child per month, depending on their income and family size. For larger families, the monthly fee is capped at three children. If the family's income is more than 4 times the poverty level, they pay the full monthly premium charged by the health plan. There are no co-payments for services under Child Health Plus, so you don't have to pay anything when your child receives care through these plans.

Voila. Both numbers are technically correct: HHS is technically required not to include these 40K enrollments, NYSoH can still include them, their total QHP tally doesn't have to be dropped, and 40,000+ kids in New York get health care coverage. Everyone wins!

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