September 15, 2025
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Rural Health Transformation Program First and for those following along after our call last week where we spent some of our time on Thursday morning discussing the state’s participation in the new CMS Rural Health Transformation Program, the CMS application to states came out today. Here’s a link to the CMS page: The page now includes a connection to the document (attached) which is the actual application for states. ——————- On The Hill In Washington, D.C., Congressional Republicans are beginning to coalesce around the White House’s plan to keep funding flat for federal agencies through January, called a clean “continuing resolution” or CR, to avoid a looming government shutdown at the end of the month. GOP fiscal hawks have favored a longer-term CR to keep funding levels flat, and the Trump administration would prefer another four months of current funding levels rather than negotiate with Democrats on the twelve individual appropriations bills that make up an annual government funding package. (Politico, 9/15/25) Text of the continuing resolution, or CR, is expected to be released as early as this morning, three Republicans tell Meredith Lee Hill. Here’s the latest: The timeline: House Republicans want to put the CR on the floor this week. That still likely won’t give the Senate enough time to schedule a vote before next week’s recess in observance of Rosh Hashanah, however, leaving Congress with just days left to act before the Sept. 30 deadline. The holdup: House Republican leaders are working to attach increased lawmaker security funding to the stopgap bill in the wake of Charlie Kirk’s assassination. Speaker Mike Johnson told Fox on Sunday morning that all options are on the table, and three people tell Meredith it’s the final piece to resolve. Sen. Lindsey Graham has also been doing some last-minute lobbying for his bipartisan Russia sanctions bill to hitch a ride on the CR. But two people granted anonymity to discuss the views of GOP leadership tell Meredith it’s not going in without President Donald Trump’s explicit and public backing. The big problem: Democrats in both chambers insist they will not accept any funding agreement without bipartisan talks, and Republicans are going it alone. They also say they need the CR to include an extension of enhanced tax credits for Affordable Care Act insurance premiums, which are due to expire at the end of the year. Republicans are still figuring out how to proceed on that one (more on that below). A key question is how Democrats will vote in the Senate, where Republicans won’t be able to move government funding legislation without support across the aisle. Many Republicans are banking on a do-over of what happened in March, when Senate Minority Leader Chuck Schumer shored up support for a procedural vote on a shutdown-averting package negotiated only among the GOP. But Schumer got an earful from his party’s base about not fighting harder for a better deal, and he’s currently warning his GOP colleagues that a CR without the ACA credit extension is a deal-breaker. “If Republicans follow Donald Trump’s orders to not even bother dealing with Democrats they will be single handedly putting our country on the path toward a shutdown,” said a Schumer spokesperson Sunday night. Some Senate Democrats have suggested they could support a “clean” stopgap funding bill now if it’s intended to buy more time toward negotiating an ACA subsidies extension later, Jordain Carney writes in. But many of them are holding back on opining without first knowing what Republicans are officially offering. “I’m not going to comment until I see what actually happens. It’s all speculation right now,” Sen. Gary Peters told Jordain. |
And speaking of access to health insurance in New York:
On September 10th, Governor Hochul announced her intention to terminate New York’s 1332 State Innovation Waiver that had expanded eligibility for the Essential Plan. This action is expected to allow New York to access a reserve fund frozen during the waiver to replace federal funding lost as a result of the One Big Beautiful Bill Act (OBBBA).
The Essential Plan is a health insurance option for adults aged 19 to 64 with incomes too high for Medicaid, or those with lower incomes but who are ineligible for Medicaid (e.g., certain immigrants). The Essential Plan has no monthly premium, no deductible, and minimal cost-sharing for enrollees.
In 2015, New York State first created the Essential Plan as a Basic Health Plan (BHP) authorized under Section 1331 of the Affordable Care Act (ACA). In 2024, the federal government approved the State’s request to switch to a 1332 State Innovation Waiver and replace the BHP with a mirror plan. This plan, also called the Essential Plan, expanded the upper income eligibility limit from 200% of the Federal Poverty Level (FPL) to 250% of FPL (a group also known as EP5). New York’s waiver was later amended to distribute cost-sharing reduction subsidies (unavailable under the 1331 authority) to individuals between 250% and 400% of FPL. As a condition for 1332 waiver approval, a reserve fund that New York accumulated under the original Section 1331 authority (from 2015-2024) was frozen, preventing the state from accessing over $10 billion dollars while the waiver is in effect.
The OBBBA eliminates federal support for a large group of Essential Plan enrollees, namely those who are not lawful permanent residents (green card holders) or who are not eligible for Medicaid due to immigration status. As a result, the State expects to lose federal funding for nearly half of current Essential Plan enrollees, approximately 730,000 individuals. Because of this lost federal support, the state has decided to revert the Essential Plan back to a BHP and access the BHP reserve fund to maintain benefits for those with incomes up to 200% FPL who are losing federal funding.
The State intends to implement these changes by July 1, 2026. Adults with incomes from 200%-250% of FPL will be transitioned to Qualified Health Plans, with higher cost-sharing and higher premiums, affecting approximately 440,000 New Yorkers. The State seeks to collaborate with CMS to design and provide affordable coverage options for these members who will no longer qualify for the Essential Plan. (Source: Sachs Policy Group, 9/11)
Additional Resources for NYS Council members:
1) In a radio interview with David Lombardo on the Capitol Connection, NY State of Health (NYSOH) Director Danielle Holahan explains New York’s current response to federal changes that impact how New Yorkers currently access health insurance coverage and the potential problems ahead:
Federal impacts on coverage: New York State of Health Executive Director Danielle Holahan explains how the Hochul administration is responding to federal changes that impact how the state ensures health insurance coverage for 1.7 million low-income New Yorkers.
2) Next, please see attached slide that lays out the timeline for important changes to the NYS public health insurance market (unless something changes):
3) Finally, here’s information on a bipartisan bill working its way through Congress on the topic of the Enhanced Tax Credits many New Yorkers rely on to assist them with the purchase of health insurance through the NYSOH:
Bipartisan Bill to Extend ACA Enhanced Tax Credits for One Year Introduced in House
On September 4th, Reps. Jen Kiggans (VA-02) and Tom Suozzi (NY-03) introduced the Bipartisan Premium Tax Credit Extension Act, which extends the enhanced Premium Tax Credit (PTC) for insurance purchased via the Affordable Care Act (ACA) Health Insurance Marketplaces for one year, through December 2026. The American Rescue Plan Act expanded PTC eligibility and amounts to help consumers maintain coverage during the Covid-19 pandemic. These enhanced PTCs were extended by the Inflation Reduction Act. Without Congressional action, the enhanced subsidies are due to expire at the end of 2025. The loss of enhanced PTCs would bring health care costs thousands of dollars higher for most of those in the individual market in households earning up to approximately 700% of the federal poverty level, and it would re-institute the “subsidy cliff” at 400% of the poverty level. The sponsors of the bill state that the one-year extension of the PTC will provide ongoing financial protections for consumers while Congress works on a more “permanent solution” to insurance affordability. The Bipartisan Premium Tax Credit Extension Act can be found here.