Eliminates the prospective enrollment waiting period for children under the age of nineteen enrolling in the child health insurance plan program by enrolling a child retroactively to the first day of the month in which they are approved for coverage under such program.
Summary
This bill amends the Public Health Law to change how children under age 19 are enrolled in the Child Health Insurance Plan (CHIP) program. Under the bill, once a child is determined eligible and a completed application is submitted, coverage would begin retroactively to the first day of the month in which the child is deemed eligible, rather than waiting for prospective enrollment timing. The bill also applies this retroactive enrollment rule to presumptive enrollment procedures used by approved organizations or the health insurance exchange marketplace.
The bill further clarifies that subsidy payments to approved organizations must cover health care services provided during any retroactive presumptive enrollment period. In addition, it amends the claims-filing rules for out-of-network providers so that services furnished during a retroactive presumptive enrollment period are treated as having been provided to an eligible person. The act would take effect immediately.
Impact
The bill would amend section 2511 of the Public Health Law by repealing and replacing the existing enrollment language for CHIP-eligible children, expanding retroactive coverage protections and aligning subsidy and claims rules with that coverage change. It would affect approved organizations, the health insurance exchange marketplace, out-of-network providers, and families seeking child health coverage, while also modifying how claims and subsidy payments are processed for services delivered before formal enrollment is finalized.
Sentiment
The bill text and caption indicate a consumer- and coverage-expansion approach, aimed at preventing gaps in coverage for children and ensuring that approved children receive benefits from the start of the month in which they become eligible. No committee transcript or vote record is provided, so there is no documented recorded debate or opposition in the supplied materials. Based on the bill’s purpose, the general posture appears supportive of broader access to child health coverage and administrative simplification.
Contention
The main policy issue is the retroactive start date for coverage, which shifts financial responsibility to the program for services delivered before formal enrollment is completed. Potential points of contention include the administrative and fiscal impact on approved organizations and the state, the treatment of out-of-network claims during retroactive periods, and whether retroactive coverage could create additional billing or verification burdens. No specific opposing arguments or named stakeholders are included in the provided record.
Eliminates the prospective enrollment waiting period for children under the age of nineteen enrolling in the child health insurance plan program by enrolling a child retroactively to the first day of the month in which they are approved for coverage under such program.
Permits coverage under Child Health Plus to take effect retroactively to the first day of the month in which the application was submitted for children who meet the eligibility criteria, provided that the applicant for insurance submits a completed and signed application and required information and documentation within sixty days of the child's birth.
Expands coverage for the treatment of asthma to include a second rescue and maintenance inhaler, along with any medically necessary devices for children under nineteen years of age.
Expands coverage for the treatment of asthma to include a second rescue and maintenance inhaler, along with any medically necessary devices for children under nineteen years of age.
Enacts "Isabella's law" to require all health insurance policies and medical assistance to provide insurance coverage for the cost of medically necessary hearing aids for children under the age of 16.
Prohibits approved organizations providing coverage under the child health insurance plan from discriminating against health care providers which do not participate in the organization's health care network.
Payment rates established for certain substance use disorder treatment services, and vendor eligibility recodified for payments from the behavioral health fund.
Cover Outstanding Vulnerable Expansion-eligible Residents Now Act or the COVER Now Act This bill establishes a demonstration program to allow local governments to provide health benefits to the Medicaid expansion population in states that have not expanded Medicaid. Under the program, local governments may provide coverage for individuals who are newly eligible for Medicaid under the Patient Protection and Affordable Care Act (i.e., the Medicaid expansion population) for a maximum of 10 years, or until their respective states expand Medicaid. The bill provides a 100% federal matching rate for the first three years of program participation. The bill prohibits states from taking certain actions against participating localities, such as withholding funding, increasing taxes, or restricting provider participation. States that violate these requirements are subject to certain funding penalties.