Committee on Hospitals

Good afternoon. Welcome to the hearing for the Committee on Hospitals. If you're here for the hospital, you are in the right room. Sorry. At this time, one asks please everyone please to silence your electronic devices. Also, at this point moving forward, no one is to approach the dais, and also there is no food and beverages allowed. in the hearing room.

Also, if you would like to make an in-person testimony today, please see one of the sergeant-at-arms here today. That being said, Chair, we are ready to begin. Thank you.

Good afternoon. I am Councilmember Mercedes Narcisse, Chair of the Committee on Hospitals. Thank you for joining us today for our oversight hearing on examining H&H NYC Care program and access to healthcare for uninsured New Yorkers. Over the years, New York State has made significant progress in expanding access to health insurance and today has one of the lowest uninsured rates in the nation.

Through investment in Medicaid, the Essential Plan, Child Health Plus, and other public coverage programs, millions of New Yorkers have gained access to preventive care, primary care providers, prescription medications, and treatment for chronic conditions. Yet, despite these achievements, access to coverage remains uneven. Certain populations including immigrants or our new arrival, Hispanic New Yorkers, and Black, and many working families continue to experience higher rates of uninsurance and face barriers to enrollment and maintaining coverage.

In New York City, a 2025 report from the Department of Health and Mental Hygiene found that immigrant adults were nearly twice as likely as U.S.-born adults to be uninsured. For New Yorkers who fall through the cracks of the traditional insurance system, New York City Care by NYC Health Hospitals serve as a critical part of the city's healthcare safety net.

Established under Mayor Bill de Blasio. The program launched in 2019 as a pilot at H&H facilities in the Bronx and has since expanded citywide, providing uninsured New Yorkers with low-cost and no-cost healthcare services regardless of insurance, income, or immigration status, including primary care, Specialty care services like cardiology, rheumatology, orthopedics, and podiatry. Mental health and substance abuse services.

Referrals to specialists like social workers, therapists, and psychiatrists. Obstetrics and gynecology, family planning, STI testing and treatment. Affordable medications. Eye care, dental care, emergency services, and other social support services, and access to durable medical equipment, which is DME by most, to eligible New YorkerCare patients. However, border cuts to healthcare eligibility at the federal level have caused approximately 197,000 New Yorkers to lose coverage.

Get that number, 197,000 New Yorkers to lose coverage. In July of 2025, President Trump signed the One Big Beautiful Bill Act, HR 1, which included cuts to federal funding for New York's essential plan. Beyond the essential plan reduction, HR 1 also imposed new Medicaid eligibility requirements that are expected to take effect on January 1st, 2027. City officials estimate that as many as 900,000 thousand New Yorkers could be affected by that federal Medicaid changes, which is one big ugly bill for us.

Besides the recent federal policy changes, there are several other ongoing barriers that prevent eligible city residents from enrolling in or maintaining health insurance coverage. Challenges such as navigating complex eligibility rules, renewal requirements, language barriers, limited familiarity with the healthcare system, unable— I mean, unstable employment, lack of employer-sponsored insurance, housing insecurity, and difficulties accessing enrollment assistance often lead to to coverage disruption.

These disruptions in care can have detrimental consequences. Uninsured individuals are more likely to delay or skip medication and treatment because of cost concerns, leading to higher risk of chronic diseases and early mortality. As a result, New Yorkers may seek care only after their conditions have become more severe, increasing demand for emergency department services and uncompensated care, which could place additional financial and operational strain on New York City's safety net hospitals, which already serve a disproportionate share of Medicaid and uninsured patients.

Preventive care plays a critical role in keeping New Yorkers healthy and reducing the need for costly emergency interventions. We call it pennywise, dollar foolish. Last week, during the committee's joint hearing in ambulance response times, we heard firsthand about the significant strain already facing the city's emergency department and EMS workforce. Ensuring that residents can enroll in and maintain health coverage is an important part of addressing these challenges, as access to preventive and primary care can help reduce avoidable emergency room visits and ease pressure on the broader healthcare system.

Continued investment in programs that support enrollment and re-enrollment in healthcare coverage will be essential to strengthening New York City's healthcare safety net. As New York faces a period of uncertainty in healthcare coverage, understanding how, how New York CityCare is serving uninsured residents and how the city can can strengthen its healthcare safety net will be more important than ever.

I look forward to today's testimony. I know the room is not as crowded as expected because this is a big deal. Testimonies will help us, right? To hear— we today will be hearing from shareholders, stakeholders, and shareholders, of course. Opportunity to expand awareness of the program and any policy, operational, or outreach investment that may be needed to ensure New York CityCare continues to meet the evolving needs of New Yorkers.

Before I conclude, I would like to thank Committee Counsel Raina Lee, Policy Analyst Manoel Butt, Financial Analyst Molly Howard, and my staff for all the work they do, especially in the district office. I want to say thanks to Deputy Chief Frank Shea, Drashina Jilo, and of course, my dear fellow, that's Matthew Lee. Thank you for being here.

I would like to turn it over to the committee counsel to administer the oath witness from the administration.

Thank you, Raina. Good afternoon. We will now hear testimony from the administration. Before we begin, I'll administer the affirmation. Panelists, if you could raise your right hand, I will read the affirmation once and then ask each of you individually to respond. Do you affirm to tell the truth, the whole truth, and nothing but the truth in your testimony before this committee and to respond honestly to councilmembers' questions?

I do. Okay. Thank you. As a reminder for all of our witnesses, if you could please state your name prior to testimony for the record. Thank you. Okay. Thank you, Chair Ortiz. You may begin.

My name is Dr. Ted Long. I'm a primary care doctor in the Bronx and our system chief medical officer for clinical services and population health at New York City Health+ Hospitals. Good afternoon, Chairwoman Narcisse and members of the Committee on Hospitals. I'm joined today by Dr. Jonathan Jimenez, executive director of NYC Care and a family physician at New York City Health+ Hospitals Gotham Health Cumberland.

It's exciting for me to share with you today why NYC Care has received national recognition for its impact on health equity and the impact this program has had on New Yorkers. At New York City Health+ Hospitals, our focus is on being a fully integrated health system that enables New Yorkers to live their healthiest lives. As we see healthcare access changing rapidly due to shifts at the national level with the implementation of HR1, H+H is committed to excellence in healthcare, innovating to increase awareness of the importance of preventive healthcare while making it as affordable, and accessible as possible for New Yorkers typically excluded.

This is where NYCCARE enters. In 2019, NYCCARE launched in the Bronx before expanding to all 5 boroughs in 2020, with the goal of bringing a healthcare access membership program that guarantees low-cost and no-cost services to New Yorkers who do not qualify or cannot afford health insurance based on federal guidelines. This program is the nation's largest and most comprehensive initiative to guarantee healthcare regardless of immigration status or ability to pay, and brings direct access to New York City Health+ Hospitals, the nation's largest public healthcare system.

Today, NYC-CARE has approximately 125,000 members. An individual is considered eligible if they do not qualify for or otherwise cannot afford private health insurance based on federal income guidelines. To learn more about their eligibility and get enrolled, New Yorkers can meet with a New York City Health+ Hospitals financial counselor, visit one of our 20 community-based organizations, or call the NYC Call Center at 646-NYCARE.

Once enrolled, NYC Care members can access covered services on a sliding fee scale at our facilities, which includes our 11 hospitals and all of our Gotham Community Health Centers. Since NYC Care is not health insurance, there are no premiums, deductibles, or copays. New patients are offered a primary care appointment within 2 weeks at one of our Health+ Hospitals locations.

NYC Care members gain access not only to primary care and preventive care services, but the full slate of specialty care that Health+ Hospitals offers. This includes routine screenings, mammograms, and services such as obstetrics and gynecologic care, dental care, behavioral health care, and eye care. Members can have visits with any provider within our network. Within behavioral healthcare, services include mental health and substance use treatment, as well as access to telehealth and virtual express care.

Members have access to 24/7— to a 24/7 member service hotline in over 300 languages and dialects by calling the same NYCCARE number that they may have used to enroll. Members also have access to affordable prescription benefits and 24/7 pharmacy access. As of 2025, NY Care members also have access to low-cost or no-cost prescribed DME, or durable medical equipment, for their medical conditions, a benefit that over 2,500 members have utilized during its first year.

Accessing high-quality, affordable healthcare services that put patients first should not be a challenge, and NY Care aims to make that— to make it as seamless as possible. NY Care meets New Yorkers where they are to bring exceptional healthcare services to all. Since its launch, NYCCARE has had over 1 million community outreach interactions in collaboration with contracted CBOs throughout the 5 boroughs.

Additionally, NYCCARE members have completed over 1 million primary care appointments. Peer-reviewed studies have shown that new NYCCARE members and new Medicaid enrollees show comparable utilization of primary care and specialty care. More importantly, the 2 groups showed the same level of chronic disease control. Above all, Health+ Hospitals is focused on keeping New Yorkers engaged in preventive health services, which not only has positive impacts on New Yorkers' long-term health, but also for H+H.

Data shows that even when members become eligible for health insurance and can disenroll from NYC Care, they stay engaged in care at H+H. Over the last 5 years, New York City Health+ Hospitals has seen substantial growth in primary care, with over 70,000 new primary care patients. Today, New York City Health+ Hospitals has more patients in primary care than in the history of our system.

This has been made possible through initiatives including expanding primary care physicians' abilities to see more patients, allowing for more new patient access, increasing from 1,500 patients per full-time provider to 1,750; adding to our staffing model to ensure that primary care physicians seeing more patients does not impact access to timely care, which means increasing the care team so that patients can get their care inside and outside the clinic from team members that include their primary care doctor, advanced practitioners that work directly with their doctors, chronic disease nurses, chronic disease clinical pharmacists, social workers, and community health workers.

Using timed, data-driven clinic slot opening tools to ensure the highest utilization possible for primary care providers has also increased access. Finally, focusing on reducing no-shows through an iterative process so that no appointments go unused, including changes to the SMS and telephone call reminder systems, both the messaging itself as well as the timing of the messaging. At New York City Health+ Hospitals, our North Star is to treat healthcare as a human right and provide the highest standard of care to all who walk through our doors.

NYC Care continues to provide access to real, comprehensive healthcare that shows meaningful results in advancing healthcare equity for its members. Rooted in innovation, patient trust, and an overarching goal to ensure all New Yorkers, regardless of their immigration status or ability to pay, have access to healthcare, NYC will keep making healthcare a human right in New York City.

Thank you for the opportunity to testify today on this incredibly important topic, and I'm very happy to answer any questions.

Thank you. Before I go any further, I want to acknowledge we've been joined by C.M. Fedler, Powers, Albert, Albert, oh. Epstein. I'm just always messing up that one. Epstein. And who else? No. So thank you, thank you. We started, since I have a member from the union, and Shirley always said, right, healthcare is a human right, and you just said it.

That's right, because when you're in New York City specifically, Since we the lead city, I believe they call us capital of the world. So we need to do that effectively, especially when it come to healthcare. And we were having that discussion here. Healthcare, without your health, you're nothing basically. So healthcare is so important for us to keep it going and giving folks, you know, care.

That's what we are here for. We give it right.

So how many New Yorkers are currently enrolled So our current number, this is as of October 23rd when we pulled the data, 125,766. Say it again, sorry, I just got distracted. I talk at great speeds. 125,766. Thank you. How has New York CityCare enrollment changed since its launch in 2019, and has the program experienced increased enrollment following recent changes to Medicaid and essential care essential plan?

So yeah, thank you for asking. So going back to 2019, because my team and I were the same team, we launched the program in 2019. So I remember every detail of it. And I'll tell you a quick anecdote about the first patient that I ever saw with NYC Care and talk about how that's contributed to the numbers increasing over time and some of the changes.

What NYC Care really did starting in 2019 is it unlocked healthcare access in a way that people didn't believe that they had it before. My first patient was a woman that hadn't seen a doctor in 43 years. Never had a mammogram, never had a Pap smear, didn't know if she had diabetes. I gave her everything, all the preventive care that she deserved in that visit.

And I'm careful to use the word deserved because at the end of it she started crying, and I asked her why, and she said before seeing me and enrolling in the NYC Care program, she had never felt like she deserved— that was her word— care before. It was heartbreaking, but it really stuck with me that that's, that's the difference that we made in her life.

And then I have no doubt she went and told 10 friends and family members And within the first couple years of the program, we blew through our initial goal. We initially set out to enroll 100,000 New Yorkers in the NYC Care program. Blew through that, reached up to about 150,000 at the height of the program. And since then, with today, we're having 125,000.

The reason for us having— us losing about 25,000 patients, the main reason is not a bad thing. Decrease. New York State, in the context of the program, has allowed for people that are 65 and above to enroll in Medicaid if they're low income, regardless of immigration status. So we actually were able to have a lot of our NYC Care patients that I know transition from being NYC Care to New York State Medicaid.

So, but the good news is they're still at New York City Health+ Hospitals. That's a good one to have people able to go to Medicaid. But now with the re-enrollment, it will be a problem for more folks to transition from NYC Care to Medicaid for what's going on right now and essential plan. And I truly believe in the work that you're doing.

We have been joined by Farias Amenda on Zoom. So thank you. for, for, for that, um, for having someone in New York City seeing a doctor after 43 years. So that's— The work we're doing with NYC Care is so important. According to the mayor's management report, NYC Care enrollment decreased in fiscal 2026, which we just spoke about.

What factors contributed to the decline? You told me that. So what is the report? How— what's strategy that you're doing to bring new ones? Like, if we're still promoting, what are we doing? Yeah. So right now, just to zoom out for a second, NYC Care since 2019 has always sought to do as much community engagement as we can so that every New Yorker knows that healthcare is their human right if they enroll in this program.

And we welcome everybody through our doors. An important way we do that, by the way, is that we offer an appointment to you within 14 days of your phone call. So if you call us, we're going to offer you maybe an appointment near to where you live, maybe one a few blocks down the road, but always within 14 days.

So in terms of to your question about how we've sought to increase or grow the program, we've— I would say we've continued to work with our 20 contracted CBO partners to continue to get the word out about the program and then enroll you in the program if you're not eligible for health insurance and then make you that appointment within 14 days.

One important point I just want to draw out, because I'll quote you from earlier, Churnasies, because this resonated with me. Coverage disruption is going to be the name of the game going forward here. It's not like people are just going to fall off of Medicaid and just enroll in NYC Care and that's problem solved. People are going to have changes in eligibility.

There's a recertification piece that's going to change. Work requirements, they may not get their certification in time and then have to submit later. So they may be temporarily in NYC Care. So what we want to do is we want to today make sure that everybody knows not only is this program a place where you can go treating healthcare as a human right in our city, but if you fall off of health insurance, the program will catch you.

So that's a transition that we're making in the messaging that we're working through our community-based organizations to do. And we expect that especially with these changes coming up associated with not only the EP-5 changes, which I can go into more detail about, but the upcoming Medicaid changes, predominantly recertification and work requirements, we're going to need to catch more people than ever.

So now our goal is to get as ready as possible so that every New Yorker can always know that healthcare is a human right through the NYC Care program. Thank you.

And can H&H walk us through the NYC Care enrollment process and identify any operational barriers that may prevent eligible New Yorkers from successfully enrolling? Yeah, it's a really good question, and I'll get— I'll answer. There's 3 specific ways you can enroll. Before I go to that, I wanna make an important point. The enrollment process for NYCare starts, before I go into the details, with seeing if you're eligible for insurance.

If you're eligible for insurance, we want to enroll you in insurance. If you're eligible for Medicaid, we want to enroll you in Medicaid. It's better for you and better for our system, better for our city. So the first step of enrollment is we, every single NYCare enrollee has to go through what we call financial counseling. Or in other words, to see if they're eligible for health insurance.

For those that aren't eligible, which will happen for 2 reasons, the first reason being based on immigration status, the second reason being if it would cost you too much money based on federal guidelines to be able to reasonably afford health insurance, then we would offer to enroll you in the NYC Care Program. And there's 3 ways that that happens.

The first is we could do it actually all over the phone now. So we would talk to you on the phone, We could register you in MyChart, which is like a portal you get on your phone. And you can actually upload the documents that we need you to upload through MyChart. So it's a fairly seamless process that way.

A barrier that we've seen there, to answer your question about barriers, is if you don't have a phone or internet access, that would be a barrier to using that phone-based option because it does rely on you giving us the documents. In that case, we transition to option 2, which is in-person enrollment. So you can come and enroll in person even if you've been evaluated for health insurance by the phone.

Or you could do the whole thing in person. So I have patients that are coming in to see me for the first time. They'll go through the whole insurance eligibility process and then either end up with an insurance plan or NYC Care in the context of seeing me. The third thing that— the third way you can enroll is through one of our trusted partners, one of our community-based organizations.

They go through a similar process. So you'll be evaluated for health insurance, and if you aren't eligible for health insurance, they can enroll you in the program. And there are certain forms that they ask you for that they can help you to upload. I'll give you an example here of one of the forms. So there's the DOH Form 5090, which is your self-attestation of identity if you don't have the standard forms.

So we work with you based on where you are to make sure that if you have the standard forms or if you don't, you can fill out that form to have you upload the right documents so we can enroll you in the program quickly.

So my follow-up. Yes. So if someone come in the hospital, They don't have any insurance at all. So right there, they can be assessed right there. They don't have— so how do we promote for folks to just come and find out, like, where you're at? Yeah. As Dr. Long said, the goal is to connect every single New Yorker to healthcare.

And we want to make sure that if they're eligible for insurance, we enroll them. And so that's, that's a first step. But it's not a barrier. We always tell people in the community, our community organizations, anyone that we get in touch with, come to us if you need care. We will not turn you away. We will take care of you no matter what, no matter your immigration status or your income.

And we'll figure out the process of applying for health insurance at the same time in parallel. These pathways are for people who are having the forethought, they're planning, right? They're calling. They already know they want a primary care appointment. Well, we can start that process as They have those documents available. So basically, if you call on the phone, you want to be seen by a doctor.

So their role, or whoever receives calls, or however, is to come in, we'll care for you, and we'll find out whatever else. And in fact, when you call our call center, before you complete the process of enrollment, they ask you where and when you would like to make your primary care appointment. Because the point is, can we get folks connected to primary care?

Every single New Yorker. That's the goal. Thank you. So if you remember one thing from Dr. Jimenez and me today, it is however many numbers it is, 10 numbers. 646-NYC-CARE is the one number to remember, the one number you can share with everybody. It's the one-stop shop for everything we're going to talk about today. Mm-hmm. 646— you can repeat it again for people watching to know that.

646-NYC-CARE. Okay. We're promoting it. We have been joined by CM Sanchez.

How long does the enrollment process typically take from initial contact to activation of service? If you have your documents with you, we can go through that process in 30 to 45 minutes. Once you submit them to us, it can take, you know, I think it's 2 days to a week or so for you to get in the mail the stuff that we're going to send you, which is really important.

I'll actually come back to that in a second, but I think what Dr. Jimenez is saying is very important that Even as we're enrolling you in the program and we're going to be sending you things in the mail, we're gonna make you that appointment right away. That's what's the most important thing. Yes. And we're really proud, and I just really wanna underline this because it was so hard to do.

We've offered more than 90% of all NYC Care enrollees since 2019 an appointment within 2 weeks, which is unheard of across the rest of the country or on the private side. Call another healthcare provider and try to get a new patient appointment in 2 weeks. It's nearly impossible. So we're very, very proud that we've moved heaven and earth.

We literally had Saturday meetings running the list of those that we didn't have a 2-week appointment for and calling them back and offering them a sooner appointment just to make sure they could feel what it meant to really access healthcare through the program. To go back for a second, when we said we mail you things in the mail, this is very important.

So before the NYC Care Program, we would never turn anybody away from New York City Health+ Hospitals, but your experience was you'd call and we'd say, sure, we'd love to see you, but the wait time can be 3 months, 6 months. And then you may take that appointment, and then you may find access somewhere else, and you may not end up going.

So we had a very high no-show rate. We were scheduling people really far out, so it wasn't as meaningful to them. When we're doing what we're doing now— and you didn't know who your doctor was going to be. So when you enroll in the program now, we send you a card, a member card in the mail that will have your name on it, your doctor's name on it, the 24/7 contact number to call, 646-NYCARE, with any questions you have about anything.

And then also your individualized fee scale. So you, for example, Chair Narcisse, would know this is how much it's going to cost to see Dr. Long. This is how much each medication is going to cost me based on my individualized income, because we got all that data for you when we were evaluating you for health insurance. This is how much it's going to cost to see every specialist.

This is how much it's going to cost to go to the emergency room. So all those financial barriers that existed yesterday before the program are all torn down today to give people that certainty on being able to access care without financial fear. We also are going to mail you a brochure which has all the information in it with how to, you know, what it means to be part of the program.

We want to make you feel like you're a part of something, a part of the program. And I think that's one of the secret ingredients that's kept people coming back and made the program so effective. Oh, I'm gonna have to follow up on that. For specialty, let's say they come from another doctor and they know specifically what's wrong. and to see a specialty?

And after the enrollment, how long you be? Let's say a GI or cardiologist. How that process go? Great question. So this is something that yesterday the answer probably would've been simpler before the program existed where you just would have a referral and you'd get into the queue. We've completely changed that. So the way it typically works now is if you get seen somewhere else, let's say you go to the emergency room and you're told to come to Health+ Hospital, something like that, You'll come through the front door of primary care.

So I see patients all the time that were referred from a specialist outside the system, or went to the emergency department, or had an admission, and then were referred to us. Mm-hmm. I will then see them, evaluate them, and what we do for specialty care now, which is way more effective than the system we had before, is we have something called eConsult.

So basically, let's use an example. If you're feeling— having a racing heartbeat or something, I can ask that question via eConsult to the cardiologist. and the cardiologist— so you're not just going to get put into a queue regardless of being triaged. They're gonna actually triage and say, okay, I would like to see this patient in 7 days, in 3 days, in 14 days, in 30 days.

So the specialist is already having a role in triage before your appointment's even booked. Mm-hmm. That makes it so that if you have more of an urgent issue, we'll get you in more quickly, and the specialists are involved from day 1 after that referral is placed. A lot of times too what happens is You may have been referred to us.

I'll give another example here. Patients, this was a long time ago, with a mass in their wrist. Mm-hmm. I got the x-ray. There was a concern, the read of the x-ray was concerning for a potential, you know, it listed as a growth. Growth can mean cancer. That's very scary. But I sent the eConsult and the patient wasn't even triaged to be seen.

It was just answered, oh, it's normal. So the patient didn't even have to worry about seeing ortho. So eConsult not only gives us— and statistically it's about 1 out of every 5 patients gets the answer within a matter of hours from the specialist so that they don't even have to wait for the appointment. But everybody else gets their specialty appointments based on the urgency that's defined by the specialist that will be seeing them.

I'll add to that briefly, just that the point I think for our patients and for all New Yorkers is to get their problem taken care of wherever it is. whether it's a cardiologist or primary care doctor. And what's happening now is I feel well supported as a family doctor. I have all the specialist knowledge at my fingertips to take care of that problem right there and then where the patient is.

I think usually when patients are asking for a cardiologist or ENT, they think they need that to get the problem taken care of. But often a primary care doctor can do it with the right support. And that's what we're doing right now. I agree.

What percentage of individuals who begin the enrollment process successfully complete it, and what are the most common reasons applicants do not ultimately enroll? Do you have a percentage? We don't have the percentage, but we know that many folks complete the process of enrollment because our goal is that I think actually, sorry, I recall right now we have 90% of our uninsured patients have gone through the process of health insurance screening.

So they either have health insurance or they have— they're enrolled in NYC Care. The people who don't, there are many different barriers that go into that. Maybe they're looking for documents, they couldn't find. And it's a process of engagement where we're reaching out to folks every time they come to an appointment. We remind them and encourage them to get in touch with our financial counselors who are well trained to guide people through that process.

And it's also importantly for, I think, this 10% of folks who haven't gone through the health insurance screening process to get enrolled in either insurance or NYC Care is some folks need that extra support. And We also rely on our community-based organizations to walk people through the process to make sure they feel the reassurance that we're there to take care of them no matter what.

And this is just a matter of making sure they get all the benefits that they are entitled to or eligible for. Thank you. What resources or operational changes could help make enrollment easier and more accessible for eligible I'll start and I'll see if Jonathan agrees. I think he will. The, the CBOs are a crucial part here. You know, if we waited for people to only come to us, I think the program would not have, you know, grown to nearly the size that it is today, which we're proud of.

So I think having trusted messengers go out there into our communities, which has been a cornerstone of the program since 2019, continuing and amplifying that effort, I think especially now when we're entering a time of confusion with all the changes, will be more critical than ever. We'll do our best to tell our patients what's going on. We're going to do a ton of outreach to patients as well.

I have some statistics on that. But ultimately, I think a lot of this will fall to the trusted messengers that our patients are going to go to first, the CBOs. So we have to keep those relationships, those partnerships, I think now stronger than ever. You want to add something? Absolutely. And I would add that one of the greatest things we've done with our community-based organizations who are already doing health insurance screening is that they're able to directly enroll into NYC Care.

And so expanding those partnerships with organizations, institutions that are already doing the health insurance screening process, which is, as we highlighted, I think the major part of enrollment into NYC Care and connection, would really help us. So that's something we're actively always looking for, more partnerships to directly enroll folks into NYC Care. And I think we can be a source of partnership. 51 of us.

And absolutely, and as well as the churches, we know that when you go to church, you get people. So on Sunday morning or Saturday, we can get more. So keep on promoting throughout, because most of the folks that we will find uninsured, a lot of them may end up in churches that you're not going to see on the street or other places.

Yeah, I'm glad you mentioned that. We'd love to be at every single event that you all have constituent-facing, because agreed, we never know when we're going to encounter someone who doesn't have a primary care doctor. And it may be even a friend of someone who doesn't have a primary care doctor, but finding out about NYC Care is crucial, and we want to be everywhere that we can.

And to make that offer concrete, you know, if there are events or places where you think we should go, you know your communities better than we do. Let us know. We have teams and community-based organizations that we talked about. That we can have go to the events to talk to people, to enroll people. So I think again, now people have more questions than ever given everything going on with Medicaid.

So use us. We want to be there with you. That's the reason I'm talking about it like this, because I know with whatever going on in the city of New York from the federal, we're paying the price in New York City. So we have to be very smart around it and trying to get our brothers and sisters, the new arrivals out there, help them out.

Absolutely. And we, we see— I mean, we lived it from COVID that diseases, infectious diseases, is not in a bubble. It can spread to every one of us and we all can be affected. So the more we align with that, knowing that we're all in it together, the better we'll do. Um, definitely.

After enrolling in New York CityCare, what percentage of members receive a primary care visit within 6 months. Now, I think some of them you said you're doing excellent on that. Yes. To say it again— Too excellent. Because we probably have a lot of guests. No, you don't have to repeat it. Because if you want to, okay. What do you want to add to it?

More than 90% of all NYCCARE members have been offered a primary care appointment, a new patient appointment within 2 weeks. In 2 weeks. 2 weeks. That I remember. Not 6 months. What services are most frequently utilized by New York CityCare members, including primary care, specialty care, behavioral health services, prescription medications, and preventive care. So the top 5 that go behind primary care, which is the gateway to everything— The gateway.

Okay. OB-GYN, eye care— OB-GYN? Yep. Okay. OB-GYN, eye care, dental care, cardiology care, in podiatry care. Not bad. What happened to the GI? Because we know we have an increase in colon cancer. That's why I'm saying it. I'm not saying it as a joke because actually many people wonder. If we could stay there for a second, it's actually a really good question we think a lot about.

So it used to be that GI was one of the services where there was a bottleneck because we were following what we call the USPSTF Preventive Services guidelines where you'd need a colonoscopy every 10 years. Mm-hmm. What we do today though, which is way more efficient and effective, is we could do an annual test where you don't have to drink the liquid, get put to sleep, go through the colonoscopy, and just do what's called a FIT test.

Mm-hmm. And I talk to my patients about this when I'm in clinic every week. All they have to do is just do a quick test once a year, and that's in lieu of a colonoscopy. But what that does is all of the— they would have otherwise been waiting in the queue to see a gastroenterologist to get the colonoscopy.

So by doing things differently with the technology that's being developed out there, we've been able to save our gastroenterologists, lowering their wait times for things that really need to go to them. We're able to do more, more in primary care. And patients prefer this so much more. You don't have to miss a day of work. You don't have to get someone to take care of you that day.

It's way better and it's increased our screening rates. I will agree and not agree too much on that. Because the fact is the nurse now going to be not against the doctor, but I will say that for a person that have history, I will definitely let them go on their colonoscopy. I think is more— so we on the same page on that?

Yes. If you have an abnormal test in the past or a strong family history, you do need to still get your colonoscopy. For people that don't fall into those 2 categories, you're eligible for this new test, which fortunately is many people. And just to also agree with you, one of the things that I'm proudest of that has enabled all of this to work is we have, I think, one of the best primary care staffing models with ratios for all of the nurses who we can't do anything without that are embedded in each of our primary care teams across our whole system.

We could not do hardly anything we've talked about if we didn't have the right team members. We all work together. I love that. Thank you. I wanted to highlight just a really impressive stat as well, that 3 quarters of our members complete a primary care appointment within a year and 80% of our members complete a specialty visit within a year.

So those are just the top 5, but they see cardiology, gastroenterology, orthopedic surgery, all of our specialties. All right. Give me one sec. Who's on the list for questions? Okay. Now I will pass it on to my colleague. She has to run for books, powers. Thank you so much, because you know the kids got to get picked up from school.

But thank you for the testimony.

Just really quickly, I have a question— I have 2 questions focused on HR 1 and losing essential plan coverage, and I have 2 on budget and capacity. I'll read all of those questions and you tell me what I need to repeat. Sounds good. Deal? Deal. Okay, so about 450,000 New Yorkers lost essential plan coverage in July, and only about 242,000 found new plans.

Do we know how many of those 242,000 without plans are eligible for New York City care? Is this data available by borough? And how has the Health and Hospitals seen come in, whether by enrolling in New York CityCare or showing up uninsured in the emergency room. And Medicaid work requirements begin January 1st, just over 2 months from now.

How many Health+ Hospital Medicaid patients will be subject to those requirements, and what will H+H do to support those people? I'm going to hold the last 2 because I know that was a lot. No problem. I got, I got the 3 here. So the first is a very interesting one. Just to rewind for everybody, EP5 went away on July 1st of this summer.

Among— and the statistic you're referencing, I believe, was in an article in Crain's from September 4th, where it was found that 59% of people that had been in EP5, using New York State data, had enrolled in a different insurance plan since July 1st. So one thing I want to say is there was an open question when EP-5 went away.

Nobody knew whether 0% of people were going to find another insurance plan, 100%, where that number would fall. And the answer, at least as of September 4th, was around 60% of people that had been on EP-5 had found another insurance plan. So not NYSEHR, but another insurance plan. Many of them went into a different EP category, 1, 2, 3, or 4.

Many of them went into Medicaid because based on a change of their income. And thousands of them, on the level of thousands, went into NYC care. But what we've seen is, to me, the conclusion here is that we had a very concerted effort at New York City Health+ Hospitals for our EP5 patients that had their coverage through EP5 to talk to them right away, early and often, and try to see what they'd be eligible for, another insurance plan or things like that.

So the fact that we, with our efforts and the efforts of others, We're able to help 6 out of every 10 people in just the first 2 months alone enroll in another insurance plan shows us that if we— that we can do a good job with a very hard, very concerted effort to close communication with all of our patients to try to be in touch with them and to make sure that they can stay on an insurance plan.

Is that going to work for everybody? Absolutely not. But this gave us a lot of clues about what doing a good job is and how we can, you know, get ready for the Medicaid transition. That was your third question. Maybe I'll skip to your third question. I'll go back to your second one. So what are we doing to get ready for on January 1st when the Medicaid changes happen?

They're gonna come in 2— there's 2 big components. You have to recertify every 6 months and you have new work requirements. So we see this coming from— this will be a crisis, don't get me wrong, but we see this crisis coming from a mile away and we're gonna move heaven and earth to do as much preparation as we can, just like we did with EP5.

Thank you. So for recertification first, today when I go to my clinic in the Bronx, even with before recertification on the 6-month interval happens, we label it in our electronic medical record. Your name will come up and you'll be labeled in red, recertification date of X. So then I know as your doctor, hey, I want to remind you to talk to one of our financial counselors.

Also, our financial counselors are going to call you many, many times to let you know that your recertification date is coming up. And here we're gonna work with you on it. Here's what we're going to do to help you. Here's how we're going to help you to recertify. So we're gonna have a very cohesive effort on that.

And just to get to stay ahead of that too, here's another statistic. To let patients know about what's happening, 'cause we know there's going to be a lot of confusion, we've already sent out nearly 400,000 emails where the message of the email is, if you have questions, call our financial counselor. Here's the direct number. And more than half of them were open.

So we're trying to get the word out now. Our financial counselors are going to serve a really key role. And from the recertification perspective, all of our team members are going to be aware. It's labeled in red in our electronic medical record. And we're going to be calling you as often as we can to help you to recertify.

It's going to be very hard, but we are going to do everything we can to help. On the work requirements piece, there's going to be a lot of questions about this too. So our financial counselors are going to be our one-stop shop. one number to call, the person to talk to is a financial counselor, whether it's about how do you recertify, what documents do you need, what reminders do you need, and also for work requirements, what qualifies as that, what's going to— what's a certified, you know, what are the certified ways to meet the work requirements.

The buzzer. So, I'll finish up with this one. I apologize. I just— it's very complicated, and I wanted to give you the full picture. So all of that's to say on the issue of how we're going to help people to enroll in Medicaid, we're thinking about this mechanically and putting very comprehensive plans together with one of the cornerstones being financial counselors and connecting all of our patients to them from our doctors to the emails we send.

Your third question, which I'll just answer briefly, is more of a follow-up. You asked about the effect on the ED and what we're going to see with the ED as these changes happen. The first 2 areas of healthcare that are going to be affected by this magnitude of— during our CCN coverage disruptions are going to be primary care.

People are going to be worried about losing their doctor and the ED. People are then going to go to the emergency department. So our ED colleagues are very aware of this and we have laser focus on looking at the numbers to see any changes that we see both in primary care and the ED. And we're going to be getting ready.

We're staffing up, making sure our teams are ready, aware, so we are prepared. Thank you so much. The Chair is going to be gracious to ask my last 2 questions because I have to hop on the train. Thank you, Chair. No problem. My pleasure. I might as well go to my colleagues there because they're going to— Epstein next.

Yeah, thank you for your time. I appreciate it.

Can I just ask you about how much of this treatment is remote? Is remote? We can pull data on the proportion that are telehealth. It's not a very big number. Yeah, it'd be great to know. What percentage of people request remote treatment and aren't getting that kind of remote treatment? Because what we've heard from people is, obviously, because of family and work, as we said with our colleague, childcare, the time that they need to be able to get to medical appointments is really limited, especially people who are lower income who have multiple jobs.

I'm wondering what H&H is doing to make sure that people have access to remote care. Yeah. Well, I mean, on that one, I can give you a much more clear answer. So I mean, I live this every week in clinic. So whenever my patients are being brought back to the clinic, I offer them, do you wanna see me in person?

Or I literally say exactly what you just said. I know you have work, I know what your job is. Do you wanna just talk by phone or talk on your phone? And yeah, I'd say probably every clinic, 1 or 2 of my patients would prefer to follow up from work. I can see their work in the background and to have a telehealth visit with me.

It used to be more, especially as Chair Narcisse was saying, Coming out of COVID we completed about 1 million telehealth visits. So we actually— the jury was out a little bit about how people were going to prefer to get care. And it's turned out to be— we can pull the exact statistics. Yeah, I would love that data just to be helpful for us to be able to see what that trend is, if more people are doing it.

And if you have it by geographic, you know, like my colleague in the Bronx versus my colleague in Brooklyn, we'd love to see kind of what that looks like and whether there's geographic trends for this population and if they're seeking more telehealth or if they're not, and then figuring out what kind of what those barriers are to wanting it or having access to it.

Yeah, totally. And just to, again, to say from my perspective, we offer it to everybody. It's people's choice whether they want to take us up on that or whether they want to come in to see us. And what oftentimes happens is so much of what we do requires a test. So if you need to have your blood drawn or you need to have a mammogram or pap smear or something like that, I think from my patients' point of view, that's one of the reasons why they prefer to just even take time off work to come in to see me, because our model of care at New York City Health+ Hospitals, which is very important to us, is a one-stop shop.

Yeah, no, I really do appreciate it, but it'd be great if you could follow up with that data.

Just, I'm wondering, I would love to figure out how you do enrollment through the SHO program, like how much of enrollment in New York Cares happens through SHO and how you partner with them to ensure that enrollment happens. Yep. So, by way of background, my team and I also started the SHO program in the spring of 2021.

Yeah, I know we talked about it back at Bellevue back in the day when it started. I remember. Yes. We're still here. And actually this year we're expanding the SHO program by 50% in terms of the units we have out every day. So actually, do you want to take that about SHO and NY Secure enrollment? I think I'll actually have to follow up with you.

I don't know. So as we discussed, financial counseling and the health insurance screening process is the crux of enrollment in NYC Care or health insurance. Right. And I don't know if, as a part of the show vehicles, they include a financial counselor. Certainly, telephonically, as we already talked about, they could be connecting folks, and I know that's a part of all of our processes.

So I'm almost certain that they're doing that. But the issue might be about whether they have someone in Yeah, I would love to know why they're doing it, and if they're not, why they're not doing it. That might be helpful for us to have that information. Yeah, I can shed a little more light on it. So we'll get back to you about the specifics, but with the SHOW program, one of the interesting dynamics is the SHOW program is for people experiencing unsheltered homelessness that are living on our streets.

And the SHOW program, when we see people, we do have them see if they're eligible for insurance at they have insurance. Interestingly, the majority of people that we see that are unsheltered have insurance. The majority have Medicaid for the reason that unfortunately, if you're unhoused, you're 3 times more likely to go to the emergency room. So we see you on that end and we will, if we enroll you in Medicaid at that point, when you see, when you're seeing the SHO program, you're already enrolled.

So I would view it as, we'll get back to you on the specifics of how SHO enrolls people. I think it's by the phone, but we'll get back to you on that. But it's a, The SHO program is part of a larger ecosystem where we have several different opportunities to enroll people in insurance. And, you know, I would say for better or worse, we do find that most people are insured or already insured.

Right. I appreciate that follow-up. And I know you mentioned that we could help advertise. If your team could send over like languages we could add to our e-blast, that would be really helpful. So we would have it that we can just continue to kind of remind people that it's available. You know, especially as Councilmember Sylvana Brooks-Prowess raised, you know, we're talking about potentially increasing uninsured New Yorkers because of, you know, draconian federal cuts.

So it'd be great to have that information we can be sharing out publicly. We 1,000% agree. We'll send you everything you need. And we are— the offer is still on the table for us to join you at any important events from your perspective. And at the buzzer, I'll say again, I'm going to keep saying this, 646-NYC-CARE.

Yes, Chair, can I get just one more minute? Thank you. So can you tell us what the New York City unenrolled population was before July 1st, 2026, and what the unenrolled population is today? And what do you expect the unenrolled population will be in January or February of next year? You mean the uninsured population? Yeah, yeah, sorry, uninsured population.

Do you know the numbers? The total uninsured population? The Department of Health and Mental Hygiene recently had an estimate that the full— at the full effects of HR 1, there would be close to 900,000 people that might become uninsured. But we know, as Dr. Long was talking about, that many of those folks will find other pathways to connect to health insurance, and we're certainly going to do everything we can to Yeah, you said 60% is likely to be insured in another way.

Well, this is what your experience has been this summer. That potentially leaves 40% of almost a million people potentially needing New York City CARES to be able to get some support. Actually, yeah, let me back up for a second. If you'll give me just a minute here, I'll try to be as concise as I can with the numbers.

The Department of Health collects the data, so we're not the arbiter of that data, but For the purpose of this hearing, let's ballpark it at, I think it's 700,000 or so, of people in New York City are uninsured. So a portion of them are part of the NYC Care program. And when EP5 went away, EP5 went away in totality.

So everybody that had EP5 on June 30th did not have EP5 on July 1st. So in that scenario, the 60% is of those that lost everything. how many were able to find a different insurance plan. So it's a related question. To me, it's more of a how we were able to engage with them to help them to find another plan that they were eligible for.

With the Medicaid changes, it's going to have a similar flavor, but it's going to be slightly different. People's eligibility for Medicaid is not what's changing. It's they have to recertify every 6 months and they have to complete the work requirements. So it's all of these things that are being put in front of them to ultimately cause a lot of them to fall off of health insurance, which is deeply disturbing to my patients.

I will tell you, we're terrified about what's coming up. But our approach to that is going to be similar. That's where there's the strand of similarity with EP-5. We're going to have our financial counselors call you. We've already sent out hundreds of thousands of communications. We're going to be in touch with you about the work requirements, helping you to find a program, helping you to understand what a certified work requirement is.

So, For the— with the Medicaid changes, it's not like on January 1st, 2027, there's going to be 900,000 uninsured people in New York City. It's going to be gradual over time. So there's 2, I would say, equally important things that we have to do to get ready. Number one, we need to be in touch with our patients to make sure we're helping them to recertify, helping them to meet the work requirement.

And number 2, for anybody that falls out or loses coverage and falls, NYCCARE has to be there and be strong and be ready to catch them. I know that's what we're here for today, but I just wanted to make the point that these things are connected together. And then just one last question. Just this overlapping map of where you have people through NYC Care, it's like maybe a geographic map of where those people are, and then where the expectations of people who are losing care are going to be coming from across the city, so we can figure out where collectively we can push our resources to ensure whether in Councilmember Audubon's district or my district, in Councilmember Felder's district, where are we seeing the potential expansion of uninsured people that we can help you get the word out to probably get people to get the care they need to do the prevention?

We'd love that. So just to be concrete about this, I'm a very boring mechanical thinker. So we're going to send you the telehealth data breaking down for 100 primary care visits how many are telehealth versus in-person to help to calibrate about meeting people where they are. And then we can pull together like a map or a grid of NYC Care distributed by geography.

And then potential data where you think people might be losing care over the next 6 months where we might want to increase outreach and education. Yeah, on that one, we may— that may be more for the Department of Health. But we're happy to coordinate liaise and ultimately disagree with what you said. Wherever you are hearing concerns in your community, that's where we want to be.

If the Department of Health can help you, if you need us to reach out to them directly, I'm sure you have connections to the Department of Health as well. Yes, sounds like a plan. But for now, we don't want to know where they are. Natalie, if you can send it to us. Sounds good.

We know we're going to have issues in New York City and all over the country. What percentage of New York CityCare members remain actively connected to care 1 year after enrollment? So Jonathan shared the numbers, but we can look at this in 2 different ways. I think the numbers he shared are probably good ones. So after 1 year, 77% 77%?

Come back for another primary care visit. And I think it's 80% have had a specialty visit in their first year. On a continual basis, let's say 70-plus percent recertify with us every year. We do require you as part of the program to recertify every year. The reason for that is your income can change, or your eligibility for insurance can change.

And it should, from year 1 to year 2, you would you qualify for health insurance, we want to check in with you and be able to get you the health insurance you qualify for at that point. And an important message that we deliver to all our patients also as a part of this health insurance screenings process is that we are not— you're not going to lose access to care, right?

So we're always telling our patients, just come to seek our care regardless of your insurance status. And this is going to be really important as folks are falling on and off with these new Medicaid requirements. Both work requirements and recertification. And I'm assuming they get contact after the recruiting. I heard that you're saying that you continue correspondence with them, sending them information so they know, despite what's going on now, you still can come to us.

We are here for you. Yes, absolutely. And just to give you another quick anecdote, because that has really stuck with me. This is a really scary time. I know. people, while they don't understand all the nuance of all the Medicaid changes and all that, people know that scary things are on the horizon. They could lose the coverage, the care that they have.

Mm-hmm. But from my patient's point of view, I'll just tell a quick story. I had a patient that I saw in clinic recently, and this is heartbreaking. I've worked with her very closely for a serious chronic condition she has. And I went into my office and she was there. She started crying. And I asked her what was wrong.

And she said, nothing to do with her healthcare. She said that she had to change an insurance plan because of everything we're talking about here, and the new insurance plan said that I wasn't the doctor on the plan, and that she thought she lost me. Yeah. And it was terrifying for her, and I just know that she's just the first of so many people that are gonna have that same fear and really horrible experience of being told they're losing their doctor, being scared of losing their doctor.

So what we say, what I told her, and what I tell all my patients, which is what we tell everybody at H&H, If you lose your health insurance plan, you will not lose your doctor. And that's what it means to treat healthcare as a human right at Health+ Hospitals. For you, I don't have the concern. I just want to make sure it's across the board that we're all utilizing, you know, the same approach, caring for the patient and encouraging them, because this is a very challenging time where people are really scared.

New York City CARE services diverse patient populations with a wide range of language needs. What steps is New York City Health hospitals taking to ensure members can access enrollment, appointment scheduling, care coordination, and clinical services in their preferred language? Our 646-NYCARE number allows you to, through telephonic interpretation, access 300 languages and dialects. All right. Have there been any recent assessments of language access needs among New York City Care members, and what gaps, if any, has H&H identified in interpretation or translation services?

So we have a team that continually goes through wait times, things like that, to make sure that for the many languages and dialects that we interpret for, that we have reasonable wait times and good access. We have not heard— I have not heard any issues recently. I do have the most common languages that people request. Phil, give me just a moment, or if you have it up.

Spanish, Chinese and its related dialects, French, and Polish are the most commonly requested. But really, at contact, we ask people, what is your preferred language? And it's clearly visible when anyone interacts with them. So I see that— I always check to see, does this person prefer Spanish or French? And then I have a phone on my desk that at the touch of a button, I can have a telephonic interpretation available so that I can communicate with the patient.

How does H&H monitor whether language barriers are contributing to missed appointments, delayed care, or lower utilization of services among New York So the main way that we look at that is through our no-show rates, and we break it down by population and see if there are any trends that we've seen. This is something that we continually monitor.

I don't have— I haven't seen any trends that would be noteworthy to be responsive to your question, but we do look very carefully at how our patients are making appointments, whether they come or not, if it's based on how long the appointment was scheduled out for, if it's based on whether they— we allow you to schedule through MyChart, so you can log on to MyChart and make your appointment with me as a new patient or existing patient directly on MyChart.

So we look at the no-show rates there. So we have different ways of looking at it, and it's something we'll continue to look at going forward.

Do you observe an increase of people seeking for their health and saying that now they're scared? Is that an increase right now? If there's an increase, we know it's coming. So are we prepared for it? Do we have enough staff to take care of the enrollment for like the one that coming to enroll for Medicaid or whatever that we can assess what's going on?

Yeah, that is, in my view, this is going to be a crisis. It's going to be a crisis with up to 900,000 New Yorkers at risk for losing Medicaid. The difference between this crisis and COVID, as you brought up earlier though, is that we can see this coming. So we're doing many things right now to strengthen our resources to help you to stay on insurance and to strengthen the NYC Care program.

In terms of— just to quickly— I'll just say in a line, we're putting teams together to help you with financial counseling, things like that that you would need. Okay. And on the NYC Care side, what we're doing to get ready is to make sure that we're maximizing our capacity now. One of the important ways that we do that is we very carefully built a care team model.

So that it doesn't need to be me that sees you for every single visit that you need. It could be our Treat to Target nurse that sees you for your blood pressure or diabetes control, which is a highly effective evidence-based program. It could be our clinical pharmacist. That's visits I don't need to have with you to control your diabetes that we can have in a different way.

So we are bolstering our capacity to get ready. We are solidifying our relationships with our community partners. We see this coming, and as always with New York City Health+ Hospitals, we will do everything in our power so So that nobody will ever be turned away. So do you believe that we have resources to meet the demand that's coming over our way?

So the resources for NYC Care, we are in constant communication with OMB about the money that we're spending, the money that we need both for NYC Care and for us as a system. But we anticipate the NYC Care program is going to expand. I think I just want to emphasize one of the things that you said earlier.

It's not just going to expand in terms of people permanently enrolling in the NYCare program. What I think is going to happen is you used the words coverage disruption. I think that's going to be what happens. Yeah. So it's going to be a complicated protocol of we call you, talk to you about recertification, talk to you about work requirements.

Works for some people, others fall through the cracks, maybe for 2 months. But in that period of time, we'll enroll you in NYCare, then maybe you enroll back in Medicaid. But it's going to be a lot of this fluctuating types of coverage that people have. So we see that coming as part of this crisis from a mile away, which is why we're making sure that we have a strong contact center, a strong financial counselor team, things like that, so that whatever happens to you, the bottom line is you'll never lose your doctor and you'll always be covered in our system.

A follow-up question for me. Do you think— I mean, what's the capacity actually of enrollment that you can endure right now? with the resources that you have? So today we could take in on the level of tens of thousands of new patients to New York City Health+ Hospitals. Now that's not exclusively NYC care, but that's with the teams that we have today.

So seeing that this is something that's going to be coming up on the horizon, we are seeking to do everything we can to make our system strong, the program strong, and build as much capacity as we can. But we do think that there's going to be thousands, if not tens of thousands, of New Yorkers that maybe it's not for the full year but are going to be affected by these coverage disruptions and would benefit from enrolling in the NYC Care program going forward.

I just want to be specific. What's the structure capacity that you have in NYC Care right now, approximately? You don't have to be specific, actually. Give me a range of what you can actually absorb. Well, so the— I can be specific, but it's to a little bit of a broader question. So we look at capacity for the primary care capacity we have across New York City Health+ Hospitals.

Mm-hmm. So the simple math is, if I filled— remember I said earlier in my testimony that we have a panel size of 1,750 patients per primary care doctor, per 1.0 FT, very precise. If we filled everybody's panel so that every panel for every primary care provider would be full, we could take in 15,000, 20,000 patients today. So it's not infinite, it's not zero, and that's something that we're going to seek to strengthen as we go forward.

Okay.

Before I pass it on to my colleagues, there's a couple of questions, books, powers left on a budget capacity. What is New York CityCare current annual budget and cost per member? If enrollment climbs because of federal cuts, does H&H expect to need new city funding? That's where I was going with it. I figured. So the budget that we have for the NYC Care program today is $100 million a year.

Mm-hmm. By the way, that's been the same budget that we've had since a couple of years after the inception of the program. So within that budget, that includes things like the payments we make to our CBO partners. It includes marketing. It includes the cards that we talked about earlier that send you in the mail. And it includes the coordination of care for our new patients, which need more, that are going to see Dr.

Jiménez or me in clinic. So clinical services too. As the program's expanded, the amount of money that we spend for the program has expanded too. So we are in very close communication with OMB about the cost of the program from our point of view, you know, stacked up against the $100 million that we're allocated each year. Okay.

Beyond funding, what else is needed to make sure as many New Yorkers who are losing coverage are supported by NYCCARE or otherwise? It's really you. If we could walk out of the hearing today all believing and saying that healthcare is a human right and you just have to call that 10-digit number, then we will have made the world a better place.

We need everybody to let New Yorkers know that calling 646-NYCARE unlocks the gateway for them and their family members to enroll in insurance or in NYC Care, but not leave that phone call without an appointment to a lifesaving primary care visit. In a time when people are terrified about Trump's policy and what this means for them and all these things, having one number to call I think is the most important thing we can communicate together.

I'm in agreement with you. I'm not fighting you on that. I love it ever since it started. I'm going to pass it on to my colleague, Alda Ball. Thank you.

Always a pleasure to hear you speak. Always. I, you know, the data shows that, you know, Hispanic New Yorkers are uninsured at twice the rate of Black and Asian and 3 times the rate of white New Yorkers. What are the demographics of New York CityCare enrollees, and does— and do you see a gap? in enrollment? Great question.

I'll let Jonathan. So, a predominant number, a percentage of our members are Hispanic or Latinx, 71%, and 13% are Black or African American. With respect to gaps, we are constantly looking for folks who are uninsured and unconnected to care. It's very hard to get a sense of what the denominator is. But in terms of how many people are out there that are uninsured and unconnected, which is why our mission is always to be in every place we can be, because every time I meet someone who hasn't seen a doctor in 10, 20 years, which unfortunately still happens, we know we have more work to do.

The thing that gives me pride in working at New York City Health+ Hospitals and doing the work we do is that we do not discriminate based on whether you're insured or have insurance. And we're seeing that— we see that in the outcomes. So we mentioned colon cancer screening rates, for example. At New York City Health+ Hospitals, whether you have health insurance from Medicare, commercial insurance, Medicaid, or uninsured and enrolled in NYC Care, the screening rate is the same.

Which is just a miracle that we take for granted here in New York City. I don't take it for granted as a primary care doctor, certainly. And we see that across the board with control for diabetes, control for hypertension. I just want to make sure that that was clear because we are constantly looking for where are the gaps, where are the populations that we're not— that we need to get up to the standard of care.

And that is shown in the results that we produce. Yeah. Do you have any— do you target particular communities where you're seeing this gap in insurance coverage? In your outreach, I mean. Yeah, no, totally. I'll start and I'll turn to Jonathan. But I want to— I think outreach is so important. And for me, I'll say on a personal level, this program is how I really learned the value and absolute crucial role that outreach has in a program like this.

If you take out our relationships with our CBO partners, if you take out the outreach components of the program, I don't think it would have succeeded. So I think that from the beginning of the program, our decision to make sure that we were in partnership with CBOs, I think, has been a cornerstone of our success. Jonathan is very close to that, so if you want to share a little more about how things have gone.

We contract with 20 community-based organizations that have been serving their community for decades and are well-trusted. Messengers about the care that we provide and about the enrollment process. And we strive, when we contract with them and partner with them, to make sure that they also reflect the diversity of New York City. So they speak dozens of languages and have served all the different communities in New York City.

They're in every single borough. So that's sort of our approach to the gaps. Let's be in as many places as possible and anywhere that we're needed. And we also receive feedback in important feedback regularly from them. We meet with them monthly on an individual basis and then all together as well monthly to share both between them experiences about where we need to be that we aren't already and also receive feedback about where it's an event that we need to go to that we aren't— we haven't been already present at.

Happy to have you at all of my events in District 13.

A couple more questions, if I may, Chair. How many— what's the capacity at Jacobi Hospital, which is in my district in the Bronx? And has that number changed, and do you anticipate that number changing? And I ask that question because Bronx has the highest unemployment rate in the entire city at 7.1% right now. Yeah. compared to 4 or 5% in other parts of the city.

So looking ahead to, you know, the employment requirements now with Medicaid, we're going to have a lot of people in the Bronx losing coverage. And that's a great concern of mine, particularly for hospitals like Jacobi, North Central Bronx, all the public hospitals in New York City. We need to Build capacity here. I couldn't agree more. As you know, I've been a primary care doctor in the Bronx for almost 10 years now.

So I am desperately worried about every single one of my patients when they come in. I'm already thinking, you know, what's your world going to look like when you start to— when you have to recertify every 6 months? What's your world going to look like when you have to go through the work requirements? Because I know you're not working now for X, Y, and Z reasons.

In the Bronx specifically, New York State has an application now to CMS, which I don't believe has been approved, but I think is in the— I think New York State's done everything they can to have a work requirement exemption for the Bronx. I believe New York State believes that the criteria are met, but I think CMS has to approve it.

That would be— I don't want to make it seem like that's a panacea to the problem, to the issues that the people in the Bronx, my patients, will have. But it'll be something that'll be helpful to get our feet under us in year one. especially the program. From my point of view though, just to agree with you, even if we get this exemption in year 1 that's specific to the Bronx, I don't think we should do anything else differently though.

I think we should build capacity the same way. Maybe we just have a little bit more time. And I think we should do the same outreach to get people ready to recertify, see what it takes, see what it feels like, see what it means for them. And I think we should treat the work requirements in a similar way to get people ready too.

So regardless, we're going to have all the folks in the Bronx that we need, And if we happen to get this exemption too, that would make it potentially a little bit easier for my patients. Thank you.

How do patient outcomes at Jacobi compare to other H&H hospitals, and what is being done to close any of those gaps? Good question. We can pull the data on the outcomes in Jacobi. We actually have a population health dashboard, so I can pull up in a matter of minutes the by-site by Gotham site, or by hospital, and pull up things like A1C control for diabetes, hypertension control, things like that.

I do just want to say one thing, because you've— you and I are, I know, very close in how much we care about the health outcomes in the Bronx. As I'm sure everybody knows, the Bronx is often listed as number 62 in terms of health outcomes of the 62 counties in New York State. Mm-hmm. But a little bit of reason to be optimistic about how we can do things differently is where I practice in the Bronx.

It's not Jacobi, it's Morelsania, so just down the street. We recently got an award for having the best blood pressure control in all of New York State. Beat every other place, every other private. So even though the Bronx on average has lower health outcomes, we at New York City Health+ Hospitals and my clinic have proven that we can exceed everybody else too.

So how can we provide that care, which I believe we do at all of our clinics, everywhere, both across Health+ Hospitals, but across New York City as well? To regale you with a few more data points, our hypertension control rate in my clinic is 84%. So between 8 and 9 out of every 10 of my patients that have high blood pressure, I have the certainty to know that I'm gonna get them under good life-saving control.

So I care very deeply about the Bronx. We've shown in the Bronx that we can do a better job than anybody else in New York State. So let's work together to make it happen everywhere in the Bronx. Thank you. I appreciate that. Very welcome.

C.M. Feldman. Thank you. So I'm going to do the same thing that my colleague did. I'll mention a few questions at once. And so H&H is currently pursuing the absorption of Maimonides Medical Center. I just wanted to make sure you're aware of that. I heard. Which is reportedly financially distressed, and that's been, that's been one of the reasons, you know, of the change.

H&H has made Maimonides' future financial stability contingent on being able to close collect enhanced— I underline that— Medicaid reimbursement rates. Hundreds of thousands of recipients in NYC, New York City, may no longer be eligible. And NYC Care does not replace the Medicaid reimbursement lost when a patient becomes uninsured. So the following 3 questions. Mm-hmm. Would Maimonides become an NYC care provider under the proposed takeover?

Two, what will be the additional uninsured patient volume and cost? And does the financial plan for Maimonides account for patients moving from Medicare coverage to NYC care? And finally, will you provide the council with projections showing how NYC Care and hospital services at Maimonides would be protected if those payments or Medicaid enrollment declines. I just want— I don't want to feel like I jammed you with something that really wasn't on the agenda for the hearing.

So If you want to, you know, get me the information, you know, and give it to the chair as well, you know, in writing, you know, hopefully expeditiously, I would be happy. If you want to answer me, I'm happy as well. I'm just— no, I mean that seriously. I don't want to feel like, you know, you were here, so I got you, you know.

That's all. I appreciate that. Maybe I can answer a couple of your questions here, and then we can get back to you in writing with the rest. Yes, sure. Because I think you bring up a very, very legitimate concern, which is that a lot of the basis for the health and hospitals, but also with the integration of Maimonides, the financial plan is based on the average commercial rates, which would be the enhanced Medicaid rates.

But that's only going to work if people stay on Medicaid. So I think that is a very, very legitimate and extremely important points. As it pertains to what we've talked about here today and NYC Care, I think I want to emphasize one of the things I said earlier, and then we'll get back to you in writing about the rest.

While NYC Care is very, very important and has made a tremendous difference for our patients, it's half the equation as we're seeking to fight back against all these changes coming up. The other half is how can we keep people on the insurance plans that they were on before? And that's where I think with the joining together of Maimonides, we have to make sure that we have plans that are very carefully curated to meet the needs of the patients at Maimonides.

The good news is, I think with what we've seen in EP5 so far in our approach with financial counselors, we've seen that we can be effective. But it's not a done deal. I mean, this is going to be that crisis we can see coming, you know, 6 months down the line here. So you can count on us having a laser focus on keeping people on Medicaid, because I couldn't agree with you more about that.

Thank you. And for some of the details about the process for that, how that pertains to the financial plan, things like that, we can get back to you in writing. Yeah. I just want to, first of all, thank you very much. But I just want to, you know, repeat is that as it is, you know, the plan was to try to increase the Medicaid recipients that they're serving.

I don't see how, no matter how good a job you do and anybody else does, I don't see how it's possible that that's going to happen, certainly not in the, you know, in the at least short term, you know. I don't see how it's possible, you know, with the cuts. No matter how, you know, even if you're Superman and I— You know, it doesn't matter.

This is kryptonite, you know. So I just— I certainly want the information you send me. I'm just going to say, no matter what you send me, I don't see in a practical way how— I think you understood the rest. Very much understand and appreciate, and we'll be in touch. Thank you. You're welcome.

All right. CM Sanchez. All right. So we're moving right along. What are the current average wait times for NYCK members to access primary? You told me 2 weeks. I remember that. I could say it again. But the specialty, the specialty, the behavioral health services, And how have those wait times changed over the last 3 fiscal years? Yeah, so behavioral health is a really good question.

So similar to specialty care, we don't just make referrals and create a waitlist for behavioral health. What we do is we triage based on acuity or need. And I'll give you a very pragmatic example of this, but I think it really points out the cornerstone of our approach. We believe strongly in the collaborative care program and approach to behavioral health.

For everybody, what that is, is it is a team of social workers under the supervision of one psychiatrist that can deliver therapy and care to people with depression or anxiety. The way it works is we screen all of our patients for depression and anxiety, and then among those that screen positive, we either offer to connect you to collaborative care, or— this is where the triage piece comes into it— if your PHQ-9 is high enough, we actually do a warm handoff to your social worker that will be your treating social worker. that day.

I do that often myself. I walk my patient to— her name is Doris, sorry Doris— our social worker that will be their collaborative care therapist. And then that way we can assess for safety but also get them engaged, make them comfortable with who's going to be delivering care to them going forward. So the answer to your question of what are the wait times for behavioral healthcare, it depends on your acuity, depends on other factors.

But ultimately collaborative care lets us get everybody in the door much more quickly because we basically are amplifying the reach of one psychiatrist through all the different social workers that are on that team. And if you have enough of a need right away, we'll do a warm handoff to give you a same-day visit.

What are the current average wait times for NYCK members seeking screening? Oh, sorry, I was not on. Okay. What are the current average times for NYCCARE members seeking screening, mammograms, and colonoscopy? And how do those wait times compare to previous years? So with— I'll start with mammograms and I'll talk about colonoscopies because that pertains to the FIT test that we talked about.

Yes. One of the things that we've started to do now, which has been proven very effective for increasing the proportion of our eligible women that receive mammograms, is offering same-day access. So what I do for my patients is when they come in and see me, if it's one of my patients that's going to need a mammogram in the coming months, I say, you're here today, can you take— do you have a little bit of time to stay?

Mm-hmm. And then I actually can make their appointment for them to receive their mammogram the same day that they see me. me. Mm-hmm. That's actually solved a couple of problems. It's actually reduced wait times, not only because we see a lot of people the same day, but also we were seeing a higher no-show rate because we'd schedule somebody out and then they wouldn't go, and then we'd have that slot that wasn't able to be filled.

So that enables us for patients that don't want to wait to have a sooner appointment too for their mammogram. So same-day access, I would say, is the most important thing we've done. For colorectal cancer screening, our preferred test is the FIT test, which is that once a year test that we do in collaboration with our nursing members of our team.

And that doesn't take very much time. We basically, our nurses educate them on the test, give them the test. I see this happen every week. And then they take the test themselves and oftentimes will do it at home or in the clinic and give it right back to us. For those that need a colonoscopy, that had been, there had been, you mentioned from before compared to now, There had been longer wait times for colonoscopies before when we were doing screening colonoscopies on everybody.

For everyone. Right. Now we focus on the 2 populations that you mentioned, somebody that's had a positive test in the past or a family history. So that's caused a dramatic decrease in wait times. Like approximately? We can get back to you on the details, but it's very significant. Okay.

Which specialties currently experience the greatest demand among NYC Care members, and are there service areas where access challenges remain? So the top 5 areas when you go beyond primary care are OB-GYN, eye care, dental, cardiology, and podiatry. And are there service areas where access challenges, they remain throughout? It's a good question. The reality is access challenges with different specialties change day to day.

Mm-hmm. So if we lose a team of rheumatologists or neurologists, that will cause— that'll make it harder to access services in those specialties. So for example, right now we have longer wait times for neurology because we lost neurologists that were in our system. So now we're seeking to build that back up. And then when we have, the wait times will go back down.

And there may be another specialty in the future if some people should leave that would have longer wait times. So it is a moving target. I think it, to me though, speaks to the importance of we're not just reliant on putting your name on a waitlist, which was the way things have been done in the past. Today, if you have a need, we're going to have the neurologist look at your need, for example, through the eConsult.

Maybe you don't need to be seen. Or I'll give you a good example of this. We recently had a backlog in hematology. Hematology is an interesting field in medicine, as you know, because they rarely ever need to see the patient. It's all— They don't see patients. So it can be answered via questions. So what we did to unlock access there and really solve that problem was we put everything through eConsult.

And lo and behold, what you'd expect to happen happened. The vast majority of hematology needs were addressed with a response back. So we have different ways of addressing needs as they change. respect to specialty access. But our NYC Care patients have the same access that all of our other patients do, starting with eConsult to make sure that any of our patients with more need are seen more quickly.

Okay, so there is nothing you can tell me on which one is the longest in the waiting time, the specialty that you have that mostly like the top one now? We can give you that. We can pull the top ones today. I just want to give the caveat that it may be different in next week, next month.

So what are the steps you're taking for those to address the capacity constraint? So a couple of things. So in terms of specialty capacity, we have several workflows that we're working on now. Number one is making sure that we have high-quality eConsult for every specialty in every clinic. What we're doing for that is we actually joined a national collaborative for eConsult.

So we've been able to learn the best practices from everybody across the country. So we have the metric that we're trying to hit, which is about— we want 1 out of every 5 visits or 1 out of every 5 e-consults to be answered such that the patient doesn't need to be seen in the clinic. We're getting close to that.

We know that's the right metric to hit because others have hit that metric and we're learning from them in this national collaborative that we've joined. It's through the AAMC. Other things that we're working on is on the workforce side. We're doing workforce planning to see where— I gave the example of neurology a minute ago. But where people have left our system recently or where we know we're going to have gaps in the future, and very proactively with our hiring affiliates looking for people in those specialties, which oftentimes cycle along the lines of residencies.

So, you know, it's the easiest time to hire people in July because they just finished their residency or fellowship. So we can plan ahead in that way with workforce planning. Other things that we're doing are with some specialties we're trying out direct access scheduling. So you can actually schedule an appointment through MyChart. That's live in 5 areas today.

We also are looking at time release slots or optimizing templates. So this is a little bit in the weeds, but you asked a question that has piqued my interest. So one way that we learned in primary care, which we're now talking to our specialty councils too, is if you release an appointment a certain days ahead of when a patient would want to be seen, they're more likely to go to that appointment.

So it used to be in primary care, we'd schedule an appointment 3 months out. And then the no-show rate was very, very high. It was more than 50% for new patients, because nobody knows what they're gonna be in 3 months. So what we did is today, really learning from what we did with NYC Care as well, we time release appointments at 10 days.

So that's sort of the sweet spot of maximizing your chance you're actually going to go to that appointment and giving you the feeling that you're accessing care in a timeframe that makes sense for you. So now that we've done that and succeeded in primary care, we're doing that for— we're going to We're talking to our specialty colleagues about optimizing their templates as well.

Other things that we're doing to increase access— so I could keep going here, but I'll just give one more example— is using the contact center in different ways. So it used to be that you would, for a lot of specialty clinics, have to call yourself, wait on hold. And also, there were appointment slots that weren't taken. So that was not an efficient way of doing things.

Having one protocol where our contact center is able to actually go into the templates and schedule appointments directly. We just started to do that for the first time in behavioral health a year ago. I believe the statistic— I'll have to fact-check this, but I'm pretty sure this is right— is that we've unlocked 4,000 new appointments that wouldn't have existed before.

That's 4,000 New Yorkers that have behavioral health issues that wouldn't have been seen before if we hadn't been able to optimize our templates and have the contact center really increase our efficiency. So I know I can keep going all day on this, so I'll conclude there and see if that answers a question. Yeah, you did. But I know we— from last time, I don't remember when was the last hearing.

I cannot recall which hearing. Rheumatology is one of the hardest ones to get. How are we doing with rheumatology? Oh, you have a great memory. It was the SHO hearing. Yes, you're exactly right. I gave the example then because at that point we had lost several neurologists at the same time. So I believe we've actually rehired— I'll have to double-check— but I think we filled all the vacancies.

If not, we've made some new hires. So rheumatology? So rheumatology is not the same issue today that it was when we last talked. It's better. It's much better today. But it's a perfect example to your point of specialty access changes when people leave our system, and we have to then focus on hiring and using these other strategies or levers to pull that I just talked about.

Okay. As a matter of fact, they're both important, neurology and rheumatology, and we're not getting that many after they retired and we have issues.

H&H NYC Care Programs has reported positive outcome in chronic disease management. What are the most recent performance metrics for diabetes control, hypertension control, preventive screening, and other key key health indicators among NYC Care members? I know you talk about the Bronx, that you're doing very well in hypertension, but now I want to know throughout. Oh, don't worry, I have all the data for you here.

I was waiting for that question. So we've taken it upon ourselves, given that the program, we now have several years of experience in it, to actually do rigorous research on it and publish it in peer-reviewed national journals. So there's 2 publications I'll just quickly outline for you that I think paint the picture of the impact NYC Care has had.

The first question we had was among those that enroll in NYC Care, what proportion of them have an improvement in their chronic disease? Oftentimes these are people, in my example I gave earlier, that haven't seen a doctor in a very long time. My patient hadn't seen a doctor in 43 years. What can she expect if I tell her she has diabetes or high blood pressure?

The answer to that question is 73% of our new enrollees that we diagnose with hypertension in their first visit have a significant improvement within the first 6 months, which we think is very remarkable. 53% of our patients that we diagnose with diabetes have a significant improvement in the first 6 months too. So we know the program is having a big impact on people that had many times undiagnosed conditions before.

The next question is, okay, So then what happens over time? How do they compare to the rest of our patients too? So that the first publication, by the way, was in the Journal of Public Health Management and Practice in 2024. This next one, which I'm particularly excited to tell you about, is published in one of the major journals, Journal of General Internal Medicine, in 2025.

So just last year. What we did is we compared a new NYCCARE enrollee to a new Medicaid enrollee. So new versus new, not somebody that's been in care for 20 years, New patient versus new patient. First question is, for diabetes and hypertension, is there a difference if you enroll in NYC Care versus if you enroll in Medicaid?

No. The answer to that question? No difference at all. Identical outcome. So if you enroll in either program, we're going to— we have the same chance of getting your chronic disease under good control. Interestingly, we even saw a signal, so it was statistically significant, but this is just one study, that patients in NYC Care actually had a lower hospital admission rate than new patients in Medicaid.

So all of that we take to say that we view NYC Care as having a clear impact once you enroll, and it's sustained, achieving the same chronic disease outcomes as patients that are new in Medicaid, maybe even slightly better in some ways. And if you translate that in terms of the data that's out there about if you have insurance, the lives that are saved, The NYC Care program to date has saved 1,569 lives.

So I don't know if I'm going to push it if I ask you, do you have the data of the readmission within 30 days from the NYC Care compared to Medicaid? Do you have that data too? We did not study hospital readmissions as part of that study. I can see if we have that. Readmissions is an algorithm that in a not interesting way, I was part of the team at Yale that developed the hierarchical logistic regression model that's used by CMS for the readmission algorithm.

And we can see if we could break it down that way, but in this study we looked at hospital admissions and chronic disease outcomes. Okay. The reason I'm asking the readmission rate, because I know the compliance you have tied up together, so I was going to see see how we're doing in terms of teaching to try to get the people to stay at home and the follow-up with the patient.

Yeah, well, the cornerstone is the primary care follow-up is the key piece. We do— we know our patients come back to us in primary care. But that's a good point that we're judged by various different measures, including chronic disease control, hypertension, breast cancer screening, whether you have a statin when you have diabetes. And we're constantly looking at these measures across different payers.

And what we see is that there is no difference between our NYC Care members, our uninsured patients, and our insured patients, which is the achievement of health equity. Well said. Okay, I'm still going to do that one. To what extent does NYC Care help connect members to preventive and primary care before conditions I mean, worsen and require emergency or inpatient care?

So on the preventive care side, we break it down into 2 buckets. There's chronic disease prevention and treatment, and there's prevention like vaccines, cancer prevention, things like that. In the first category, the numbers I shared, I think, show that we do very well with chronic disease, with prevention of your chronic disease getting bad such that you have to go to the emergency room or be admitted to the hospital.

And the data shows that. On the other side of how do we do with preventive care, I thought Dr. Jimenez shared a really good number. Maybe you could share again the colorectal cancer screening number. Oh, yes. For colorectal cancer screening, we have 77% of our NYC care members have completed their colorectal cancer screening. And for our general population, for everyone, 78%.

It's essentially the same. So going back to what we were talking about. We're seeing the same outcomes because we treat everyone the same. So you're doing an excellent job. Thank you. Let's keep on doing it for NYC Care.

What metrics does H&H use to track— that's H&H— use to track patient access, including wait times, specialty care utilization, language access, and successful transition to health insurance coverage? And can those metrics be shared with the council on a regular basis? Good question. So, um, to break it down in terms of how we think about access for primary care and specialty care, um, the first number, which actually dates back to 2019, that we look at is, um, were you able to get a timely appointment?

That's why, um, agreeing with your question, we cared so deeply about offering you an appointment within 14 days of calling us. And, um, that's why we took literally Saturdays to call people back to achieve more than 90% to date have been offered a primary care appointment within 14 days. So that's access in primary care. Access in specialty care, in terms of metrics, we do have different ways of tracking this.

We track the number of e-consults, the number of e-consults that result in an appointment versus being answered back to primary care. And we track wait times for clinics as well. So we can follow up with you with some data for all of that. And then, next part of your question was about conversion of NYC Care to insurance.

That's a really good question. And I think that's one of the big things that we're fully in gear and preparing for to see going forward. And I think a lot of people, when the HR1 changes start to impact my patients, I hope I'm able to keep most of them on Medicaid, but many will fall off. NY State Care will be there to catch them.

But then the goal for me would be to get them back onto the Medicaid plan that they were on before. So statistics around that we don't have today because we're just starting to go into that starting January of 2027. But we'd be happy to keep in touch with our experience with that as we go forward. Thank you.

Does H&H collect data on how patients learn about the program? How do New Yorkers most commonly learn about NYC Care? Yes, absolutely. So when folks call our call center, we ask them how they heard about us, and it's actually changed over time. Interestingly, when we first launched, it was advertising, community-based organizations. Over time, though, because our patients have both joined us and received great care, they tell their friends.

Now, number one is friends and relatives. That is how they're hearing about the program. And I think it's a great highlight of how we create a culture of a right to healthcare in New York City and why we invite every single person, including you all and all other City Council members, to help us spread the word, because it really is, you know, through relationships that people are hearing about the program.

Well, like I said, we offer ourselves here. I think my colleagues are offering ourselves. Because we know the trouble is coming. Some trouble is coming. And I have the numbers right here. So it's first is friends and relatives. Number 2 is referrals from healthcare providers. Number 3 is our community-based organizations. And number 4 is our online public advertisements as well.

Great. Now, there's a lot of online that we have to pay much. I know some seniors not in those online spaces, but the kids can— you can put advertisement where the kids have to tell their grandma, their auntie in the house. Exactly. We've actually done that. Spread the word. Absolutely. We've done that on social media. We have videos, uh, encouraging young folks to talk to their family members, their parents, their tíos and tías, everyone.

Tell Mommy and Daddy and Poppy. Exactly. Yeah.

Which outreach strategies have been most successful in driving enrollment, including partnership with community-based organizations, hospital clinics, and public awareness or campaign, or like we said, mouth-to-mouth, I mean, people-to-people mouth-to-mouth? I mean, I think, Dr. Chawla, I think community-based organizations, I think, has been our most important partnerships. We've done it from the very beginning, and it was such an important part of us having that trust from community members because we know not everyone is going to feel comfortable walking up to a facility, as much as we try to provide the best patient care and best service.

And so they've been our trusted messengers in the community, telling people about the services that we provide, helping people enroll. And over the long term, I think they're a great reason why we're where we are now, where we've enrolled over 100,000 people, right, surpassed our initial goal, and we've had over a million interactions through our community-based organizations with New Yorkers as well.

Such amazing work, and we're continuing to do every single day. Thank you. How does HNH evaluate the effectiveness of outreach investment and enrollment campaign? Well, we look at various metrics. Another part of important part of our public awareness work is our advertising and marketing. So one, we advertise in print media of many different languages. Okay. We advertise online through Google Ads and other websites, and we track, you know, how many people are seeing this, how many people are clicking, what percent we do per dollar, which ones are most cost-effective in our constantly looking at where, where, where can we stretch our dollar the best to reach the most people.

And then we also are innovative in our approaches. We started working with influencers to reach young folks as well. Influencer? That's a joke, so good. Well, folks who have a following and anyone who has a platform, we want to be on there to help people find out about NYC care and encourage folks to talk to their family members if they don't already have primary care.

We also are starting and have been working with a Light the Way truck, an experiential marketing experience where a truck wrapped in NYC Care logos, creatives, and messaging goes around the city spreading the word about— I see that a lot. I love that. I love to hear that. Yes, we're going to be bringing it back this fall as well.

It's been received just with great joy from the community, and it's been an important way of spreading the word. And don't forget to tag us, the 51 council members. Okay, we will, we will. Tag us because a lot of people seeing us, some of us are very— some of us, I think, influencers too. Well, one thing we've actually done with the truck is— oh, perfect.

Okay, okay. We'll have to talk more about that. Not me. I'm saying some of it. I don't have the time to read everything. Anyway, what additional resources would help expand awareness of New York CityCare among eligible New Yorkers? What would help? Continuing the community-based partnerships, which we are doing, is crucial. And we're often looking at where are there areas we haven't reached already.

I think the other area I mentioned previously is direct enrollment. So we'd love to partner with more organizations that are already doing health insurance screening because they're receiving the result of whether someone is eligible for NYC Care or not. And when we partner with them directly, it helps make it that much easier for folks to enroll in NYC Care and then also puts us in more places around the city so that the access and availability is increased.

Just to say one more word on that, I think it's, as Jonathan's saying, We want to be everywhere, but we're going to be amplified if we can get our— if we can have our voices together. And at the end of the day, we want people to know that anybody can call 646-NYCARE and enroll in the program or get the help that they need.

I'm just so worried about people that are scared, don't know what to do, or confused. And I think of so many of my patients. I'm going to, you know, myself tell them, remember, be proud to have the card that you have. 646-NYCARE is your lifeline, and it'll always connect you back to us. us. And now we're going to put you there telling them that.

646-NYC. I'll see you in the Bronx tomorrow. We got you. You can do that in social media. Just— we can spread it because I'm sure that most of us will. Because guess what? You're a doctor delivering the care. There you go. So who to trust?

Um, the mayor's management report notes the important role financial counselors play in helping New Yorkers access coverage and care. How many individuals receive enrollment assistance in fiscal 2026, and how does H&H measure the effectiveness of those efforts? You measure them. So I think for the— I'll start and I'll turn to Jonathan. With our patients in NYC Care, we ask that you go through the process once a year to confirm whether you're eligible for an insurance plan at that point.

Or if you can afford an insurance plan. So every year, if you look at a whole 1-year period, everybody in the program will have gone through that process again. And, you know, the goal of it is, like we talked about earlier, if you are eligible for an insurance plan, success is getting you into that insurance plan. If you're not eligible for an insurance plan, or if your status hasn't changed, we'll keep you in the NYC Care program.

We'll send you a new card that has at the top of it again, your recertification period will be, or, you know, we'll check back in with you in a year. Thank you for doing that.

To what extent does transportation pose a barrier to care for NYCCARE members, particularly those requiring specialty services or frequent appointments? Well, transport— getting to appointments is a barrier for everyone. It's something everyone has to go to their appointments, and currently it is not a benefit of NYC care. So it's certainly something we encounter. But our New York City, you know, we make great use of our buses and trains so that people often willingly and excitedly commute to see us all across the city.

You know, my— one of the great examples, my whole family gets their care at Gouverneur. They have for generations. They live all across Brooklyn, but— and we see that across the system. You know, what matters to patients is who they make a connection with, and that's why we focus so much on that initial connection with primary care.

I'm always concerned of the disabled population. Do you see a trend on that, how they— because with calling their— I'm not going to put anyone out there, but when they call in for transportation, sometimes you know, the delay and elevators, or some cannot do public transportation. So all those things, have you seen that people missing appointments due to those kind of difficulties?

Which I'm going to— I'll start and then turn to Jonathan because he— it was Jonathan's idea a year or two ago to make a big expansion within the NYC Care program to make sure that people people with disability can always get the DME that they need. So actually, Jonathan, do you want to share? This really was your brainchild, so I want to give you— Yeah, well, we saw that there was a gap, and folks, because it's not NYC Cares and it wasn't health insurance, it was challenging to find durable medical equipment.

We created a new benefit so that if you needed a wheelchair, if you needed a cane, a walker, any number of equipment that you need to live a dignity dignified life, a healthy life. Now your primary care provider or other specialty care provider can order it online at their desk and it's delivered to your home. And so that's certainly contributed a great deal to folks being able to get around and get to their appointments.

And just to— if I could say one more thing there, because I think it's a really emblematic and perfect example of NYC Care is— we talked about the data. It's been incredibly impactful for our patients, for our city, but it's a special program too. Other cities don't have programs like this. So when other jurisdictions have reached out to us, as I shared earlier with you, they're blown away by the impact that we're able to have with this program.

And as an example, I mean, if you're somebody that's uninsured in another city and you need a wheelchair, it's very difficult, almost impossible to get the care, the services and the care that you need. Whereas here, we're going to enroll you in a program by calling one number. going to see a doctor within 2 weeks and you have full access to DME.

So it's just a foundationally different experience than everybody else in so many other jurisdictions across the country, which is why we believe so strongly in this program. I appreciate it too. I used to own a DME company, so I know sometimes when you don't have insurance, you don't have— you cannot pay the special wheelchairs. Some special wheelchairs can be $20,000, $25,000.

So you got it. It can be very, I mean, difficult. And some of them Medicaid not covering them. So it can be hectic for families that are dealing with that. It can be a lot of pressure. Does H&H collect data on missed appointments attributable to transportation challenges? If so, what trends has the system identified? That's where I was going.

For no-show rates, I mean, we track no-show rates. As Dr. Long was saying, we are constantly iterating about how to message, how to schedule in the best way to reduce no-show rates. But I don't believe at the moment we track the reason why. The reason why. Because they're not showing up. So we'll have to look back at— We can see if we have anything in the data.

Because transportation challenges can be real. That's what I was saying. Some of the places that they have to get out, if they take trains, they don't have no elevator. They can't be— I have no doubt it contributes certainly to no-show rates. We can take a look in our data and see if we have anything on that. We do, to Jonathan's point.

We have a very careful way of looking at no-show rates because that's been one of our most important indicators to improve access. So we try to do everything we can to To make sure people are coming. Certain ones you cannot do anything about it, more likely, but some that you can do something about. Maybe that's the reason you collect data, to see what can you improve in those things that you collect.

Are there additional transportation assistance program partnerships or investments that HNH believes will improve access to care for NYC Care members? I'll start and I'll turn to Jonathan. I think actually I'll go back to what you said a second ago that In terms of identifying what we think our patients could benefit from, I think we should start with taking a look at the data to see if we have anything that would give us an indication of where the barriers exist today.

I don't know if you want to share more, if you have any experience. No, I mean, I think that one of the major reasons that anyone not connected to care isn't is because they don't know about NYC Care. So I would welcome, I think, more resources for community-based organizations, community engagement work, as well as our advertising and marketing work that makes sure we get in front of everyone and sort of really expand that idea of a right to healthcare.

Okay.

What additional investment— I'm changing gear into financial. What additional investment, staffing, infrastructure, or operational changes would be necessary for NYC Care to serve larger uninsured populations over the next several years? Because it's going to be a roller coaster. Yeah, I know it's, it's going to be a roller coaster, but again, we can see the roller coaster starting, you know, 6 months down the line, and this is the time where we need to get ready for it as a city.

And I also want to say, you know, the city's taking a lot of other activities too. So DOHMH recently announced that the new HEART teams. I think that's a great way to also go into our communities, see who needs help, connect people to care, see if they're eligible for insurance, things like that. I think we need to fire on all cylinders to solve the overall problem of just this fluctuations, uncertainty, and again, going back to what you said, coverage disruptions.

So to answer your question about what we could do to build capacity between now and then, Mm-hmm. I think we need to make sure that we're hiring up as much as we can. It's very, very important to us, and you can let me know if you agree with this, that we need to put equal importance on the care teams, meaning our nurses, as with our doctors.

We need to make sure that we're hiring the whole care team, 'cause that's the secret ingredient to achieving all the health outcomes that we talked about here. So those are big areas of focus for us in the next, I would say, several months, is to make sure that we're going through with each of our sites to make sure we have the care teams, hire up any gaps that we have so that we can say, as we start to— as our patients start to feel this happening, we have the financial counselors that are reaching out that need to reach out.

We have enough clinical pharmacists so that for our patients with diabetes, we can make sure they're getting through to the right, most effective team member, things like that. That's my goal for the next couple months. I can see an advertisement for that. Like, you know, as they drop you the insurance, Yeah, I love that. What investments would have the greatest impact on expanding NYC Care reach and effectiveness over the next 5 years?

I think that's related to what I mentioned previously, right, that our work in the community is really crucial. Our effectiveness really depends on whether people are connected to care and then telling their friends and family about the care, whether our community-based organizations are equipped and staffed to do outreach and be at health fairs and educate the public about the program and assist folks in enrolling.

And then I think also contributing is our message of inclusion. that we strive to create through all of our advertising and marketing. And yeah, whether it's placed in print or in the subway, a right to healthcare, you are a New Yorker from day one, are all messages that highlight if you have any health concern, we're here to take care of you.

There's a no wrong door approach. Call 646-NYC-CARE. That's the crucial piece. I appreciate that.

Something in my head and I just get the note I need to ask you. Because I was thinking about— because you mentioned about the HART program that the mayor spoke about it, right? Do you have any information on it? What's the specifics of the program? Do you have anything on it? And is H&H involved in the process?

Or are you involved in the process? Of course, for any specifics, I'd have to defer to our colleagues at DOHMH. But I will say that we've been in close touch with them about when we reach out to people, you know, the insurance enrollment process, getting people into NYC Care if they're not eligible for an insurance plan. And importantly, whether the person is enrolled in NYC Care or enrolled in an insurance plan, we're working with the OHMH to know there's gonna— we're creating a well-paved path to health and hospitals for actual clinical care.

So if you have Medicaid or NYC Care, I want to see you in the Bronx. How can the council best support you for the outreach, which we say we willing? We're not— I'm not, you know, influencer, but I have a little follower, like I think over 5,000, whatever that is. But yeah, how can we best support you?

Service delivery, long-term, you know, sustainability of it. Because we want to help. You have 5,000 more followers than I do, so. But I really think that this is that moment where if we can all be sharing the same message that healthcare in New York City is a human right, we have this special program, there's one number to call, and we'll join you at events.

We'd love to invite you to some of our events. I think if I put myself in the— from the point of view of my patients, having one clear message with the certainty that you're going to be caught if you fall, I think, is the most important thing. I tell you, I see the commercial already. So at least people can trust you.

You're the doctors, you're delivering the care, and your passion to care.

Are there legislative or budgetary or policy changes the council should consider to help strengthen New York City care and improve access to care for uninsured New Yorkers? I would say in one word, yes. We as a city agency are in close touch with OMB that is constantly assessing our fiscal needs including for NYC Care but for H&H in general.

I will say City Hall has been very supportive of thinking through with us about what the impact of these changes is going to be and making sure that the NYC Care program is going to be as strong as it can possibly be as we begin to go into this uncharted territory with, to use your words once again, so much coverage disruption and fear out there.

So we would welcome and love all of the support that you can offer, which is not just financial, but also just making sure that looking out the window, we can together tell as many people that there is— I won't do the thing again— a number to call for help. 646— you can repeat it. That's all right. That's all right.

Okay, one more time. 646-NYCARE. Okay, we got you. So there's no policy you can think we can change. Um, OMB is helping you out. So if you have anything, you know, I'm— I appreciate your work too. I have your cell phone. Yeah. What— and you too. I'll get it. I'll get it. Of course. And what additional resources or partnership, um, would most— most— I mean, sorry, would most help H&H meet the needs of uninsured New Yorkers?

Anything you can think of additional to what you just said? Some of the things we mentioned, I think, you know, so one thing we haven't mentioned, we're always looking for more partnerships, places we haven't been. I think you mentioned churches. That's an area we'd love to be in. It's such an important— houses of worship all across the city.

Very important. Yeah. So, and I know that some of our community-based organizations work with houses of of worship, but we'd love to be in more places. We already work with the consulates, some consulates. We'd love to be at more consulates because it's an important place where people also trust their co-nationals there who are serving them. And it's been a great way to connect with people who need primary care and didn't know they had access to it already through NYC Care.

So. Are there successful New York City Care initiatives that could be expanded with additional council support or funding? Everything we do takes resources at H&H, and we make good use of all of it. That's part of why we have all these comprehensive ways of accessing and designing our practice, e-consults, rolling scheduling, to make sure we make good use of resources.

So we'd welcome more resources to take care of patients, absolutely, and do the outreach to make sure that people know about us. Yeah, I mean, I think just to emphasize what Jonathan's saying, I know we've talked about it a lot here, but I mean, the program is only going to be as good and effective as the number of people that know about it.

And, you know, there's going to be people that are going to be looking out there for information when all these changes start to happen. So I think my number one for the support that we would love to have and the partnership we'd love to have is, again, really trying to think creatively, by influencers, I know, but how to best get the word out to everybody across New York City.

You know, again, I talk to colleagues in other jurisdictions. They don't have any program like this to refer people to. We do. It's special. It's unique to New York City, and let's use it. So what's your advertisement Budgets look like. Ah, the budgets? Do you know? We can get back to you on that. Okay.

Beyond New York City Care, are there other H and H programs which talk about how that's just coming to be helping in the process? But other than H and H programs or services that more New Yorkers should be aware of. particularly those that help improve access to care, preventive services, behavioral healthcare, or social support services? Yeah, there are a couple I would love to use this as an opportunity to highlight.

One is— actually, both of them are related to some of our most vulnerable New Yorkers, those experiencing homelessness, especially unsheltered homelessness. So I would love for more New Yorkers to know We have a very robust and large street medicine program, our SHO, Street Health Outreach and Wellness Program. We post on our website where we're going to be on a given day.

So we'd love to get the word out to have more people come to us for low-barrier medical and behavioral healthcare right there on the street where they are. Meeting people where they are is the name of the game with the SHO program. We have special clinics too at Health+ Hospitals called our Safety Net Clinics, which I'd love more people to know about because if somebody has concerns about You know, can I get my mental healthcare for severe mental illness along with addressing the wound in my leg?

We have special clinics called safety net clinics where all those services are co-located. Very impactful. We've shown that to cut the rate of emergency department and inpatient visits down by about half if you go to the clinic. So very, very impactful clinics. And then the other thing I'd love for more people to know about is at H&H, we really care about what happens to you when you leave our clinic.

And we have a program called Housing for Health, which I wanted to take a moment to build up here. Did you know that at Health+ Hospitals, we've now housed 1,800 of our patients? That's 1,800 patients that if we hadn't done that, if we didn't have this special team, would still be experiencing homelessness, and now they're in their own home.

And part of the way we've been able to do that, which we'd always love more support on, is we've built 400 housing units on our health and hospitals land. So we'd love to do more of that or to partner in other ways to get our patients housing. But we think housing for health is so impactful because if you can combine together the primary care you can get at H&H with a home of your own, that I can't think of anything more life-changing than those 2 things.

I would not go against that because especially when I'm discharging a patient and giving all the instruction and knowing very well that person don't have a home. That break your heart. And that's why I love some of the great programs that we have, Bridge to Home, different ways. I mean, Dr. Katz and I, I'm always saying thankful for that because discharging a patient and end up on the street is not healthcare.

They're going to end up right back there with you in the hospital. Yeah. Which 800 programs have demonstrated particularly strong outcomes but may be underutilized because of limited public awareness? Well, actually, I would say the ones we talked about. The SHO program has more capacity, which, as demonstrated by the fact that we are expanding it by 50% this year.

So I think from a public awareness standpoint, the more people that know and could tell their friends or, you know, family members that are going through a hard time, hey, here's a safe place near to where you are that will literally send a team to talk to you where you are. We want to remove all barriers. So more public awareness around that would be terrific.

Yeah. I have an idea. So even the program that's not out there, again, with 51 council members, we send newsletters every— like for me, every Monday. So not big things, Because, you know, people don't like to read too long pages, but on the little short things. So when we send it out, people can see it. We could absolutely do that.

And it would have the locations where we're going to be. So you could say, you know, hey, yeah, we can have it. You can have a location where they're going to go. Yeah. And that would be very helpful.

How many safety net clinics we have and where are they located? How can people find them? So now you see, that's your chance to put it out there. Yep, that's an easy one. So in Manhattan, we have Bellevue. And by the way, for our safety net clinics, if you're a person experiencing homelessness or you're working with somebody that is experiencing homelessness and would benefit, it's open access.

They can just go in, we'll take care of them. We have community health workers that help to bring them back to the clinic, things like that. In the Bronx, we have Lincoln. So we have show units that are referring people back to Lincoln Hospital every day. In Brooklyn, we have Woodhull, and then in Queens, we have Elmhurst.

My hospital. There you go. Okay.

How does H&H— how does H&H connect NYC Care members with other H&H services, including behavioral health, community health centers, housing support, food assistance, and care coordination programs? Yeah, well, I'll start and I'll turn to Jonathan. I think actually he said it the right way a few minutes ago. Food, you know, food is a big thing for me.

People cannot go hungry. Yeah. So the care that we provide for our NYC Care members is identical to the care that we provide for all of our patients. That's very, very important to us. There's no 2 levels of care. There's one level of care and it's excellent. at New York City Health+ Hospitals. Interestingly, I think it's about a quarter of our NYC Care patients screen positive for having a social need, whether that's food, housing instability, things like that.

And if you screen positive for that, we put you into our care coordination basically program, which can mean it's either a community health worker we're going to assign you to, or a social worker, or one of our other programs. So we treat social needs as a screening process akin to screening you for depression. If you screen positive, you go down a pathway and we make sure that you don't leave the visit without a resource.

Thank you. Yeah. Now, in the past hearings, Dr. Katz has discussed volunteer opportunities at H&H that could allow patients to meet their work or community service requirement to stay on their federal health insurance plan. Are there other similar programs that are offered through H&H or through partner organizations that can help New Yorkers stay enrolled on their health plan?

Great question. So to back up for a second to put this on the record, one of the roles that's very important that we're going to play is how do you know what programs qualify? Who are you going to ask? Who are you going to call? So the answer to that is we are— we have a phone number to reach our financial counselors.

So a very important first step is, as you're thinking about what you might want to do, talk to one of our financial counselors. They'll let you know what qualifies. They'll walk you through it, and you can make a plan together. Okay. So once you've done that, this is a— I would say at the stage of work in progress.

So I will follow up with Dr. Katz about this. We are seeking to create a system-wide volunteer program that would qualify as satisfying your Medicaid work requirements. Right now, we do have programs that exist at a smaller scale but are hospital by hospital. Bellevue has a program. But we are seeking to, as one of the things, seeing the crisis looming in the distance, that we could do to be ready is to try to create either a system-wide program or a clear connection based on where you are to the most applicable program to you.

You know what? The good news I did not tell you, that was the last question that I was holding on because you— we have been here a little while. So I think, um, what's anything? I think the good news is thank you for your time and thank you for your service to New Yorkers. And don't forget the commercial where you, you yourself gonna be holding the people that dropping from, you know, from the entrance.

We'll do it together. So I'm so appreciative of you, Doc, because, um, you both professional medical, knows what's going on, and I'm so appreciative of your time. Thank you. Can I say thank you for drawing attention to this issue, which is in our hearts and so important to us? Thank you. Absolutely. Thank you so much. Thank you.

Appreciate you. Now you may go or you may stay, it's up to you. So, but I'm— thank you for your time. Thank you. And don't forget those answers because My colleagues are probably going to come. Yes, make sure that we get it here in the team and myself as well. Thank you so much. Thank you. I now open the hearing for public testimony.

I remind members of the public that this is a formal government proceeding and that decorum shall be observed at all times. As such, members of the public shall remain silent at all times. The witness table is reserved for for people who wish to testify. No video recording, no photography is allowed from the witness table. Further, members of the public may not present audio or video recordings as testimony, but may submit transcripts of such recordings to the sergeant-at-arms for inclusion in the hearing record.

If you wish to speak at today's hearing, please fill out Please raise your hand, place your name on the roll, and appearance card in the back with the sergeant-at-arms and wait to be recognized. When recognized, you will have 3 minutes to speak on today's hearing topic, examining H&H NYC Care Program and access to healthcare for uninsured New Yorkers.

We will hear all in-person testimony first and then turn to testimony on Zoom. If you have a written I mean, statement or additional written testimony you wish to submit for the record, please provide a copy of that testimony to the sergeant-at-arms. I will now call the first panel. Jane Nee Carmen Garcia. Good afternoon. Thank you. Oh, they're for you to pass.

I was like, ooh. All right, I think I say lead, Jane Lee, to the next. Thank you. You may begin.

Good afternoon, Chair and council members. My name is Jane Lee, Director of Policy at the Community Healthcare Association of New York State, representing New York's federally qualified health centers. Thank you so much for the opportunity to testify. Community health centers operate nearly 480 sites across the city, including mobile sites and school-based health centers, providing essential primary and preventive care to more than 1.4 million New York City residents, no matter their insurance status or ability to pay.

We care for 1 in 3 uninsured New York City residents and 1 in 4 New York City Medicaid beneficiaries. Yet despite the critical role of health centers in the city's healthcare safety net, they are under tremendous financial strain. In 2025 alone, New York City health centers provided more than 631,000 uninsured visits, delivering approximately $92 million in uncompensated care.

And we expect these numbers to grow as the impacts of HR 1 continue to unfold. ACHIKANYI's analysis offers a sobering picture. Nearly 150,000 existing New York City health center patients could lose their health coverage. because of the new Medicaid work and community engagement requirements, with another 15,000 patients losing coverage due to essential plan changes. New York City health centers already serve 1 in 3 uninsured.

As existing patients lose coverage and newly uninsured residents turn to health centers for care, we project that the number of uninsured patients served by New York City health centers could triple. And this comes at a time when health centers are already struggling with inadequate Medicaid reimbursement Rising costs and difficult decisions to reduce services and close sites. With Medicaid as their largest revenue source, New York City health centers could stand to lose $224 million annually under HR 1.

We ask that the New York City Council accelerate the implementation of INT 1668A that was passed back in October of 2021, expanding NYC Care to include federally qualified health centers, And to dedicate resources to expanding access to affordable coordinated care. We must equip health centers with the resources needed to respond to the growing demand for uncompensated care and preserve access to essential health services.

Thank you. Additional details are included in our written testimony, and I welcome questions. I appreciate you. So you know which direction we're going. You are sitting here. We're more likely in a bit of little trouble or a pickle, that you say. Not too scary because we have organizations like yours and of course NYC Care to care, to help us.

And you came all the way from Albany to testify for us? Yes, I did. Oh my God. So we want to say thank you for traveling to come here because we do care in New York City. And we'll have a little conversation the minute I'm finished because it's not too many people. I'm so appreciative of anyone that traveled to make it their business to make sure that we address, um, the needs of the people in New York City.

And healthcare is a human right, and we all in agreement in New York City. Of course. I mean, most of us actually, because some folks don't think so. But we do. We're in majority. So we're going to make sure that people care. It's just we have to care for humans. Yes. Thank you.

Good afternoon. My name is Carmen Garcia. I'm a community health worker supervisor at Make the Road New York. Thank you, the committee and chair, for the opportunity to share about our critical work providing vital services to low-income immigrants, Black, and Latinx families in New York City who relied on H&H for their health. Make the Road is the largest grassroots organization in New York City with a membership of over 30,000 low-income New Yorkers.

We have over 25 years of experience serving New York communities of color, immigrants, and working-class families. Who were affected by the pandemic and now for the healthcare cuts from HR 1. Make the Road New York believes that everyone, regardless of immigration status, should have access to primary and preventive healthcare with dignity and without fear. We serve as New York City care navigators, helping thousands of uninsured New Yorkers access low-cost or no-cost healthcare services.

We support them through enrollment process, helping more than 120,000 enrollees so far. One example is Jose, who came to our offices feeling unwell. He knew he had elevated blood glucose levels but has not seen a primary care physician because he was uninsured. He wasn't able to qualify for health coverage. A health advocate informed him about NYC Care, assisted him with enrollment, and connected him to urgent care services at Gotham Health Clinic.

He then was very, very expressed his gratitude for the support he received during his visit. He was diagnosed with diabetes and prescribed medication to manage his condition. Recent federal funding cuts and changes to health coverage eligibility have had impact on immigrants. New Yorkers, with additional changes coming in 2027. These policies have created barriers, confusion about eligibility, and uncertainty surrounding health insurance enrollment, resulting in gaps in healthcare access for millions of New Yorkers.

Programs like NYC Care are therefore more critical than ever, ensuring vulnerable communities can continue access essential healthcare access. Make the Road New York respectfully requests $100 million annual investment in NYC Care programs to expand the program and fund CBOs to conduct outreach, education, and enrollment. This is crucial for community-based organizations to remain integral partners on outreach, education, and enrollment efforts.

This— we are trusted messengers in our communities to play a critical role in connecting eligible individuals to care. In moments when we are seeing increased ICE enforcement across our neighborhoods, fear in the immigrant community, health and hospitals must stand firm in protecting everyone who comes to the hospital. We recommend ensuring strong internal policies so ICE does not enter a hospital So this will ensure immigrants continue to feel safe accessing health and hospital facilities.

Thank you for standing up for these vital services that immigrants and working-class New Yorkers depend on.

Thank you. I want to say thank you to you and keep on fighting. We know very well how to make the road way before I was in the space. So thank you for your leadership in the work. And we appreciate you. And I'm happy that Dr. Long is still in the house listening to you, asking you for that extra thing you can do to work.

So thank you so much. Appreciate your testimony. And we make sure that we look and do what we have to do. And I have your paper and I'm in the space to bring your request. Thank you. Thank you so much. All right. Thank you. Thank you for coming out. And I'm going to come out to— in to talk to you.

Anyone else? No. All right. I still have to go through the process. Okay. Okay. All right. Thank you to all of you who came here to share your thoughts, experience today. If there is anyone in the room who wishes to speak but has not yet had the opportunity to do so, please raise your hand and fill out an appearance card with the sergeant-at-arms at the back of the room.

Seeing none, that concludes the in-person That concludes the portion of our public testimony. We will now move to the remote testimony. If you are testifying remotely, please listen for your name to be called. Once your name is called, a member of our staff will unmute you. You may then start your testimony once the sergeant-at-arms sets the clock and cues— I mean, cues you to begin.

Good afternoon. If you are on the line, if you're on Zoom, please raise your hand so we can see you. All right. If there is no one else in the Zoom who wishes to speak but has not yet had the opportunity to do so, Please use the raise hand function and our staff will unmute you. All right.

Seeing no hands, I would like to note again that members of the public can submit written testimony to testimony@council.nyc.gov within 72 hours of this hearing. Thank you. All right, seeing none, now we may conclude. Thank you for your time, everyone in the room. Thank you, thank you, thank you. We done.