Relates to permitting pregnant individuals to enroll in the state health insurance exchange at any time

Summary of specific provisions

Section one adds a new section 3114 to the insurance law to provide that pregnancy shall be an event that triggers a special enrollment period available to individuals for enrollment at any time in a qualified health plan in the state health insurance exchange. This section also provides that the date of health plan coverage is effective on the date of the application.

Section two provides the effective date.

Justification

Eligible New Yorkers may enroll in qualified health plans through the state's health insurance exchange, the New York State of Health Marketplace, as established under the federal Affordable Care Act. New Yorkers may enroll in health plans during a designated open enrollment period, and during a special enrollment period if they experience a qualifying event. Qualifying events that trigger a special enrollment period include marriage, divorce, gaining citizenship, and birth, among others. This bill adds pregnancy to the list of qualifying events for a special enrollment period. This will enable pregnant individuals, who are otherwise eligible for exchange plans, to enroll in a health plan at any time.

Women who become pregnant and who have income below 223% of the Federal Poverty Level may already enroll in Medicaid at any time of year in New York State. However, if a woman's income is over this limit and she does not have employer-sponsored health care, she may face high out-of-pocket costs to secure prenatal and maternity care, or even worse, go without care. This bill allows women who are not eligible for Medicaid and who become pregnant outside of the exchange's open enrollment period to apply for a qualified health plan.

The New York City Comptroller recently released a report that examined this issue and highlighted the health benefits of prenatal care for pregnant women and newborns, and the potential long-term cost savings of prenatal care to the state's health care system.* Babies born to mothers who received no prenatal care are three times more likely to be born at low birth weight, and five times more likely to die, than those whose mothers received prenatal care.** Diseases that pose health risks to pregnant women can be mitigated by maternity care,

including preeclampsia, placental abruption, diabetes, heart conditions, and Graves' disease.*** Further, a study in the Journal of the American Board of Family Medicine found that prenatal care for teen mothers would save between $2,369 and $3,242 per pregnancy.****

Several states have already expanded the number of qualifying events for special enrollment periods on their state health exchanges. Pregnancy is a significant, life-changing event and should be added to New York State's list of qualifying events for health exchange coverage. This bill will promote the health and well-being of pregnant women and their newborns, and ensure better health outcomes for this population.

Fiscal implication

None to the state.

Effective date

January 1, 2016

* Office of the New York City Comptroller Scott M. Stringer, "Time to Deliver: Pregnancy and the Affordable Care Act," March 2015.

** US Department of Health & Human Services, http://mchb.hrsa.gov/programs/womeninfants/prenatal.html.

*** Postolowski, C., Young Invincibles. "Without Maternity Coverage: The Need for Special Enrollment in the Health Insurance Marketplaces during Pregnancy." December 2014.

**** Hueston, W., et al. "How Much Money Can Early Prenatal Care for Teen Pregnancies Save?: A Cost-Benefit Analysis." J Am Board Fam Med May-June 2008.