New York: Essential Plan expansion boosts QHP/BHP enrollment by over 114K!

New York State of Health

As I've written about several times before, starting April 1st, New York State expanded their wildly popular Essential Plan program (NY's name for the ACA's Basic Health Plan program) up the household income scale from 200% of the federal poverty level (FPL) to 250% FPL:

On March 1, 2024, the U.S. Department of Health and Human Services (HHS) and U.S. Department of Treasury approved New York's Section 1332 State Innovation Waiver application to expand the Essential Plan.  Section 1332 State Innovation Waivers allow states to pursue innovative strategies for providing residents with access to high quality, affordable health insurance.  The waiver was approved for five years, from 2024 through 2028.

...Key Components of the Waiver

This approved State Innovation waiver expands health insurance and covers health-related social needs, improving health care and advancing health equity.  The waiver includes the following key components: 

Extending Affordable Health Insurance to Over 100,000 New Yorkers – The Essential Plan will be expanded to New Yorkers with incomes between 200 and 250 percent of the FPL, making the high quality, affordable program available to over 100,000 additional New Yorkers.

...Promoting Individual Market Premium Stability – Federal funding from this waiver will also support an Insurer Reimbursement Implementation Plan established to mitigate premium increases for individual market enrollees from the impact of the population with estimated household income 200-250% of FPL moving to the Essential Plan. In addition to maintaining stable premiums in the individual market, this waiver will also support stability with respect to plan participation for the individual market.

Short version: New Yorkers who earn between 200 - 250% FPL are now eligible for the Essential Plan, which is a much better value for the vast majority of them than even heavily subsidized ACA plans.

The expansion was implemented starting April 1st, and as noted, in addition to up to 100,000 more New Yorkers gaining coverage, a chunk of the existing ACA exchange Qualified Health Plan (QHP) enrollees who earn 200 - 250% FPL were supposed to be transferred over to the newly-expanded EP program as well.

Now that the expansion has gone into effect, my colleague Andrew Sprung reminded me that NY State of Health posts monthly updates of their enrollment data, so let's take a look!

As of the end of the 2024 Open Enrollment Period (OEP) on January 31st, the official numbers for New York were:

  • BHP Enrollment: 1,198,396
  • QHP Enrollment: 288,681
  • Combined Total: 1,487,077

Of the QHPs, 62,043 earned between 200 - 250% FPL according to the 2024 OEP Public Use File.

At first this might make you think that only 69,584 of the 200 - 250% FPL EP category circled above are newly enrolled (ie, not transferred over), but keep in mind that due to natural attrition over time, not all ~69.5K were still enrolled as of April 1st anyway.

According to the May report above, total QHP enrollment only dropped by 55,530 from January - May....and not all of that drop came from the 200 - 250% bracket.

With that in mind, my guess is that perhaps 50,000 or so of the "Essential Plan 200 - 250" column came from QHP transfers, with the remaining ~82,000 being brand new enrollees.

What's also noteworthy is that total enrollment in BHPs + QHPs combined is up 114,308 people since the end of January. Considering the normal attrition which normally takes place over the course of the year, this means the EP expansion has been more successful than it might look at first glance.