Healthcare (Medicaid)

in committee · New York · Senate Jan 7, 2026

S 586: Establishes a mandated window of five business days for both Medicaid and private insurers to respond to pre-authorization claims for testing and/or treatments made by physicians on behalf of oncology patients

Establishes a mandated window of five business days for both Medicaid and private insurers to respond to pre-authorization claims for testing and/or treatments made by physicians on behalf of oncology patients.

Topics ✓ HealthcareSupports HealthcareMandates 5-day insurer response window for oncology pre-authorizations, improving timely access to cancer treatments and reducing delays in care.95% confidence

Sub-Topics Medicaid

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in committee · New York · Senate Jan 7, 2026

S 5249: Relates to Medicaid eligibility for striking workers

This bill (S 5249) automatically grants Medicaid eligibility to workers participating in strikes or labor disputes, ensuring they maintain health coverage during the strike period. It directly affects striking employees who would otherwise lose Medicaid due to employment status, without requiring them to reapply. Key provisions include limiting coverage strictly to the duration of the strike, prohibiting the consideration of personal resources (like savings) when determining eligibility, and allowing temporary "presumptive eligibility" through health department processes. The bill requires the Health Commissioner to create implementing regulations for eligibility rules and covered services.

Topics ✓ HealthcareSupports HealthcareAutomatically maintains Medicaid for striking workers, preventing coverage loss during labor disputes and expanding access without reapplication or resource assessment.95% confidence ✓ Labor & EmploymentSupports Labor & EmploymentAutomatically maintains Medicaid for striking workers, protecting health coverage during labor disputes without requiring reapplication or considering personal resources.90% confidence

Sub-Topics Medicaid Collective Bargaining

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in committee · New York · Senate Jan 7, 2026

S 5361: Provides for a minimum reimbursement rate for ambulatory behavioral health services

This bill (S 5361) requires health insurers in New York to reimburse licensed behavioral health providers (under public health or mental hygiene laws) for ambulatory behavioral health services at a minimum rate equivalent to what the state's Medicaid program (Medical Assistance) pays for similar services. It applies to all health insurance policies covering medical, major medical, or comprehensive coverage, including group plans and health maintenance organizations. Insurers may negotiate higher rates with providers but cannot pay less than the Medicaid-equivalent rate established under the Ambulatory Patient Group (APG) methodology. The law takes effect September 1, 2025, for all new or renewed policies.

Topics ✓ HealthcareSupports HealthcareRequires insurers to reimburse behavioral health providers at Medicaid rates, improving access to mental health services and strengthening coverage under healthcare policies.95% confidence

Sub-Topics Insurance Medicaid Mental Health

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in committee · New York · Assembly Jan 7, 2026

A 1359: Relates to the establishment of rates of payment for medical assistance for needy persons

This bill requires New York's health commissioner to update medical assistance payment rates for hospitals and health services at least every four years, ensuring rates reflect current operational costs rather than outdated data. It directly affects hospitals, health service providers, and Medicaid programs by mandating that reimbursement rates align with recent cost information for efficient operations. Key provisions include prohibiting the use of base-year calculations older than four years and requiring annual public disclosure of reimbursement methodologies on the state health department's website. The changes aim to modernize payment structures for Medicaid and related programs without altering eligibility or benefit levels.

Topics ✓ HealthcareSupports HealthcareRequires updating Medicaid reimbursement rates to reflect current costs, ensuring hospitals receive adequate funding for services to needy persons.90% confidence

Sub-Topics Medicaid

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in committee · New York · Assembly Jan 7, 2026

A 2170: Repeals the state Medicaid spending cap and related processes; repealer

This bill repeals a 2011 law that imposed a spending cap on the state's Medicaid program, specifically removing Sections 91 and 92 of Chapter 59. It directly affects how the state Department of Health manages Medicaid funding by eliminating the annual growth limit on state funds for Medicaid. The key mechanism is the complete removal of these specific legal provisions, allowing Medicaid spending to increase without the previous restriction. This change takes effect immediately upon enactment.

Topics ✓ Budget & TaxesSupports Budget & TaxesRepeals Medicaid spending cap, enabling increased state funding for essential healthcare program without annual restrictions.95% confidence ✓ HealthcareSupports HealthcareRepeals Medicaid spending cap, removing restrictions on state funding for Medicaid programs, directly increasing flexibility for healthcare funding and access.95% confidence

Sub-Topics Government Spending Medicaid

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in committee · New York · Senate Jan 7, 2026

S 3762: Provides for coverage for certain individuals under the 1332 state innovation program

This bill creates a New York State 1332 innovation program under a federal waiver, providing health insurance coverage for New Yorkers under age 65 with household incomes between 133% and 250% of the federal poverty level who don't qualify for Medicaid or employer-sponsored insurance. It requires coverage for essential health services, including access to cancer centers (at Medicaid reimbursement rates), dental, vision, and support for chronic illnesses. Eligibility excludes those eligible for Medicaid, the Child Health Insurance Program, or affordable employer coverage. The program is subject to federal approval and aims to fill coverage gaps for this specific income group.

Topics ✓ HealthcareSupports HealthcareExpands health coverage for uninsured NY adults (133-250% FPL) via state innovation program, mandating essential services including cancer care, dental, and chronic illness support.95% confidence

Sub-Topics Children's Health Insurance Medicaid

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in committee · New York · Assembly Jan 7, 2026

A 7220: Relates to the general hospital indigent care pool and funding for safety net and enhanced safety net hospitals

This bill adjusts funding for hospitals serving high numbers of low-income and uninsured patients (safety net hospitals). It allocates $139.4 million annually to major public hospitals and $969.9 million to other general hospitals, but applies annual reductions of $150 million (2020-2022) and $275.4 million (2023 onward) to the latter group - unless hospitals qualify as "enhanced safety net hospitals" under specific criteria. To qualify, hospitals must meet metrics like serving at least 45% Medicaid/uninsured patients, operating under financial hardship, or providing critical community services. Starting in 2026, the bill mandates an additional $228.4 million in funding for qualified safety net hospitals to support their operations and maintain services for vulnerable populations.

Topics ✗ Budget & TaxesOpposes Budget & TaxesBill imposes $275.4M annual cuts (2023+) to general hospitals unless qualifying as enhanced safety net, defunding non-qualifying essential providers despite initial funding allocation.85% confidence ✓ HealthcareSupports HealthcareAllocates $139.4M annually to public hospitals and $969.9M to safety net hospitals with conditional funding retention to support low-income care access.95% confidence

Sub-Topics Hospitals Medicaid

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in committee · New York · Senate Jan 7, 2026

S 1712: Relates to including the services and care of school psychologists under Medicaid

This bill (S 1712) requires Medicaid to cover services provided by school psychologists certified under education law, where those services would otherwise qualify for Medicaid coverage. It directly affects students receiving psychological services in schools and school psychologists who provide those services. The key provision adds a specific category to Medicaid coverage, clarifying that such services must be covered without altering the scope of practice defined for school psychologists under education law. The bill takes effect 180 days after enactment.

Topics ✓ EducationSupports EducationRequires Medicaid to cover school psychologists' services, expanding student access to mental health support in schools without altering scope of practice.95% confidence ✓ HealthcareSupports HealthcareExpands Medicaid coverage to include school psychology services, directly supporting mental health access for students without altering scope of practice.95% confidence

Sub-Topics Student Health Healthcare Workforce Medicaid Mental Health

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passed · New York · Senate Jun 4, 2026

S 6736: Relates to requiring Medicaid to cover a wearable medical device to treat certain forms of cancer

Requires Medicaid to cover a wearable medical device that uses low-intensity, alternating electric fields delivered to the tumor site to treat glioblastoma and other cancers as recommended by medical and scientific evidence.

Topics ✓ Budget & TaxesSupports Budget & TaxesRequires Medicaid to fund a new cancer treatment device, increasing state government spending on public health programs as mandated coverage.90% confidence ✓ HealthcareSupports HealthcareBill mandates Medicaid coverage for a cancer treatment device, expanding access to evidence-based medical care under public health programs.95% confidence

Sub-Topics Medicaid

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in committee · New York · Senate Nov 25, 2025

S 6377: Requires Medicaid to cover gender-affirming care regardless of federal funding; prohibits discriminatory practices by health care entities and insurers; relates to coverage for treatment for gender dysphoria

This bill requires New York Medicaid to cover all medically necessary gender-affirming care, regardless of federal funding availability. It prohibits healthcare entities (including hospitals, licensed professionals, and insurers) from discriminating against patients based on gender identity, sexual orientation, or other protected characteristics. Insurers must cover treatment for gender dysphoria without excluding it based on transgender status, and cannot apply annual deductibles or coinsurance for this care - except in high-deductible health plans. The law also mandates that insurers provide appeal rights for denied coverage related to gender dysphoria treatment.

Topics ✓ HealthcareSupports HealthcareBill mandates Medicaid coverage of gender-affirming care, prohibits discrimination by healthcare entities/insurers, and requires coverage for gender dysphoria treatment, expanding health coverage and protecting patient rights.95% confidence

Sub-Topics Insurance Medicaid

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