Bill > A06522

This bill allows Medicaid accountable care organizations (ACOs) - which are groups of healthcare providers who collaborate to provide coordinated, high-quality care - to purchase experience-rated health insurance for their members under specific conditions. The bill amends the insurance law to permit these organizations, particularly those comprised of private physician practices with a certificate of authorization, to obtain group health insurance policies. To qualify, the ACO must meet several requirements: it must have at least 150 member employers, insure over 500 individuals, have all employers enrolled as Medicaid providers, and demonstrate that Medicaid represents at least 60% of their annual revenues. The insurance policy can cover members or employees, with premiums potentially paid from the organization's funds, members' funds, or a combination of both. The bill ensures that such policies must cover a minimum number of individuals (at least 100 or 50% of eligible individuals) and provides guidelines for how insurance coverage and potential dividends should be structured. The changes are designed to provide more flexible insurance options for Medicaid-focused healthcare organizations, taking effect 180 days after becoming law.

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https://www.nysenate.gov/legislation/bills/2025/A6522