S T A T E O F N E W Y O R K
________________________________________________________________________
10926
I N A S S E M B L Y
April 9, 2026
___________
Introduced by M. of A. PAULIN, LASHER, DINOWITZ, ANDERSON, BORES,
BURDICK, CRUZ, DAVILA, DE LOS SANTOS, DILAN, FORREST, GALLAGHER,
GLICK, GONZALEZ-ROJAS, HEVESI, HOOKS, KELLES, LEE, LEVENBERG, LUNS-
FORD, MITAYNES, MORENO, OTIS, POWERS, RAGA, RAMOS, REYES, ROSENTHAL,
ROZIC, SAYEGH, SEAWRIGHT, SEPTIMO, SHIMSKY, SHRESTHA, SIMON, SIMONE,
TAPIA, TORRES, WEPRIN -- read once and referred to the Committee on
Health
AN ACT to amend the public health law and the social services law, in
relation to coverage for New Yorkers losing insurance due to the
implementation of HR 1
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Title 7 of article 2 of the public health law is amended by
adding a new section 268-i to read as follows:
§ 268-I. STATE PREMIUM ASSISTANCE PROGRAM. NO LATER THAN JANUARY
FIRST, TWO THOUSAND TWENTY-SEVEN, THE MARKETPLACE SHALL ESTABLISH AND
ADMINISTER A STATE PREMIUM ASSISTANCE PROGRAM THAT OFFERS EQUIVALENT
FINANCIAL ASSISTANCE TO INDIVIDUALS WHO ARE LAWFULLY PRESENT IN THE
UNITED STATES AND WHO ARE INELIGIBLE FOR THE BASIC HEALTH PROGRAM,
PREMIUM TAX CREDITS, OR COST SHARING REDUCTIONS, BASED ON THEIR IMMI-
GRATION STATUS. THE STATE PREMIUM ASSISTANCE PROGRAM SHALL OFFER EQUIV-
ALENT LEVELS OF ASSISTANCE AS THE FEDERAL PREMIUM TAX CREDITS AND COST-
SHARING REDUCTIONS BASED ON THE ENROLLEES' INCOMES.
§ 2. Paragraph (d) of subdivision 3 of section 369-gg of the social
services law, as separately amended by section 2 of part BBB of chapter
56 and section 86 of chapter 669 of the laws of 2022, is amended to read
as follows:
(d) (i) except as provided by [subparagraph (ii)] SUBPARAGRAPHS (IV)
AND (V) of this paragraph, has household income at or below two hundred
percent of the federal poverty line defined and annually revised by the
United States department of health and human services for a household of
the same size; and has household income that exceeds one hundred thir-
ty-three percent of the federal poverty line defined and annually
revised by the United States department of health and human services for
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD15269-03-6
A. 10926 2
a household of the same size; however, MAGI eligible noncitizens
lawfully present in the United States with household incomes at or below
one hundred thirty-three percent of the federal poverty line shall be
eligible to receive coverage for health care services pursuant to the
provisions of this title if such noncitizen would be ineligible for
medical assistance under title eleven of this article due to their immi-
gration status;
(ii) [subject to federal approval and the use of state funds, unless
the commissioner may use funds under subdivision seven of this section,
has household income at or below two hundred fifty percent of the feder-
al poverty line defined and annually revised by the United States
department of health and human services for a household of the same
size; and has household income that exceeds one hundred thirty-three
percent of the federal poverty line defined and annually revised by the
United States department of health and human services for a household of
the same size; however, MAGI eligible aliens lawfully present in the
United States with household incomes at or below one hundred thirty-
three percent of the federal poverty line shall be eligible to receive
coverage for health care services pursuant to the provisions of this
title if such alien would be ineligible for medical assistance under
title eleven of this article due to their immigration status;
(iii)] subject to federal approval if required and the use of state
funds, unless the commissioner may use funds under subdivision seven of
this section, a pregnant individual who is eligible for and receiving
coverage for health care services pursuant to this title is eligible to
continue to receive health care services pursuant to this title during
the pregnancy and for a period of one year following the end of the
pregnancy without regard to any change in the income of the household
that includes the pregnant individual, even if such change would render
the pregnant individual ineligible to receive health care services
pursuant to this title;
[(iv)] (III) subject to federal approval, a child born to an individ-
ual eligible for and receiving coverage for health care services pursu-
ant to this title who would be eligible for coverage pursuant to subpar-
agraphs [(2)] TWO or [(4)] FOUR of paragraph (b) of subdivision [1] ONE
of section three hundred [and] sixty-six of [the social services law]
THIS ARTICLE shall be deemed to have applied for medical assistance and
to have been found eligible for such assistance on the date of such
birth and to remain eligible for such assistance for a period of one
year[.];
(IV) SUBJECT TO THE USE OF STATE FUNDS, AN INDIVIDUAL WHO IS PERMA-
NENTLY RESIDING IN NEW YORK STATE UNDER COLOR OF LAW WITH A HOUSEHOLD
INCOME BETWEEN ONE HUNDRED THIRTY-THREE AND TWO HUNDRED PERCENT OF THE
FEDERAL POVERTY LINE SHALL BE ELIGIBLE TO RECEIVE COVERAGE FOR HEALTH
CARE SERVICES PURSUANT TO THIS TITLE REGARDLESS OF THE AVAILABILITY OF
FEDERAL FUNDING;
(V) SUBJECT TO THE USE OF STATE FUNDS, AN INDIVIDUAL WHO IS A CITIZEN,
OR LAWFULLY PRESENT, OR IS PERMANENTLY RESIDING UNDER COLOR OF LAW WITH
A HOUSEHOLD INCOME BETWEEN TWO HUNDRED AND TWO HUNDRED FIFTY PERCENT OF
THE FEDERAL POVERTY LINE SHALL BE ELIGIBLE TO RECEIVE COVERAGE FOR
HEALTH CARE SERVICES PURSUANT TO THIS TITLE REGARDLESS OF THE AVAILABIL-
ITY OF FEDERAL FUNDING.
An applicant who fails to make an applicable premium payment, if any,
shall lose eligibility to receive coverage for health care services in
accordance with time frames and procedures determined by the commission-
er.
A. 10926 3
§ 2-a. Paragraph (d) of subdivision 3 of section 369-gg of the social
services law, as separately amended by section 3 of part BBB of chapter
56 and section 86-a of chapter 669 of the laws of 2022, is amended to
read as follows:
(d) (i) except as provided by [subparagraph (ii)] SUBPARAGRAPHS (IV)
AND (V) of this paragraph, has household income at or below two hundred
percent of the federal poverty line defined and annually revised by the
United States department of health and human services for a household of
the same size; and has household income that exceeds one hundred thir-
ty-three percent of the federal poverty line defined and annually
revised by the United States department of health and human services for
a household of the same size; however, MAGI eligible noncitizens
lawfully present in the United States with household incomes at or below
one hundred thirty-three percent of the federal poverty line shall be
eligible to receive coverage for health care services pursuant to the
provisions of this title if such noncitizen would be ineligible for
medical assistance under title eleven of this article due to their immi-
gration status;
(ii) [subject to federal approval and the use of state funds, unless
the commissioner may use funds under subdivision seven of this section,
has household income at or below two hundred fifty percent of the feder-
al poverty line defined and annually revised by the United States
department of health and human services for a household of the same
size; and has household income that exceeds one hundred thirty-three
percent of the federal poverty line defined and annually revised by the
United States department of health and human services for a household of
the same size; however, MAGI eligible aliens lawfully present in the
United States with household incomes at or below one hundred thirty-
three percent of the federal poverty line shall be eligible to receive
coverage for health care services pursuant to the provisions of this
title if such alien would be ineligible for medical assistance under
title eleven of this article due to their immigration status;
(iii)] subject to federal approval if required and the use of state
funds, unless the commissioner may use funds under subdivision seven of
this section, a pregnant individual who is eligible for and receiving
coverage for health care services pursuant to this title is eligible to
continue to receive health care services pursuant to this title during
the pregnancy and for a period of one year following the end of the
pregnancy without regard to any change in the income of the household
that includes the pregnant individual, even if such change would render
the pregnant individual ineligible to receive health care services
pursuant to this title;
[(iv)] (III) subject to federal approval, a child born to an individ-
ual eligible for and receiving coverage for health care services pursu-
ant to this title who would be eligible for coverage pursuant to subpar-
agraphs [(2)] TWO or [(4)] FOUR of paragraph (b) of subdivision [1] ONE
of section three hundred [and] sixty-six of [the social services law]
THIS ARTICLE shall be deemed to have applied for medical assistance and
to have been found eligible for such assistance on the date of such
birth and to remain eligible for such assistance for a period of one
year[.];
(IV) SUBJECT TO THE USE OF STATE FUNDS, AN INDIVIDUAL WHO IS PERMA-
NENTLY RESIDING IN NEW YORK STATE UNDER COLOR OF LAW WITH A HOUSEHOLD
INCOME BETWEEN ONE HUNDRED THIRTY-THREE AND TWO HUNDRED PERCENT OF THE
FEDERAL POVERTY LINE SHALL BE ELIGIBLE TO RECEIVE COVERAGE FOR HEALTH
A. 10926 4
CARE SERVICES PURSUANT TO THIS TITLE REGARDLESS OF THE AVAILABILITY OF
FEDERAL FUNDING;
(V) SUBJECT TO THE USE OF STATE FUNDS, AN INDIVIDUAL WHO IS A CITIZEN,
OR LAWFULLY PRESENT, OR IS PERMANENTLY RESIDING UNDER COLOR OF LAW WITH
A HOUSEHOLD INCOME BETWEEN TWO HUNDRED AND TWO HUNDRED FIFTY PERCENT OF
THE FEDERAL POVERTY LINE SHALL BE ELIGIBLE TO RECEIVE COVERAGE FOR
HEALTH CARE SERVICES PURSUANT TO THIS TITLE REGARDLESS OF THE AVAILABIL-
ITY OF FEDERAL FUNDING.
An applicant who fails to make an applicable premium payment shall
lose eligibility to receive coverage for health care services in accord-
ance with time frames and procedures determined by the commissioner.
§ 3. Paragraph (b) of subdivision 5 of section 369-gg of the social
services law, as amended by section 7-a of part BBB of chapter 56 of the
laws of 2022, is amended to read as follows:
(b) The commissioner shall establish [cost sharing] COST-SHARING obli-
gations for enrollees, subject to federal approval; PROVIDED FEDERAL
APPROVAL SHALL NOT BE REQUIRED FOR INDIVIDUALS RECEIVING STATE FUNDED
COVERAGE FOR HEALTH SERVICES. There shall be no cost-sharing obligations
for enrollees for dental and vision services as defined in subparagraph
(ii) of paragraph (c) of subdivision one of this section; services and
supports as defined in subparagraph (iii) of paragraph (c) of subdivi-
sion one of this section; and health care services authorized under
subparagraphs (II) AND (iii) [and (iv)] of paragraph (d) of subdivision
three of this section.
§ 3-a. The opening paragraph of paragraph (a) and paragraph (b) of
subdivision 5 of section 369-gg of the social services law, the opening
paragraph of paragraph (a) as amended by section 51 of part C of chapter
60 of the laws of 2014, and paragraph (b) as amended by section 7-b of
part BBB of chapter 56 of the laws of 2022, are amended to read as
follows:
Subject to federal approval, the commissioner shall establish premium
payments enrollees shall pay to approved organizations for coverage of
health care services pursuant to this title; PROVIDED FEDERAL APPROVAL
SHALL NOT BE REQUIRED FOR INDIVIDUALS RECEIVING STATE FUNDED COVERAGE
FOR HEALTH SERVICES. Such premium payments shall be established in the
following manner:
(b) The commissioner shall establish [cost sharing] COST-SHARING obli-
gations for enrollees, subject to federal approval; PROVIDED FEDERAL
APPROVAL SHALL NOT BE REQUIRED FOR INDIVIDUALS RECEIVING STATE FUNDED
COVERAGE FOR HEALTH SERVICES. There shall be no cost-sharing obligations
for services and supports as defined in subparagraph (iii) of paragraph
(c) of subdivision one of this section; and health care services author-
ized under subparagraphs (II) AND (iii) [and (iv)] of paragraph (d) of
subdivision three of this section.
§ 4. Subdivision 7 of section 369-gg of the social services law, as
amended by section 2 of part H of chapter 57 of the laws of 2021, is
amended to read as follows:
7. Any funds transferred by the secretary of health and human services
to the state pursuant to 42 U.S.C. 18051(d) shall be deposited in trust.
Funds from the trust shall be used for providing health benefits through
an approved organization, which, at a minimum, shall include essential
health benefits as defined in 42 U.S.C. 18022(b); to reduce the premi-
ums, if any, and [cost sharing] COST-SHARING of participants in the
basic health program[; or for such other purposes as may be allowed by
the secretary of health and human services]. Health benefits available
through the basic health program shall be provided by one or more
A. 10926 5
approved organizations pursuant to an agreement with the department of
health and shall meet the requirements of applicable federal and state
laws and regulations.
§ 4-a. Subdivision 7 of section 369-gg of the social services law, as
amended by section 51 of part C of chapter 60 of the laws of 2014, and
as renumbered by section 28 of part B of chapter 57 of the laws of 2015,
is amended to read as follows:
7. Any funds transferred by the secretary of health and human services
to the state pursuant to 42 U.S.C. 18051(d) shall be deposited in trust.
Funds from the trust shall be used for providing health benefits through
an approved organization, which, at a minimum, shall include essential
health benefits as defined in 42 U.S.C. 18022(b); to reduce the premiums
and [cost sharing] COST-SHARING of participants in the basic health
program; or for such other purposes as may be allowed by the secretary
of health and human services. Health benefits available through the
basic health program shall be provided by one or more approved organiza-
tions pursuant to an agreement with the department of health and shall
meet the requirements of applicable federal and state laws and regu-
lations.
§ 5. This act shall take effect July 1, 2026; provided however that
the amendments to paragraph (d) of subdivision three of section 369-gg
of the social services law made by section two of this act shall be
subject to the expiration and reversion of such paragraph pursuant to
section 3 of part H of chapter 57 of the laws of 2021, as amended, when
upon such date the provisions of section two-a of this act shall take
effect; provided further that the amendments to paragraph (b) of subdi-
vision five of section 369-gg of the social services law made by section
three of this act shall be subject to the expiration and reversion of
such paragraph pursuant to section 3 of part H of chapter 57 of the laws
of 2021, as amended, when upon such date the provisions of section
three-a of this act shall take effect; provided further that the amend-
ments to subdivision seven of section 369-gg of the social services law
made by section four of this act shall be subject to the expiration and
reversion of such paragraph pursuant to section 3 of part H of chapter
57 of the laws of 2021, as amended, when upon such date the provisions
of section four-a of this act shall take effect.