The Center for Consumer Information & Insurance Oversight
New York Health Insurance Marketplace Grants Awards List
New York has received six grant awards to build its Health Insurance Marketplace - Opens in a new window . This includes a Planning Grant, an Early Innovator Grant, five Level One Establishment Grants and a Level Two Establishment Grant.
Summaries of New York’s applications for each grant are provided below:
Establishment Grant Level Two Application Summary
Administrator: New York State Department of Health
Award Amount: $185,822,357
Award Date: January 17, 2013
Application Due Date: November 15, 2012
Award Supplement: $ 41,048,858 (September 20, 2013)
Level of Funding: Level Two
Summary: New York is receiving a Level Two Establishment Grant to support outreach and marketing, In-Person Assisters training and certification, and stakeholder engagement activities. New York will use funds to develop and operate the Call Center and back-end eligibility operations, make enhancements to the System for Electronic Rate and Form Filing (SERFF), and support costs for existing and new staff in 2013 and 2014. New York will purchase and maintain an accounting system for the marketplace (Exchange), will use funds for financial and operational audits, simulation modeling, and program evaluation. Funds will be used to pay for the balance of the marketplace IT system design and development costs including IT consultants and privacy and security consultants.
Award Supplement Award Amount: $ 41,048,858 (September 20, 2013)
Summary: New York will use the level two grant supplement funding in the areas of customer service, stakeholder consultation and engagement, and IT consulting staff. To increase overall efficiencies and customer support, the funding will be used to expand coordination across all programs, including public and commercial coverage and individual and small business exchanges to improve customer service and the customer experience.
Establishment Grant Level One Application Summary
State: New York State Department of Health
Award Amount: $63,826,144
Award Date: December 15, 2014
Application Due Date: October 15, 2014
Level of Funding: Level One
The New York State of Health Marketplace received funding to support additional development that is needed to implement upgrades to further enhance the consumers shopping experience, support the open enrollment period in 2015, and continue ensuring program compliance.
Administrator: New York State Department of Health
Award Amount: $10,774,898; $48,474,819; $95,496,490; $82,188,253
Award Date: August 12, 2011; February 22, 2012; August 23, 2012; May 2, 2014
Application Due Date: June 30, 2011; December 30, 2011; June 29, 2012; February 14, 2014
Award Supplement: $ 19,016,553 (September 20, 2013)
Level of Funding: Level One
Summary: New York has made significant progress under its exchange planning grant, early innovator grant, and consumer assistance program grant. This funding will: support background research; seek stakeholder input through a series of policy discussions focused on Exchange design and operation options; fund IT Systems; expand the capacity of its consumer assistance to serve the needs of small businesses, to expand assistance to individuals in regions of the State that currently have limited in-person access and expand consumer assistance with commercial insurance issues. The proposal also requests funding for key staff to begin the process of implementing the Exchange around governance.
With this second Level One grant, New York will continue its preparations to demonstrate operational readiness as required under the proposed Exchange Certification process. New York will use funding to develop and deliver an operationally-ready New York Health Benefit Exchange IT system; integrate services, functions, processes and systems across state agencies with the Exchange; establish New York’s All Payer Database which will be an integral component of the Exchange’s quality rating process and risk adjustment methodology; provide the actuarial work for New York-specific risk adjustment methodology; and complete new analyses and refine existing studies. New York’s grant will also maintain key Exchange planning staff and help build the services for work in the areas of Exchange eligibility and enrollment; customer assistance, complaints and appeals; certification of quality health plans; and the SHOP Exchange.
New York will use its third Level One Establishment Grant to hire executive leadership to: (1) further operationalize the Exchange to; (2) further enhance the IT Systems needed to operate the Exchange; (3) continue activities around the establishment of New York’s All Payer Claims Database; (4) develop the back-end operations of the Exchange Call Center and overall strategy to provide customer support and other consumer assistance activities; and (5) begin researching a campaign to educate enrollees in preparation for open enrollment in October 2013.
New York’s fourth Level One Establishment Grant will support a series of information technology system development needs. In addition, funding will support a significant increase in Customer Service Center and Eligibility and Enrollment staff and the associated rent and equipment needs to support these staff. Lastly, funding will support the Consumer Health Advocates program in 2014. The program is a network of 18 agencies which provide on-the-ground assistance to consumers in the communities where they live and work. Funding would be utilized to inform and educate consumers about appeal rights for services through commercial health plans; help empower consumers to be able to access their health coverage and be their own advocates; and providing feedback to stakeholders. The contract would be able to serve approximately 16,000-22,000 consumers.
Award Supplement Award Amount: $ 19,016,553 (September 20, 2013)
Summary: New York will use the level one grant supplement funding to improve the IT legacy systems upgrades and quality assurance process, to support of a multi-faceted effort to use advertising to drive enrollment through the Marketplace, and to improve the overall consumer assistance process.
Early Innovator Grant
Grantee: New York Department of Health
Award Amount: $27,431,432
Summary: New York proposes to build off its eMedNY Medicaid Management Information System (MMIS) system to build products for the Exchange. The eMedNY Medicaid Management Information System (MMIS) processes payments for approximately one of every three health care dollars paid in the state. It is also the primary source of Medicaid data used for financial reporting, program analysis, auditing, and quality measurement. The Department plans to use MMIS’ assets as the basis for designing and developing an Exchange to serve all New York State health insurance consumers. This approach will also result in the development of Exchange IT components fully extensible and scalable to any other jurisdiction.
State Planning Grant
Awarded September 30, 2010
Administrator: New York Department of Insurance
Amount Awarded: $1,000,000
- Determine whether its current insurance regulations that go beyond the protections of the Affordable Care Act should be maintained or whether they need to be modified to limit adverse risk selection in the Exchanges.
- Compile and evaluate background research from current research platforms and private funding by January 2011.
- Engage stakeholders in the evaluation, planning and development process throughout the one-year planning period.
- Evaluate the extent to which New York can or should integrate and build on existing programs, as appropriate.
- Identify and utilize existing resources and capabilities, as appropriate, throughout the one-year planning period and determine the need for additional resources.
- Design Exchange governance structure and draft legislation, if required.
- Evaluate financial accounting, auditing, and reporting requirements and potential pathways to securing compliance.
- Identify existing technical infrastructure resources and needs.
- Create business operations plan and policies for Exchange.
- Identify legislation and regulations needed to create, promote, and regulate the Exchange.
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