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New York State of Health\u00a0(NYSOH)\u00a0recently announced that\u00a0cost-sharing reduction programs\u00a0made possible by\u00a0the State 1332 Innovation Waiver will continue until the end of 2026.\u00a0These\u00a0crucial affordability programs\u00a0reduced deductibles and eliminated co-payments for outpatient maternity care and out-of-pocket costs for diabetes-related treatments for individuals enrolled in Qualified Health Plans on the individual market.\u00a0On July 1,\u00a02026,\u00a0the State will\u00a0transition from the 1332 Waiver back to the Basic Health Plan, but\u00a0this\u00a0will not affect these cost-sharing programs\u00a0through the end of the year. In addition,\u00a0this transition will\u00a0not affect the State\u2019s free insulin program for those with State-regulated health coverage, which was enacted through the State budget in 2024.<\/span>\u00a0<\/span><\/p>\n \u00a0<\/span>What is changing?<\/span><\/b>\u00a0<\/span><\/p>\n In March,\u00a0<\/span>New York State of Health announced<\/span><\/a>\u00a0that the Centers for Medicare and Medicaid Services (CMS) approved New York\u2019s request to\u00a0terminate\u00a0its Section 1332 Waiver and return to the Basic Health Plan under Section 1331 of the Affordable Care Act. This transition partially mitigates the impact of HR1, known as President Trump\u2019s One Big Beautiful Bill, enacted on July 4, 2025. The transition will preserve health insurance for 1.3 million New Yorkers but\u00a0terminates\u00a0free Essential Plan coverage for 444,000 others. As described on\u00a0<\/span>HCFANY\u2019s Protect Health Coverage<\/span><\/a>\u00a0page,\u00a0the State could have\u00a0passed\u00a0<\/span>S9589<\/span><\/a>\/<\/span>A10926<\/span><\/a>\u00a0to prevent this loss of coverage.<\/span>\u00a0<\/span><\/p>\n The State\u2019s cost-sharing reduction program is funded by this 1332 Waiver,\u00a0and the federal government denied the State\u2019s request to keep funding to\u00a0maintain\u00a0these programs for the rest of the year. However,\u00a0NYSOH\u00a0just\u00a0announced that this program will not lapse in July and\u00a0will continue\u00a0until the end of this year.\u00a0HCFANY\u00a0thanks\u00a0the State for continuing to protect patients from federal cuts to health care.\u00a0Data from New York State of Health\u2019s latest\u00a0<\/span>enrollment report for 2025<\/span><\/a>\u00a0reveals that these three initiatives saved over 62,000 New Yorkers enrolled in Qualified Health Plans around $50 million in health care costs. Based on claims data, these cost-sharing programs have benefited 3,800 with prenatal and pregnancy care, 26,600 with diabetes care, and reduced deductibles for 41,800 with Marketplace Silver plans. You can\u00a0<\/span>see the entire list of prenatal and diabetes services here<\/span><\/a>.<\/span>\u00a0<\/span><\/p>\n Consumers who have Qualified Health Plans and have a household income between 200% and 400% of the Federal Poverty Level can still enroll in these cost-sharing programs.\u00a0If\u00a0an\u00a0individual is\u00a0already\u00a0on a silver plan,\u00a0they will be automatically enrolled\u00a0in this program. If the individual would like to switch,\u00a0they can visit NYSOH and make this change by completing a \u201cLife Status Change\u201d in their\u00a0application.\u00a0Some consumers may have received a notice\u00a0in early June\u00a0indicating\u00a0the termination of cost-sharing; they should disregard it.\u00a0<\/span>\u00a0<\/span><\/p>\n What is not changing?<\/span><\/b>\u00a0<\/span><\/p>\n Fortunately, insulin will remain available to those with State-regulated health insurance with no cost-sharing. New York became the first in the nation to fully\u00a0eliminate\u00a0copayments, coinsurance, and deductible requirements for covered prescription insulin by amending the state insurance law in the State\u2019s FY2024-2025 final budget. This new law went into effect on\u00a0January 1, 2026.\u00a0<\/span>Research shows<\/span><\/a>\u00a0that eliminating\u00a0co-payments for\u00a0some chronic\u00a0care medications\u2014including insulin\u2014generates more insurance claims savings. This law replaced a 2020 statute that had capped insulin copays at $100 per month. The State\u00a0subsequently\u00a0eliminated\u00a0co-payments for maintenance and emergency inhalers in a law that takes effect on January 1, 2027.<\/span>\u00a0<\/span><\/p>\n HCFANY hopes the State continues to ensure that New Yorkers have access to affordable, quality care, especially for the\u00a0<\/span>half a million New Yorkers who will lose Essential Plan coverage this July due to federal health care cuts<\/span><\/a>. Stay tuned, as HCFANY will review the final budget once it is released.<\/span>\u00a0<\/span><\/p>\n<\/p><\/div>\n