HR1, the well-documented federal healthcare overhaul signed by President Donald Trump last year, was designed to fundamentally reshape the nation’s healthcare safety net. Through new work requirements, stricter eligibility standards, and reduced federal support for states with large immigrant populations, the law has already begun pushing vulnerable communities off coverage rolls across the country.
In New York, where hundreds of thousands rely on Medicaid and Essential Plan coverage, the effects are expected to hit immigrant communities especially hard.
While much of the public attention has focused on the federal government and state lawmakers’ response, another industry pressure point is beginning to emerge quietly amongst private insurers that manage Medicaid plans.
On May 15, enrollees of Fidelis Care received notices informing them that they would no longer be eligible to receive care at Northwell Health, the largest healthcare provider in New York State. For many patients, the change threatens long-standing relationships with physicians and specialists they have relied on for years.
Historically, Fidelis Care built its reputation as a nonprofit insurer serving working-class families, immigrants, seniors, and vulnerable New Yorkers. Fidelis Care is a New York-based health insurance provider and a wholly owned subsidiary of Centene Corporation, a multinational healthcare enterprise. Centene acquired Fidelis Care in 2018, expanding its national footprint in government-sponsored healthcare programs like Medicaid and Medicare.
At the time, there was well documented concern from statewide consumer advocacy groups, as Centene transitioned Fidelis Care into a for-profit model. They warned about the actions happening today.
Following Centene’s publicly reported financial losses last year and mounting uncertainty surrounding federal Medicaid funding reductions, the insurer is making its first attempt to shift financial pressure downstream onto hospitals, providers, and ultimately the public.
As coverage instability grows, insurers managing Medicaid plans are increasingly looking for ways to control costs. And on Staten Island, the stakes are uniquely high.
Unlike other boroughs of New York City, Staten Island does not have a public hospital. Instead, three hospitals: Staten Island University Hospital (SIUH) North, SIUH South, and Richmond University Medical Center serve the entire community.
SIUH’s two hospitals are part of Northwell Health, and together serve as the borough’s largest provider of Medicaid care and treat patients who would otherwise visit a city hospital.
At the same time, Staten Island’s immigrant population has grown significantly over the last decade, particularly among West African, Latino, South Asian, and Eastern European communities. Staten Island has experienced the largest percentage increase in immigrant population of all New York City boroughs. The foreign-born population grew by 24% to approximately 122,200 residents, with the highest concentration and continuous influx settling in the North Shore neighborhoods.
Despite its reputation as New York City’s most Republican borough, Staten Island has among the highest rates of Medicaid enrollment, per capita, by congressional district in the nation. In the NY-11 district, Medicare and Medicaid patients make up 77% of all people admitted to hospitals and 70% of all outpatients provided care. 61% of patient service revenue in this district comes from Medicare and Medicaid.
Reimbursements for public insurance plans are purposesfully underpaid as a cost control measure by the government, so they do not cover the cost of care, driving significant underpayment to providers like Northwell for public insurance programs.
Community leaders say the healthcare system’s role in Staten Island extends far beyond traditional hospital care.
Imam Dr. Tahir Kukaj of the Albanian Islamic Cultural Center, which hosted a COVID-19 testing and vaccine site in its mosque, pointed to the hospital’s response during the pandemic as proof of its community commitment.
“I have witnessed firsthand the depth of SIUH’s dedication to the people of Staten Island. SIUH did not wait for vulnerable populations to find them, instead, they met our people exactly where they were, partnering directly with local faith institutions like ours to break down barriers to care,” Kukaj said.
He continued, “Staten Island is a unique, tight-knit, and generational community. Here our healthcare is deeply personal; many of our residents who choose medicine and caregiving as a profession work directly at SIUH. The hospital’s staff are our neighbors, our congregants, and our families.”
Under New York law, patients impacted by an insurer who drops a provider are protected by a 60-day cooling-off period, allowing current patients to continue treatment temporarily at Northwell facilities while seeking alternative coverage.
Still, healthcare advocates warn that the situation reflects a broader shift underway nationally: the federal government reducing its role and financial commitment, while states, hospitals, and providers are left to absorb the consequences.
State leaders including Governor Kathy Hochul and Assembly Speaker Carl Heastie have publicly acknowledged the growing pressure on New York’s healthcare system, while also warning that the state may not have the financial ability to fully backfill all federal cuts.
Assemblymember Charles Fall, who represents the North Shore of Staten Island and Lower Manhattan, said insurers cannot be allowed to shift the burden entirely onto patients and providers.
“Private insurers cannot put profits over our patients,” Fall said
The Staten Island representative said he plans to call on the New York State Department of Health and Department of Financial Services to closely scrutinize insurer behavior and network reductions affecting vulnerable communities.
“We have a responsibility to prevent this exact behavior,” Fall added. “If our community must inherit the burden and increased costs of caring for our own, then insurers must do the same.”
Add as preferred source on Google
