Essential Plan Eligibility Expansion Effective April 1, 2024
2024/3/4
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Posted by Provider Relations
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Provider News
Beginning March 2, 2024, current enrollees in Qualified Health Plans (Ambetter from Fidelis Care) who are within 200-250% FPL will be notified via letter from NY State of Health about the expansion of Essential Plan coverage in New York State. Members that now qualify for Essential Plan coverage will automatically be moved from their Qualified Health Plan to Essential Plan 200-250, effective April 1, 2024.
Fidelis Care is prepared to support our members and providers throughout this transition and will communicate frequently with those affected. We are making every effort to ensure continuity of care by directly reaching out to high-risk patients, transferring prior authorization approvals, and providing coverage details through the Member and Provider Portals and fideliscare.org.
Resources for Members and Providers:
Additional Information:
Overview of New York’s 1332 State Innovation Waiver
The Essential Plan eligibility expansion will take effect April 1, 2024. The 1332 State Innovation Waiver application will expand the Essential Plan (EP) to New Yorkers with incomes up to 250% of the Federal Poverty Level to the U.S. Departments of Health and Human Services and Treasury. Through this expansion of Essential Plan coverage, the State seeks to increase access to high-quality, affordable health insurance for low- and moderate-income individuals.
NYSOH’s Operational Activities Related to the QHP to EP Transition
- March 2, 2024: NYSOH will send updated eligibility and enrollment notices to the population that will be transitioned from QHP (200-250% of FPL) to the new “EP 200-250” variant. These members will be defaulted into their QHP issuer’s EP 200-250 product, but will have the option to pick a different EP Issuer, or to stay in their QHP, but at the full premium cost. Members whose QHP issuer does not have an EP 200-250 product in the appropriate service area will be auto-assigned into a plan if they do not choose one in 10 days.
- March 5, 2024: “EP 200-250” plans will be live in the NYSOH system.
- March 16, 2024: 834 enrollment transactions will be sent to Issuers to terminate QHP coverage for the population with incomes of 200-250% of FPL effective 3/31/24, and add the “EP 200-250” coverage with a 4/1/24 enrollment effective date.
If you have any questions, please contact your Fidelis Care Provider Relations Specialist. To find your designated representative, please click here.