New York State Health Foundation

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Expanding Affordable Coverage for Small Business Employees

Expansion of the Family Health Plus Employer Buy-In program was designed to help New York State’s small businesses offer comprehensive, affordable health care coverage to their employees. With support from NYSHealth, the Community Service Society (CSS) of New York examined key design and implementation issues that could increase the program’s success for small businesses and their employees.

CSS took a close look at other states’ employer buy-in programs; interviewed key stakeholders in New York; conducted an actuarial analysis of premium setting; and identified solutions to implementation and eligibility challenges. The analysis and recommendations were released in a policy brief, Expanding Affordable Coverage for Low-Waged Workers: Fixing the Family Health Plus Employer Buy-In.

As CSS conducted its analysis and identified opportunities to improve the program, the Foundation and CSS convened key stakeholders—representing small businesses, insurers, advocates, and policymakers—to provide input and feedback on the findings.

Ultimately, in 2010, New York State implemented many of CSS’s recommendations to improve the Employer Buy-In program: instituting modest co-payments; adopting an “out-of-network” Medicaid default rate; and targeting the program to businesses and unions that currently do not provide coverage or are in jeopardy of losing coverage. Collectively, these measures lower the previously existing premium of $540 per month by 25%, to approximately $397 per month.