Connecting New Yorkers to coverage: NY State of Health's program evolution

Since the Affordable Care Act (ACA) established health insurance marketplaces in 2014, enrollment has soared to record levels. By 2024, more than 45 million people nationwide had health coverage, highlighting the ACA’s transformative effect on healthcare access. The ACA requires states to operate their own state-based marketplace (SBM) or use the federal marketplace to enroll consumers into health plans.

Over the past decade, Maximus has played a key role in helping states successfully launch their SBMs. In New York, we’ve been a trusted partner from the start, providing omnichannel customer service and integrated eligibility and enrollment support to millions of New Yorkers.

Challenge

New York established its state-based health benefit exchange, NY State of Health (NYSOH), in 2012. By implementing a “single point of entry” eligibility and enrollment model, consumers benefit from a single streamlined application to apply for and enroll in both subsidized and unsubsidized coverage, including Medicaid, Children’s Health Insurance Plan, Qualified Health Plans, and the Basic Health Plan option (the Essential Plan, added in 2016).

However, for many New Yorkers, the process of enrolling in coverage was new. They needed unbiased help navigating the application completion and submission process, understanding their available coverage options, and identifying the cost of the coverage. They also needed assistance selecting a health plan that best met their health and financial needs.

Solution

Along with the need to comply with new Medicaid eligibility requirements under the ACA, New York sought a trusted partner to help them make a paradigm shift in how people applied for coverage. Individuals and families previously went to local county offices to apply for Medicaid or worked with individual health plans for coverage. 

The NYSOH marketplace created a one-stop shop for application and enrollment, regardless of income or the coverage type for which an individual or family would ultimately qualify. As one of the first fully integrated marketplaces across all programs, NYSOH could seamlessly review eligibility and enroll consumers in the appropriate programs as their eligibility changes. 

We manage the centralized NYSOH Customer Service Center, overseeing eligibility and enrollment for over 6.6 million New Yorkers seeking public or commercial insurance through more than 100 available health plan options. Our omnichannel customer service strategy has delivered a faster, more accurate, and more efficient experience. New Yorkers now benefit from a superior contact center and digitally enabled services that provide quicker access to the benefits they need.

The seamless connectivity across all services provided through the marketplace has allowed for an integrated experience for everyone involved. Together with the technology vendor, navigators, and brokers, we serve as true partners in customer service, working together to ensure every consumer receives the support they need for a successful experience.

When New York became one of the first states to implement the Basic Health Plan for lower-income adults, we stood ready to help even more people enroll in high-quality, affordable coverage. Now, more than 1.5 million New Yorkers are enrolled in the Essential Plan, New York’s Basic Health Plan.

How we did it

• Implemented a “no wrong door” approach for a variety of consumers. We created seamless, integrated customer support, which we still administer today.
• Applied innovative technology infrastructure across programs. This has increased our customer contact center staff’s speed to proficiency, allowing for a more accurate, timely, and efficient consumer experience.
• Digitally transformed customer service. We’ve incorporated interactive voice response, web chat, co-browsing via an interactive website, mobile document upload apps, and text messaging to meet consumer preferences and expectations.
• Communicated important program information. We continue to deliver outreach and education strategies, including member communications, expert translation services, outbound call campaigns, and award-winning social media campaigns designed to reach everyone, including those chronically uninsured or facing multiple enrollment barriers.
• Enhanced customer service and engagement. Managing workflow and applying proven operational processes and technology continues to result in better outcomes, such as improved coverage renewal rates, reduced coverage application processing times, increased use of technology, and faster access to benefits.

The Maximus difference

Drawing on our experience as a leading provider of eligibility and enrollment services across the nation, our partnership with NYSOH has helped increase the affordability and accessibility of health insurance coverage in New York. We’ve supported the enrollment of 6.6 million New Yorkers into comprehensive, affordable coverage and provided consumers with quicker access to benefits.