Single Source Procurement: New York State of Health-Simulation Modeling

The New York State Department of Health (NYSDOH) received approval of a Contract Reporter Exemption Request for a 12 month time extension of Contract C028195 with the Urban Institute from April 1, 2015 – March 31, 2016. The additional time is required for the Urban Institute to continue their simulation modeling primarily for the purpose of:

  • Updating the modeling to take into account the strides that NY State of Health has made in enrolling over 2 million people including the nearly eighty-eight percent who reported being uninsured at the time they applied for coverage;
  • Assessing the impact of any potential changes to the provisions of the Affordable Care Act (ACA) including issuance of federal rules as well as the impact, if any, of court rulings and policy options available to the state; and
  • Assessing the impact of the implementation of the Basic Health Program (BHP) which is a state option under the ACA for individuals up to 200 percent of the Federal Poverty Level. The Basic Health Plan was enacted into state law as part of the SFY 2014-15 budget and is scheduled for implementation on January 1, 2016.

Factors outside of the control of the Department, most notably delays in issuance of federal rules and guidance, and a federal rule repositioning of the second open enrollment period from October 2014 through December 2014 to November 2014 through February 2015 did not allow timely completion of the awarded tasks during the current contract period. The services provided by The Urban Institute through this contract are essential to understand the impact that implementation of the ACA has had in the state as well as gaining an understanding of those who remain uninsured either because they did not enroll or because they do not meet the requirements of the ACA. Throughout the implementation and operation of the Marketplace, the Department and stakeholders have relied on the modeling performed under this contract for planning purposes and to measure the performance of New York's implementation of the ACA against expected outcomes.

The NY State of Health must be positioned to quickly assess the New York State specific impact of any and all changes to provision of the federal law, federal rules and guidance yet to be issued by HHS. The potential that such actions could shift the way individuals would enroll in coverage inside and outside the Marketplace, and the resulting potential impact on the costs of coverage, make it critical that the State quickly assess and understand consequences of these changes and the various policy options available to the state.

The Urban Institute's Health Insurance Policy Simulation Model (HIPSM), which was developed specific to New York State, examines the impact of the federally enacted health reform options and federal and other changes that occur subsequent to enactment. The work performed by The Urban Institute under this single source contract provides the estimated cost and health insurance coverage impact of the ACA, which is necessary to inform on-going policy decisions about the design of New York's Marketplace. The Urban Institute is uniquely positioned to assist New York with these tasks based on their prior work related to the state's implementation of the ACA. By building on the modeling done to date, The Urban Institute can perform these services more cost-effectively than any other entity that can be identified.

Procurement / Program Name New York State of Health-Simulation Modeling
Contractor Name(s) The Urban Institute
Contract Period 4/1/15 – 3/31/16
Contract Number(s) C028195