articipation in the Community Districts D Insurance I

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1 Public Health H Insurance I ParP articipation in the Community Districts D of New N York k CityC New York City Mayor s Office of Health Insurance Access Marjorie Cadogan, Executive Director 51 Chambers Street, Room 100 New York, NY September 2004

2 Acknowledgements The mission of the New York City Mayor s Office of Health Insurance Access (MOHIA) is to increase access to health insurance for New Yorkers. The Office has two key priorities, first, to ensure that uninsured New Yorkers who are eligible for public health insurance are enrolled and second, to expand access to health insurance options for small business employees, sole proprietors and working individuals. The Office coordinates HealthStat, a citywide project bringing together the work of city agencies, community-based organizations and managed care plans to identify and enroll eligible residents in public health insurance programs. This analysis of public health insurance participation by MOHIA was written by Andrea Bachrach. The research team also included Edward Kim and Hannah Yang, working under the direction of MOHIA s Deputy Director, Christel Brellochs. Audrey Henry, MOHIA s Program Development and Communications Manager, and interns Deirdre Downey and Greg Giusto also made important contributions. This analysis would not have been possible without the intensive engagement of key partners: Peter Lobo, Deputy Director, Population Division, and staff at the Department of City Planning, who estimated the number of eligibles; Swati Desai, Executive Deputy Commissioner, Program Reporting, Analysis and Accountability, New York City Human Resources Administration (HRA); and Lisa Garabedian, Research Associate at HRA who provided critical information on children and adults currently enrolled in public health insurance programs. Additional data were provided by the New York State Department of Health and the Administration for Children s Services. Other colleagues at the New York City Department of Health and Mental Hygiene, the Human Resources Administration, the United Hospital Fund, the Commonwealth Fund, HealthStat city agencies and facilitated enroller partners generously reviewed and provided comments at various stages of the project. ii

3 Table of Contents Acknowledgements......ii Summary... iv Maps EPHINE Children in New York City by Community District vi EPHINE Adults in New York City by Community District vii EPHINE Children and Adults in New York City by Community District.....viii The Community Districts of New York City (List)....ix Report Background... 1 Methodology Major Findings Table 1: EPHINEs in the Five Boroughs of New York City....2 Table 2: EPHINE Share of Population... 3 Table 3: Top 10 EPHINE Community Districts Borough Profiles Bronx... 4 Brooklyn Manhattan... 6 Queens Staten Island Implications for Outreach and Enrollment Appendices Appendix A: Methodology.....A-1 Appendix B: New York State 2003 Income and Resource Standards... A-5 Appendix C: Additional Tables Table C1: Public Health Insurance Eligibility and Enrollment....A-8 Table C2: EPHINEs in New York City Community Districts.....A-9 Table C3: EPHINE Ranges in New York City Community Districts...A-10 Table C4: NYC Community Districts, Basic Demographic Information...A-11

4 Summary In the Fall of 2003, the New York City Mayor s Office of Health Insurance Access (MOHIA) initiated an assessment of public health insurance participation in the community districts of New York City. Its purpose was to generate information that would help target outreach by city agencies and facilitated enrollers to community districts (CDs) with the greatest number of children and adults eligible for, but not enrolled in, public health insurance programs. With its collaborators the New York City Department of City Planning and the Human Resources Administration, MOHIA determined the number of residents eligible for public health insurance, based on 2000 Census data, and the number enrolled in public health insurance programs, based on October 2003 enrollment information from the City and State. For the City as a whole and for each community district, current enrollment was subtracted from the total number of eligibles to develop an estimate of the number of residents eligible for pubic health insurance but not enrolled (EPHINE). Separate estimates were developed for children (ages 18 and under) and adults (between the ages of 19 and 64). Approximately 2.7 million New York City residents under the age of 65 are eligible for Medicaid, Child Health Plus, or Family Health Plus. Of the estimated 2.7 million eligible, 80 percent, or roughly 2.2 million children and adults were enrolled in the public health insurance programs as of October This high enrollment rate is a remarkable achievement, and is a testament to the commitment on the part of City, State, and private sector partners to provide access to health insurance for the poorest city residents. In regard to the number of New Yorkers eligible for but not enrolled in public health insurance programs, the project s major findings are as follows: Major Findings 1. New York City has approximately 536,000 people nearly 8 percent of the City s total population under 65 eligible for, but not enrolled in, public health insurance programs. Though the exact number of uninsured New Yorkers eligible for public health insurance may be slightly smaller (due to a number who have access to employer-sponsored health insurance), a large number of city residents who are eligible for public health insurance lack coverage. 2. Three-fifths (60 percent) of all EPHINEs about 322,000 persons are adults. While efforts to enroll eligible children have been more successful, almost 214,000 eligible children are not yet enrolled. 3. Adults are less likely than children to be enrolled in public health insurance despite being eligible. Nearly a quarter (24 percent) of the 1.4 million adults eligible for public health insurance are not enrolled, compared to about 16 percent of the City s 1.3 million eligible children. iv

5 4. Though they can be found in every community district across the City, certain areas have particularly high numbers of EPHINEs. Across the five boroughs, Brooklyn, with the largest population, also has the greatest number of EPHINEs. Brooklyn is also home to the top three EPHINE CDs community districts with the largest numbers of child and adult EPHINE residents. 5. Most of the CDs with large numbers of EPHINE children are in Brooklyn and the Bronx. In contrast, the top ten adult EPHINE community districts are more evenly distributed across the boroughs, with four in Brooklyn, three in Queens, two in Manhattan, and one in the Bronx. 6. CDs with high numbers of EPHINE children do not necessarily have similarly high numbers of adult EPHINEs. More than half of EPHINE residents in the Bronx are children; in the other boroughs there are more adults eligible for, but not enrolled in, public health insurance programs. 7. Some CDs have a particularly high percentage of their population who are EPHINEs. EPHINEs account for more than ten percent of the total under-65 population in 14 of the 55 CDs. 1 Moreover, in 9 CDs more than a third of all residents eligible for public health insurance are not enrolled. 8. In terms of immigrant populations, high ranked EPHINE CDs run the gamut. Included in the top 10 are both a CD tied for the lowest percentage residents who are foreign born (Brooklyn CD 2: Brooklyn Heights and Fort Greene) and the CD with the second highest foreign-born percentage citywide (Queens CD 3: Jackson Heights, North Corona). 9. Areas with the largest numbers of residents eligible for, but not enrolled in, public health insurance tend to have relatively low median household incomes and relatively high rates of poverty and unemployment. There are, however, some exceptions to this trend (high EPHINE CDs with more moderate median incomes and poverty levels), and there are also several CDs with relatively low-income populations that do not have many EPHINEs. Borough and CD-level estimates suggest specific areas of the City that should be the focus of expanded outreach and enrollment efforts. The Mayor s Office of Health Insurance Access is currently working with its enrollment partners to design and implement outreach strategies to respond to the identified areas of need. These areas are identified in the maps, which follow this summary. 1 Although there are 59 community districts in New York City, some of the smaller CDs were combined by the Census to ensure confidentiality of survey respondents. v

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8 Mayor s Office of Health Insurance Access viii

9 The Community Districts of New York City Community District Neighborhoods Community District Neighborhoods Bronx 1 Melrose, Mott Haven, Port Morris Manhattan 1 Battery Park City, Tribeca Bronx 2 Hunts Point, Longwood Manhattan 2 Greenwich Village, Soho Bronx 3 Morrisania, Crotona Park East Manhattan 3 Lower East Side, Chinatown Bronx 4 Highbridge, Concourse Village Manhattan 4 Chelsea, Clinton Bronx 5 University Hts., Fordham, Mt. Hope Manhattan 5 Midtown Business District Bronx 6 East Tremont, Belmont Manhattan 6 Stuyvesant Town, Turtle Bay Bronx 7 Bedford Park, Norwood, Fordham Manhattan 7 West Side, Upper West Side Bronx 8 Riverdale, Kingsbridge, Marble Hill Manhattan 8 Upper East Side Bronx 9 Soundview, Parkchester Manhattan 9 Manhattanville, Hamilton Heights Bronx 10 Throgs Nk., Co-op City, Pelham Bay Manhattan 10 Central Harlem Bronx 11 Pelham Pkwy, Morris Park, Laconia Manhattan 11 East Harlem Bronx 12 Wakefield, Williamsbridge Manhattan 12 Washington Heights, Inwood Brooklyn 1 Williamsburg, Greenpoint Queens 1 Astoria, Long Island City Brooklyn 2 Brooklyn Heights, Fort Greene Queens 2 Sunnyside, Woodside Brooklyn 3 Bedford Stuyvesant Queens 3 Jackson Heights, North Corona Brooklyn 4 Bushwick Queens 4 Elmhurst, South Corona Brooklyn 5 East New York, Starrett City Queens 5 Ridgewood, Glendale, Maspeth Brooklyn 6 Park Slope, Carroll Gardens Queens 6 Forest Hills, Rego Park Brooklyn 7 Sunset Park, Windsor Terrace Queens 7 Flushing, Bay Terrace Brooklyn 8 Crown Heights North Queens 8 Fresh Meadows, Briarwood Brooklyn 9 Crown Heights South, Wingate Queens 9 Woodhaven, Richmond Hill Brooklyn 10 Bay Ridge, Dyker Heights Queens 10 Ozone Park, Howard Beach Brooklyn 11 Bensonhurst, Bath Beach Queens 11 Bayside, Douglaston, Little Neck Brooklyn 12 Borough Park, Ocean Parkway Queens 12 Jamaica, St. Albans, Hollis Brooklyn 13 Coney Island, Brighton Beach Queens 13 Queens Village, Rosedale Brooklyn 14 Flatbush, Midwood Queens 14 The Rockaways, Broad Channel Brooklyn 15 Sheepshead Bay, Gerritsen Beach Staten Island 1 Stapleton, Port Richmond Brooklyn 16 Brownsville, Ocean Hill Staten Island 2 New Springville, South Beach Brooklyn 17 East Flatbush, Rugby, Farragut Staten Island 3 Tottenville, Woodrow, Great Kills Brooklyn 18 Canarsie, Flatlands ix

10 Public Health Insurance Participation in the Community Districts of New York City Background In the Fall of 2003, the New York City Mayor s Office of Health Insurance Access initiated a project to assess public health insurance participation in the community districts of New York City. Its purpose was to generate information that would help target outreach by city agencies and facilitated enrollers to community districts (CDs) with the greatest unmet need, as indicated by the number of children and adults eligible for, but not enrolled in, public health insurance programs. Given this outreach and enrollment focus, the project s aim was to identify overall trends, rather than to generate definitive numbers for each area of the City. Methodology The project calculated the number of individuals under-65 who are income-eligible using 2000 Census data and subtracted out the number enrolled in Child Health Plus A and B, Adult Medicaid, and Family Health Plus as of October EPHINE estimates were generated for the City as a whole and for 55 community districts. 2 This is the first analysis to generate these estimates at the community district level. Excluded from the EPHINE numbers were approximately 282,000 undocumented immigrant adults. These people were subtracted out of the number eligible for public health insurance because, though income eligible, their immigration status disqualifies them for the programs. This step of the analysis had significant implications, reshuffling some of the community districts that appear at the top of the rankings for the largest number of EPHINEs. Several important limitations and unknowns should be noted. One major limitation is the absence of information about the number of EPHINEs who have access to employer-sponsored or other private insurance. For this reason, this study is only able to estimate the number of EPHINEs, and cannot state the number of eligible City residents who are uninsured. The method of estimating income may overstate family income for a significant share of city residents, resulting in a lower number of EPHINEs. In addition, our estimate of the number of undocumented immigrant adults who are income eligible and were counted in the Census may overstate or understate the size of this population. One final unknown is the precise extent to which the incomes of low-income New Yorkers have risen since 1999, when household data were collected for the 2000 Census. Appendix A contains a more detailed description of the project s methodology. Major Findings Approximately 2.7 million New York City residents under the age of 65 are eligible for Medicaid, Child Health Plus, or Family Health Plus. This represents 38 percent of the nearly 7 million non-elderly city residents. 2 Four pairs of community districts were combined for the analysis. The combined districts are: Bronx 1 and 2, Bronx 3 and 6, 1

11 Of the 2.7 million people eligible, 80 percent, or 2,167,756, were enrolled in public health insurance programs as of October This high enrollment rate is a remarkable achievement, and is a testament to the commitment on the part of City, State, and private sector partners to provide access to health insurance for the poorest city residents. In recent years New York City has been at the forefront of creating public-private partnerships to identify and enroll the uninsured. This enrollment effort has been bolstered by a unique combination of state funding support, city agency partnerships, and the persistent dedication of facilitated enrollers. Nevertheless, approximately 536,000 people eligible for public health insurance programs are not enrolled. While there are signs that efforts to enroll eligible children have been successful, 213,960, or 16 percent of the 1,328,532 children eligible for public health insurance are not enrolled. New York City has a considerably higher number of EPHINE adults. Of the 1,364,714 adults eligible for public health insurance, 322,120, or 24 percent, are not enrolled. Table 1 details the distribution of EPHINEs across New York City s five boroughs. Table 1 EPHINEs in the Five Boroughs of New York City Number of EPHINEs (Borough Rank) Children - 0 to 18 Adults - 19 to 64 Total - 0 to 64 Bronx 51,843 (2) 47,652 (4) 99,495 (4) Brooklyn 73,234 (1) 105,121 (1) 178,355 (1) Manhattan 31,796 (4) 68,147 (3) 99,943 (3) Queens 43,285 (3) 83,164 (2) 126,449 (2) Staten Island 13,802 (5) 18,036 (5) 31,838 (5) NEW YORK CITY 213, , ,080 Citywide, about 20 percent of people eligible for public health insurance are not enrolled. EPHINEs also account for an estimated 7.7 percent of New York City s total population under 65. Table 2 summarizes the trends across the boroughs. Though they can be found in every community district across the City, certain areas have particularly high numbers of EPHINEs. Across the five boroughs, Brooklyn has the greatest number of EPHINEs, and is also home to the top three EPHINE CDs community districts with the largest numbers of child and adult EPHINE residents. 2

12 Table 2 EPHINE Share of Population Percentage of Eligibles Who Are Not Enrolled Percentage of Total Population Under 65 That Is EPHINE Bronx 16.30% 8.40% Brooklyn 18.90% 8.30% Manhattan 23.10% 7.40% Queens 20.70% 6.60% Staten Island 33.30% 8.10% NEW YORK CITY 19.90% 7.70% The top ten EPHINE CDs are distributed across the boroughs roughly in proportion to the City s population as a whole, with four in Brooklyn and two each in the Bronx, Manhattan, and Queens. Most of the CDs with large numbers of EPHINE children are in Brooklyn and the Bronx. In contrast, the top ten adult EPHINE community districts are more evenly distributed across the boroughs, with four in Brooklyn, three in Queens, two in Manhattan, and one in the Bronx. Table 3 Top 10 EPHINE Community Districts Rank Children - 0 to 18 Adults - 19 to 64 Total - 0 to 64 #1 Brooklyn CD 16 Brooklyn CD 16 Brooklyn CD 16 #2 Bronx CD 9 Queens CD 1 Brooklyn CD 2 #3 Manhattan CD 12 Manhattan CD 9 Brooklyn CD 8 #4 Brooklyn CD 8 Brooklyn CD 2 Queens CD 1 #5 Brooklyn CD 4 Bronx CD 1/2 Bronx CD 1/2 #6 Brooklyn CD 2 Queens CD 2 Manhattan CD 9 #7 Brooklyn CD 13 Queens CD 3 Bronx CD 9 #8 Bronx CD 8 Brooklyn CD 7 Brooklyn CD 4 #9 Bronx CD 5 Manhattan CD 3 Manhattan CD 10 #10 Bronx CD 1/2 Brooklyn CD 8 Queens CD 3 Community district-level EPHINE findings for each of the boroughs appear on the following pages. 3

13 Borough Profile: BRONX EPHINE Residents in Bronx Community Districts 35,000 30,000 25,000 Adults, Age Children, Age <19 20,000 Hunts Point Mott Haven Soundview Parkchester 15,000 10,000 5, &2 3& Community District Unlike the rest of the City s boroughs, in the Bronx more than half of EPHINEs are children. The Bronx has two of the City s ten community districts with the most people eligible for public health insurance but not enrolled. These two are Bronx CD 1/2 (Mott Haven, Hunts Point, Longwood), which has the most EPHINEs in the borough, and Bronx CD 9 (Soundview, Parkchester), which has the second highest number of EPHINE children citywide. Each of these CDs has an estimated 18,000 residents eligible for public health insurance but not enrolled. Interestingly, although the borough has the highest percentage of total population under 65 that are EPHINE, it also has the lowest percentage of eligible people who are not enrolled (Table 2). EPHINE Summary for the Bronx's 10 Community Districts 3 Number of EPHINEs: Highest ranked community district: 99,495 (52% children, 48% adults) CD 1/2 (Mott Haven, Hunts Point, Longwood) Number of CDs in the top ten citywide: 2 CDs with above average EPHINE numbers: The Bronx has 12 community districts, but two of them were merged for our analysis, leaving 10 CD groupings. 4 The average number of EPHINEs per community district citywide is 9,747. 4

14 Borough Profile: BROOKLYN EPHINE Residents in Brooklyn Community Districts 35,000 30,000 25,000 Adults, Age Children, Age <19 Ocean Hill Brownsville 20,000 Fort Greene Brooklyn Heights Sunset Park Crown Heights North 15,000 10,000 Bushwick 5, Community District Brooklyn, with the largest population, has the highest number of EPHINE children and adults citywide. The borough is also home to CD 16 (Brownsville, Ocean Hill), which has an estimated 31,092 EPHINE residents, more than three times the average number across all community districts. With roughly 20,000 EPHINE residents, Brooklyn CD 2 (Fort Greene, Brooklyn Heights) has the second largest number of EPHINEs citywide, and it is the only community district with large EPHINE numbers where more than half of eligible residents are not enrolled in public health insurance programs. The borough s other three high EPHINE CDs are CD 8 (Crown Heights North), CD 4 (Bushwick) and CD 7 (Sunset Park, Windsor Terrace). EPHINE Summary for the Brooklyn's 18 Community Districts Number of EPHINEs: Highest ranked community district: 178,355 (41% children, 59% adults) CD 16 (Brownsville, Ocean Hill) Number of CDs in the top ten citywide: 4 CDs with above average EPHINE numbers: 7 5

15 Borough Profile: MANHATTAN EPHINE Residents in Manhattan Community Districts 35,000 30,000 25,000 Adults, Age Children, Age <19 20,000 Manhattanville Hamilton Heights Central Harlem 15,000 10,000 5, &2 3 4& Community District Manhattan has significantly more adults than children eligible for public health insurance but not enrolled. The largest numbers of EPHINEs identified in Manhattan are in the neighboring areas of Manhattan CD 9 (Manhattanville, Hamilton Heights) and CD 10 (Central Harlem), each of which have over 15,000 EPHINE residents. The most EPHINE children in Manhattan reside in CD 12 (Washington Heights, Inwood), which has nearly 9,000 EPHINE children, the third largest number citywide. With an estimated 13,000 adult EPHINE residents, Manhattan CD 9 has the third largest number of EPHINE adults citywide. EPHINE Summary for Manhattan's 10 Community Districts 5 Number of EPHINEs: Highest ranked community district: 99,943 (32% children, 68% adults) CD 9 (Manhattanville, Hamilton Heights) Number of CDs in the top ten citywide: 2 CDs with above average EPHINE numbers: 5 5 Manhattan has 12 community districts, but two of them were merged for our analysis, leaving 10 CD groupings. 6

16 Borough Profile: QUEENS EPHINE Residents in Queens Community Districts 35,000 30,000 25,000 20,000 15,000 Astoria Long Island City Sunnyside Woodside Jackson Heights North Corona Adults, Age Children, Age <19 Jamaica St. Albans Hollis 10,000 5, Community District As is case in Manhattan, Queens also has significantly more EPHINE adults than children. With nearly 14,000 adult residents eligible for public health insurance but not enrolled, Queens CD 1 (Astoria, Long Island City) has the second largest number of adult EPHINEs citywide. Queens CD 2 (Sunnyside, Woodside) and CD 3 (Jackson Heights, Corona) also rank in the top ten citywide for EPHINE adults. The largest number of EPHINE children is found in Queens CD 12 (Jamaica, St. Albans, Hollis). Although the borough as a whole has the lowest percentage of total population under 65 that are EPHINE citywide, it has three community districts (CDs 1, 2, and 3) in which EPHINEs are at least ten percent of the total under-65 population. EPHINE Summary for Queens' 14 Community Districts Number of EPHINEs: Highest ranked community district: 126,449 (34% children, 66% adults) CD 1 (Astoria, Long Island City) Number of CDs in the top ten citywide: 2 CDs with above average EPHINE numbers: 6 7

17 Borough Profile: STATEN ISLAND EPHINE Residents in Staten Island Community Districts 35,000 30,000 25,000 Adults, Age Children, Age <19 20,000 15,000 10,000 5, Community District Given its small population relative to the other boroughs, Staten Island s total EPHINE numbers are not large, but the borough s three community districts all lie towards the middle of the citywide EPHINE rankings. The borough also has the City s highest percentage of eligible people who are not enrolled. An estimated one out of three Staten Island residents who are eligible for public health insurance is not enrolled. With an estimated 13,000 EPHINEs, Staten Island CD 1 (Stapleton, Port Richmond) has the largest number of EPHINE residents in the borough. EPHINE Summary for Staten Island's 3 Community Districts Number of EPHINEs: Highest ranked community district: 31,838 (43% children, 57% adults) CD 1 (Stapleton, Port Richmond) Number of CDs in the top ten citywide: 0 CDs with above average EPHINE numbers: 2 8

18 Implications for Outreach and Enrollment MOHIA was established to increase access to health insurance for New Yorkers. The Office s expanding focus involves collaborations with the Department of Small Business Services and other partners to improve health insurance access for small business employees, sole proprietors, and working individuals. But throughout its five year history, the Office s major initiative has been HealthStat, a citywide project bringing together the work of city agencies, community-based organizations and managed care plans to identify and enroll eligible residents in public health insurance programs. City agencies design and implement strategies that identify uninsured populations and facilitate enrollment for them. Health plans and community-based facilitated enrollers provide enrollment assistance for HealthStat activities. These borough and CD-level estimates suggest specific areas of the City that should be the focus of expanded outreach and enrollment efforts. With limited resources to devote to outreach and enrollment, MOHIA will target high volume and high concentration EPHINE communities. EPHINE estimates will be used to tailor outreach strategies to specific areas based on the composition of the community district s EPHINE population (the breakdown of children and adults). Given that adults are an estimated 60 percent of the City s total population eligible for public health insurance but not enrolled, MOHIA will also explore more effective ways to reach adults, both those who are parents and those who are not. MOHIA s Community Outreach Unit is now translating these findings into action. Briefings have been conducted for MOHIA s HealthStat enrollment partners, and the Office is working with city agencies to advance outreach strategies that make use of the information generated by the study. CD and zip code-based EPHINE analyses will also be used to drive the planning for special activities, including MOHIA s annual Back to School enrollment campaign. Finally, the project s findings will be a major consideration as future special projects are designed, such as a partnership initiative currently being developed with leaders from the City s faith communities. 9

19 Appendix A Methodology A1

20 Methodology This analysis builds upon the work of previous studies that have explored health insurance participation for the City as a whole and for sub-units. These include an annual report issued by the United Hospital Fund 6 based on data from the Current Population Survey, and research conducted by the New York City Department of Health and Mental Hygiene based on data from the New York City Community Health Survey. 7 This project s findings are derived from an analysis of the number of residents eligible for public health insurance, based on 2000 Census data, and the number enrolled in public health insurance programs, based on October 2003 enrollment information from the City and State. The New York City Human Resources Administration (HRA) provided data for three programs: Child Health Plus A, Adult Medicaid, and Family Health Plus. Child Health Plus B data were provided by the New York State Department of Health. For the City as a whole and for each community district, current enrollment was subtracted from the total number of eligibles to develop an estimate of the number of residents eligible for pubic health insurance but not enrolled (EPHINE). Separate estimates were developed for children (ages 18 and under) and adults (between the ages of 19 and 64). Calculation of Population Eligible for Public Health Insurance The estimate of the number of New York City residents eligible for public health insurance is based on analysis of 2000 Census Data, particularly the 5 Percent Public Use Microdata Sample (PUMS) File, which is the most detailed Census information available. The estimate is based on full-year income eligibility, and does not include people that have spells of eligibility for part of the year. The actual number of people eligible for public health insurance for any part of the year over the course of a 12-month period will vary because some people have volatile incomes and shorter periods of income eligibility. Eligibility for each individual child and adult was determined based on family size and income using the 2003 income thresholds established for the public health insurance programs from the New York State 2003 Income and Resource Standards for Health Insurance Programs (Appendix B). Eligibility for adults without children was assessed at a maximum of 100 percent of the federal poverty level (FPL). For adults with children the maximum income was 150 percent of FPL, and for children the income eligibility cutoff was 250 percent of FPL. 6 Health Insurance Coverage in New York, The United Hospital Fund, May Analysis conducted by Kenneth E. Thorpe, Curtis Florence and Peter Joski. 7 New Yorkers Without Health Care Coverage Are Not Getting the Care They Need (NYC Vital Signs Volume 3, No.1). New York City Department of Health and Mental Hygiene, March A-2

21 Inflating Income Because Census data reflect 1999 income, incomes were adjusted to account for inflation. Between the years 1999 and 2003, the local Consumer Price Index rose 11.7 percent. 8 Considering the economic conditions facing the City in recent years, there is no strong evidence that the incomes of low-income New York City residents increased at a similar rate. In the absence of a precise income inflation figure, this project assessed eligibility for each city resident based on two sets of incomes: uninflated 1999 income from the 2000 Census, and 1999 income inflated 11.7 percent. All analyses in this report are based on the midpoint or average of the two income eligibility estimates. See Table C3 in Appendix C for details on the number of EPHINEs estimated from the two income eligibility calculations. The approximation of household income used to estimate eligibility closely mirrors the true income test a potential enrollee would experience, but it is not able to account for other components of the eligibility determination process, such as the asset test applied to adults enrolling in the Medicaid program. It should also be noted that estimates of the number eligible for public health insurance may be low because the method of estimating income may overstate family income for a significant share of City residents. This occurs for family households with children that include extended family members beyond the nuclear family of parent(s) and child(ren). As a result, for children the family size and family income may be larger than that which would be counted in an actual determination of health insurance eligibility. Undocumented Immigrants The project s initial numbers overestimated the number of eligible adults by including undocumented immigrants who were counted in the Census but are not eligible for Medicaid or Family Health Plus. In order to account for this, an estimate of the number of undocumented adult immigrants was developed based on research conducted by the United States Immigration and Naturalization Services (INS) 9 and was subtracted from the original estimate of the number eligible for public health insurance. The INS research estimated that 489,000 undocumented immigrants resided in New York State. Of these 489,000, our project estimated that 90 percent, or 440,100, were counted in the Census. Estimating that 80 percent of them resided in New York City, and that 80 percent of those residing in New York City were adults, the project also conservatively assumed that all of the undocumented immigrant adults living in New York City and counted in the Census were income-eligible for public health insurance. A total of 281,664 persons were subtracted, and they were distributed across community districts according to each district s share of the total foreign-born or immigrant population of New York City. 8 Consumer Price Index for the New York MSA, United States Department of Labor, Bureau of Labor Statistics. 9 Estimates of the Unauthorized Immigrant Population Residing in the United States: 1990 to U.S. Immigration and Naturalization Service Office of Policy and Planning, A-3