New York Affordable Insurance Exchange Grants Awards List
New York has received five grant awards to build its Affordable Insurance Exchange. This includes a Planning Grant, an Early Innovator Grant and three Level One Establishment Grants.
Summaries of New York’s applications for each grant are provided below:
Establishment Grant Level One Application Summary
Administrator: New York State Department of Health
Award Amount: $10,774,898; $48,474,819; $95,496,490
Award Date: August 12, 2011; February 22, 2012; August 23, 2012
Application Due Date: June 30, 2011; December 30, 2011; June 29, 2012
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.
Early Innovator Grant
Grantee: New York Department of Health
Award Amount: $27,431,432
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.