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New York City Council
Oversight - Oversight: Examining H+H’s NYC Care Program and Access to Health Care for Uninsured New Yorkers
Read summaries and jump into the video at the segment start.
Council staff opens the hearing, asking attendees to silence devices, refrain from approaching the dais, and observe no-food rules. Staff directs anyone wishing to give in-person testimony to see the sergeant at arms.
Chair Mercedes Narcisse convenes the oversight hearing on H&H's NYC Care program and access to health care for uninsured New Yorkers. She frames the hearing around the program's role in the city's health care safety net.
Narcisse notes New York State's low uninsured rate achieved through Medicaid, the Essential Plan, and Child Health Plus, but says access remains uneven. She cites a 2025 DOHMH report finding immigrant adults nearly twice as likely as U.S.-born adults to be uninsured.
Narcisse describes NYC Care, launched in 2019 as a Bronx pilot under Mayor de Blasio and since expanded citywide. The program offers low- and no-cost primary care, specialty care, behavioral health, OB/GYN, dental, eye care, and durable medical equipment regardless of insurance, income, or immigration status.
Narcisse says federal eligibility cuts caused about 197,000 New Yorkers to lose coverage, citing the One Big Beautiful Bill Act's cuts to New York's Essential Plan. She warns that new Medicaid eligibility requirements taking effect January 1, 2027 could affect as many as 900,000 New Yorkers.
Narcisse lists ongoing barriers to enrollment and retention, including complex eligibility rules, renewal requirements, language barriers, unstable employment, and housing insecurity. She says these disruptions lead residents to delay or skip care.
Narcisse warns that uninsured New Yorkers often seek care only after conditions worsen, increasing emergency department demand and uncompensated care. She says this strains safety net hospitals that already serve disproportionate shares of Medicaid and uninsured patients.
Narcisse argues preventive care is cost-effective, calling inaction 'penny-wise, dollar-foolish,' and cites last week's ambulance response time hearing. She thanks committee counsel Raina Lee, policy analyst Manoa Butt, financial analyst Molly Howard, and her staff before turning to the oath.
Committee counsel administers the affirmation to the administration panel, asking witnesses to tell the truth and respond honestly to council members' questions. Witnesses are reminded to state their names for the record.
Dr. Ted Long, H&H system chief medical officer, introduces himself and NYC Care Executive Director Dr. Jonathan Jimenez. He says NYC Care has received national recognition for its impact on health equity and frames H&H's mission amid federal changes.
Long recounts NYC Care's 2019 Bronx launch and 2020 citywide expansion, describing it as the nation's largest initiative guaranteeing care regardless of immigration status or ability to pay. He says the program has about 125,000 members and outlines eligibility and enrollment channels including 646-NYC-CARE.
Long details covered services on a sliding fee scale at 11 hospitals and Gotham health centers, noting no premiums, deductibles, or co-pays. He highlights a two-week primary care appointment offer, a 24-7 multilingual hotline, prescription benefits, and a new durable medical equipment benefit used by over 2,500 members.
Long says NYC Care has logged over 1 million community outreach interactions and 1 million primary care appointments. He cites peer-reviewed studies showing NYC Care members achieve comparable primary care use and chronic disease control to new Medicaid enrollees.
Long describes H&H's primary care growth, including over 70,000 new primary care patients and a panel size increase from 1,500 to 1,750 patients per provider. He credits expanded care teams, data-driven scheduling, and reduced no-shows.
Long closes by saying H&H's North Star is treating health care as a human right, and that NYC Care delivers real, comprehensive care with meaningful equity results. He thanks the committee and offers to answer questions.
Narcisse acknowledges attending members and asks how many New Yorkers are currently enrolled in NYC Care. Long answers 125,766 as of October 23.
Narcisse asks how enrollment has changed since 2019 and whether recent Medicaid and Essential Plan changes increased enrollment. Long recounts his first NYC Care patient who hadn't seen a doctor in 43 years, says the program exceeded its 100,000 goal and peaked near 150,000, and attributes the decline to patients transitioning to Medicaid.
Narcisse cites the Mayor's Management Report showing NYC Care enrollment decreased in fiscal 2026 and asks what factors drove the decline and what strategies H&H is using. Long explains the shift to Medicaid for seniors 65 and older regardless of immigration status.
Long says NYC Care has always prioritized community engagement through 20 contracted CBO partners and offers appointments within 14 days. He warns that 'coverage disruption' will define the coming period, with recertification and work requirements creating temporary gaps that NYC Care must catch.
Narcisse asks H&H to walk through the NYC Care enrollment process and identify operational barriers. Long begins by stressing that enrollment starts with screening for insurance eligibility.
Long explains that every enrollee goes through financial counseling, and those ineligible due to immigration status or affordability can enroll by phone via MyChart, in person, or through CBO partners. He notes lack of phone or internet access as a barrier and cites DOH form 5090 for self-attestation of identity.
Narcisse asks how H&H promotes the program to uninsured patients who come to a hospital. Jimenez says H&H will never turn anyone away and will figure out insurance applications in parallel, and Long urges everyone to remember 646-NYC-CARE.
Narcisse asks how long enrollment takes from first contact to activation. Long says it takes 30-45 minutes with documents in hand, with materials mailed in about two days to a week, and stresses that an appointment is offered immediately.
Narcisse asks how the specialty referral process works after enrollment. Long explains the e-consult system, where primary care doctors send questions to specialists who triage urgency, and says about one in five patients gets an answer without needing an appointment.
Narcisse asks what percentage of applicants complete enrollment and the most common reasons they don't. Jimenez says 90% of uninsured patients have gone through insurance screening, and cites missing documents and need for extra support as barriers.
Narcisse asks what resources or operational changes would ease enrollment. Long and Jimenez emphasize CBO partnerships and direct enrollment by organizations already doing insurance screening, and Narcisse offers the Council and churches as partners.
Narcisse offers the 51 Council members and churches as outreach partners, noting many uninsured residents may be reached through houses of worship. Jimenez and Long welcome invitations to constituent-facing events and ask members to share their communities' needs.
Narcisse asks what percentage of members receive a primary care visit within six months. Long reiterates that more than 90% of members have been offered a new-patient primary care appointment within two weeks.
Narcisse asks which services NYC Care members use most. Long lists OB/GYN, eye care, dental, cardiology, and podiatry behind primary care, and discusses GI care and colon cancer screening.
Narcisse questions why GI isn't among the top services given rising colon cancer rates. Long explains H&H now uses annual FIT tests instead of routine colonoscopies, reserving colonoscopies for patients with abnormal tests or family history.
Jimenez shares that three-quarters of members complete a primary care visit within a year and 80% complete a specialty visit. He notes members also access cardiology, gastroenterology, and orthopedic surgery.
Brooks-Powers asks how many of the 242,000 New Yorkers who lost Essential Plan coverage are eligible for NYC Care, whether data is available by borough, and how H&H is responding. She also asks how many H&H Medicaid patients will face work requirements starting January 1.
Long explains that EP5 ended July 1 and, per a September report, about 59% of former EP5 enrollees found another insurance plan, with thousands enrolling in NYC Care. He says the concerted outreach effort offers lessons for the coming Medicaid transition.
Long details H&H's preparation for January 1 Medicaid changes, including six-month recertification and work requirements. He says recertification dates are flagged in red in the electronic medical record, financial counselors call patients repeatedly, and nearly 400,000 emails have been sent.
Long says primary care and emergency departments will be the first areas affected by coverage disruptions, with patients worried about losing their doctor turning to the ED. He says H&H is staffing up and monitoring numbers closely.
Epstein asks how much NYC Care treatment is delivered remotely and what share of patients requesting remote care don't receive it. He notes lower-income patients with multiple jobs face time constraints.
Long says he offers every patient the choice of in-person or telehealth visits and that one or two patients per clinic prefer to follow up from work. He notes H&H completed about a million telehealth visits coming out of COVID.
Epstein requests telehealth data broken down by geography to see trends for the NYC Care population and identify barriers. Long agrees to provide the data.
Epstein asks how much NYC Care enrollment happens through the SHOW program and how H&H partners with it. Long notes he helped start SHOW in 2021 and that it is expanding 50% this year.
Long explains that the SHOW program serves unsheltered New Yorkers, most of whom already have Medicaid because they are three times more likely to visit the emergency room. He promises to follow up on specifics of how SHOW enrolls people.
Epstein asks what New York City's uninsured population was before July 1, 2026, what it is today, and what H&H expects in early 2027. Jimenez cites a DOHMH estimate that up to 900,000 people could become uninsured at the full effect of HR1.
Long estimates about 700,000 New Yorkers are uninsured and explains that EP5 ended entirely on July 1, so the 60% figure reflects how many found another plan. He says Medicaid changes will have a similar but different flavor.
Long says Medicaid eligibility isn't changing, but six-month recertification and work requirements will cause many to fall off coverage. He says H&H is terrified but preparing, and that the loss of coverage will be gradual rather than a single-day event.
Epstein asks for a geographic map of NYC Care members and where newly uninsured residents are expected to be, so the Council can target outreach. Long agrees to provide a map and coordinate with the Department of Health.
Long commits to sending telehealth data broken down per 100 primary care visits and to pulling a map of NYC Care distribution by geography. He says projections of where people lose care may require DOHMH but offers to liaise.
Narcisse asks what percentage of NYC Care members remain actively connected to care one year after enrollment. Long begins to answer.
Long says 77% of members return for another primary care visit after one year and about 80% have had a specialty visit, with 70-plus percent recertifying annually. He explains annual recertification checks whether members have become eligible for insurance.
Jimenez stresses the message that patients won't lose access to care regardless of insurance status, which he says is critical as people cycle on and off Medicaid. Long shares a patient's fear of losing her doctor after an insurance change.
Narcisse asks how H&H ensures language access for enrollment, scheduling, and clinical services. Long cites the 646-NYC-CARE line's telephonic interpretation in 300 languages and dialects.
Narcisse asks whether H&H has assessed language access needs and identified gaps. Long says a team monitors wait times for interpretation, and Jimenez lists Spanish, Chinese and related dialects, French, and Polish as the most requested languages.
Narcisse asks how H&H monitors whether language barriers contribute to missed appointments or lower utilization. Long says H&H examines no-show rates by population and hasn't seen noteworthy trends, and describes MyChart scheduling.
Narcisse asks whether H&H is seeing an increase in scared patients and whether it has enough staff to handle enrollment. Long calls the coming Medicaid changes a crisis affecting up to 900,000 New Yorkers but says it is foreseeable, unlike COVID.
Long describes H&H's preparation, including financial counseling teams and maximizing NYC Care capacity through a care team model with treat-to-target nurses and clinical pharmacists. He says H&H will do everything so nobody is turned away.
Narcisse asks whether H&H has the resources to meet the coming demand. Long says H&H is in constant communication with OMB and expects NYC Care to expand, with coverage disruption creating fluctuating enrollment.
Narcisse presses for NYC Care's current enrollment capacity. Long explains that if every primary care panel were filled at 1,750 patients per provider, H&H could take in 15,000 to 20,000 patients today.
Narcisse asks about NYC Care's annual budget and cost per member, and whether H&H will need new city funding if enrollment climbs. Long says the program's budget is $100 million a year, unchanged for several years, covering CBO payments, marketing, member cards, and care coordination.
Narcisse asks what else is needed beyond funding to support New Yorkers losing coverage. Long says the key is a unified message that health care is a human right and that calling 646-NYC-CARE unlocks enrollment and a primary care appointment.
Aldebol notes Hispanic New Yorkers are uninsured at twice the rate of Black and Asian and three times the rate of white New Yorkers, and asks about NYC Care demographics and enrollment gaps. Jimenez begins to answer.
Jimenez says 71% of NYC Care members are Hispanic or Latinx and 13% are Black or African American. He says H&H constantly looks for uninsured, unconnected residents and cites equal colon cancer screening rates across insurance types.
Aldebol asks whether H&H targets particular communities where it sees gaps in insurance coverage. Long begins by crediting CBO partnerships as a cornerstone of the program's success.
Jimenez says H&H contracts with 20 community-based organizations that reflect New York City's diversity, speak dozens of languages, and operate in every borough. He says H&H meets with them monthly to share feedback and identify where to be.
Aldebol asks about capacity at Jacobi Hospital in her Bronx district, noting the borough's 7.1% unemployment rate and concerns about Medicaid work requirements. Long agrees capacity must be built.
Long says New York State has applied to CMS for a work requirement exemption for the Bronx, which he believes meets the criteria but awaits approval. He says it would help in year one but H&H should build capacity and do outreach regardless.
Aldebol asks how patient outcomes at Jacobi compare to other H&H hospitals and what is being done to close gaps. Long says H&H can pull data from its population health dashboard.
Long notes the Bronx often ranks last among New York's 62 counties for health outcomes, but says his Bronx clinic won an award for the best blood pressure control in the state, with an 84% hypertension control rate. He calls for working together to spread that success.
Felder raises H&H's proposed absorption of financially distressed Maimonides Medical Center and asks whether it would become an NYC Care provider, the added uninsured volume and cost, and whether projections will be shared. He offers to receive answers in writing.
Long acknowledges the concern, noting the Maimonides financial plan relies on enhanced Medicaid rates that only work if patients stay on Medicaid. He says NYC Care is only half the equation and H&H will focus on keeping people insured, promising written follow-up.
Felder says he doesn't see how Maimonides can increase Medicaid recipients given the federal cuts, calling the situation 'kryptonite' even for a Superman. Long says he understands and will be in touch.
Narcisse asks about current wait times for primary, specialty, and behavioral health services and how they've changed. Long explains the collaborative care model for behavioral health, where social workers under a psychiatrist's supervision deliver therapy and high-acuity patients get same-day warm handoffs.
Narcisse asks about wait times for mammograms and colonoscopies compared to prior years. Long describes same-day mammogram access that reduces wait times and no-shows, and says FIT tests have dramatically cut colonoscopy wait times by focusing colonoscopies on high-risk patients.
Narcisse asks which specialties face the greatest demand and where access challenges remain. Long lists OB/GYN, eye care, dental, cardiology, and podiatry, and says neurology wait times are currently longer after losing neurologists.
Narcisse asks what steps H&H is taking to address specialty capacity constraints. Long describes joining a national e-consult collaborative, workforce planning tied to residency cycles, direct access scheduling in five areas, and time-released appointment slots.
Narcisse asks about rheumatology access, recalling it was a problem at a prior hearing. Long says rheumatology is much better today after filling vacancies, and notes specialty access fluctuates as providers leave.
Narcisse asks for the most recent performance metrics on diabetes control, hypertension control, and preventive screening among NYC Care members. Long says H&H has published rigorous peer-reviewed research on the program.
Long presents two studies: 73% of new enrollees diagnosed with hypertension and 53% with diabetes show significant improvement within six months, and a 2025 Journal of General Internal Medicine study found no difference in chronic disease outcomes between new NYC Care and new Medicaid enrollees. He says NYC Care has saved 1,569 lives.
Narcisse asks whether H&H has data on 30-day readmissions for NYC Care members compared to Medicaid. Long says readmissions weren't studied but offers to check, noting he helped develop the CMS readmission algorithm at Yale.
Narcisse asks how NYC Care connects members to preventive and primary care before conditions worsen. Long divides preventive care into chronic disease management and screenings like vaccines and cancer prevention.
Long and Jimenez cite colorectal cancer screening rates: 77% of NYC Care members versus 78% for the general population. Jimenez says this shows H&H treats everyone the same and achieves health equity.
Narcisse asks what metrics H&H uses to track access, including wait times, specialty utilization, language access, and transitions to insurance. Long begins with the timely appointment metric dating to 2019.
Long says H&H tracks whether patients get timely appointments, e-consult volumes and outcomes, and clinic wait times, and offers to share data. On NYC Care to insurance conversion, he says statistics aren't available yet because the HR1 changes begin in January 2027.
Narcisse asks whether H&H collects data on how patients learn about NYC Care. Jimenez says the call center asks, and that word of mouth from friends and relatives is now the top source, followed by provider referrals, CBOs, and online ads.
Narcisse asks which outreach strategies have been most successful in driving enrollment. Jimenez says community-based organizations have been the most important partnership, serving as trusted messengers and helping enroll over 100,000 people.
Narcisse asks how H&H evaluates the effectiveness of outreach and enrollment campaigns. Jimenez describes tracking print and online advertising metrics and cost-effectiveness, working with influencers, and using the Light the Way truck.
Narcisse asks what additional resources would expand awareness among eligible New Yorkers. Jimenez cites continued CBO partnerships and direct enrollment with organizations already doing insurance screening, and Long stresses a unified message around 646-NYC-CARE.
Narcisse asks how many people received enrollment assistance in fiscal 2026 and how H&H measures effectiveness. Long explains that members go through an annual eligibility review, with those eligible moved to insurance and others recertified in NYC Care.
Narcisse asks to what extent transportation is a barrier for NYC Care members needing specialty or frequent care. Jimenez says transportation is not currently an NYC Care benefit but that members use buses and trains.
Narcisse raises concerns about disabled members facing transportation delays and elevator outages. Jimenez describes the new DME benefit he championed, which lets providers order wheelchairs, canes, and walkers delivered to members' homes.
Narcisse asks whether H&H collects data on missed appointments due to transportation challenges. Jimenez says H&H tracks no-show rates but not the reasons, and Long says they will look at the data.
Narcisse asks about additional transportation program partnerships or investments. Long says H&H should start by examining data on barriers, and Jimenez says more resources for CBOs and advertising would help reach people who don't know about NYC Care.
Narcisse asks what additional investment, staffing, or operational changes NYC Care needs to serve a larger uninsured population. Long says the city must get ready now and cites DOHMH's new HART teams as a complementary effort.
Long says H&H needs to hire up care teams, emphasizing nurses as equally important as doctors, and to fill gaps at each site so financial counselors and clinical pharmacists are ready. He calls this his goal for the next couple months.
Narcisse asks what investments would have the greatest impact on NYC Care's reach over five years. Jimenez says community work is crucial, including equipping CBOs to do outreach and enrollment and spreading an inclusive message.
Narcisse asks about the HART program the mayor announced and whether H&H is involved. Long defers specifics to DOHMH but says H&H is coordinating on insurance enrollment and creating a path to clinical care at H&H.
Narcisse asks how the Council can best support H&H's outreach and long-term sustainability. Long says the moment calls for a shared message that health care is a human right, with one number to call, and invites members to H&H events.
Long says the most important thing is a single clear message that New Yorkers will be caught if they fall, and that H&H would welcome Council members at its events. Narcisse jokes about appearing in an H&H commercial.
Narcisse asks whether there are legislative, budgetary, or policy changes the Council should consider. Long says yes and notes H&H is in close touch with OMB and that City Hall has been supportive.
Long says H&H would welcome all support, not just financial, and repeats the message that there is a number to call for help. Narcisse and Long joke about repeating 646-NYC-CARE.
Narcisse asks what additional resources or partnerships would most help H&H meet uninsured New Yorkers' needs. Jimenez says H&H wants more partnerships, including houses of worship and consulates.
Narcisse asks whether successful NYC Care initiatives could be expanded with additional Council support. Jimenez says everything takes resources and welcomes more funding for patient care and outreach.
Jimenez says H&H makes good use of its resources through e-consults and rolling scheduling and would welcome more funding. Long emphasizes that the program is only as effective as the number of people who know about it.
Narcisse asks what NYC Care's advertising budget looks like. Jimenez says H&H will get back to her on that.
Narcisse asks about other H&H programs New Yorkers should know about. Long highlights the SHOW street medicine program, safety net clinics that co-locate mental and physical care, and the Housing for Health program, which has housed 1,800 patients.
Narcisse shares her experience discharging patients who have no home, calling it heartbreaking, and praises programs like Bridge to Home. Long agrees that patients without housing often end up back in the hospital.
Narcisse asks which H&H programs have strong outcomes but are underutilized due to limited awareness. Long says the SHOW program has more capacity, demonstrated by its 50% expansion this year.
Narcisse suggests the 51 Council members include H&H program information and SHOW locations in their weekly newsletters. Long agrees and says H&H can provide the locations.
Narcisse asks how many safety net clinics there are and where they're located. Long lists Bellevue in Manhattan, Lincoln in the Bronx, Woodhull in Brooklyn, and Elmhurst in Queens, noting they are open access for people experiencing homelessness.
Narcisse asks how H&H connects NYC Care members with behavioral health, community health centers, housing, food assistance, and care coordination. Long says NYC Care members receive identical care to all patients.
Long says about a quarter of NYC Care patients screen positive for a social need like food or housing instability and are routed to care coordination with a community health worker or social worker. He says no patient leaves a visit without a resource.
Narcisse notes Dr. Katz has discussed volunteer opportunities that could satisfy Medicaid work or community service requirements, and asks about similar programs. Long says financial counselors are the first stop to learn what qualifies.
Long says H&H is seeking to create a system-wide volunteer program that would satisfy Medicaid work requirements, noting programs currently exist at individual hospitals like Bellevue. He says he will follow up with Dr. Katz.
Narcisse thanks the H&H witnesses for their time and service, joking about a commercial where Long catches people losing coverage. Long thanks the committee for drawing attention to the issue.
Narcisse opens public testimony, reminding attendees this is a formal proceeding and that decorum must be observed. She explains the three-minute limit, appearance cards, and that in-person testimony will precede Zoom testimony.
Jane Nee, Director of Policy at the Community Healthcare Association of New York State, testifies that community health centers serve 1.4 million New Yorkers and provided $92 million in uncompensated care in 2025. She warns that uninsured patients could triple under HR1 and asks the Council to accelerate implementation of INT 1668A to expand NYC Care to FQHCs.
Narcisse thanks Jane Nee for traveling from Albany to testify and reiterates that health care is a human right. She says she will follow up with her after the hearing.
Carmen Garcia, a community health worker supervisor at Make the Road New York, testifies that the organization serves as NYC Care navigators and has helped over 120,000 enrollees. She shares the story of Jose, an uninsured man diagnosed with diabetes through NYC Care, and requests $100 million annually for NYC Care and CBO outreach, plus policies to keep ICE out of hospitals.
Narcisse thanks Carmen Garcia and praises Make the Road's leadership, noting she worked with the organization before entering office. She says she will bring the group's requests forward.
Narcisse closes the in-person portion of public testimony after no additional speakers come forward, then moves to remote testimony. Seeing no hands raised on Zoom, she notes written testimony can be submitted within 72 hours and concludes the hearing.