Enacts the "Give Kids a Chance - Carter and Ray's Law"; mandates health insurance coverage for congenital anomalies

• Democratic2

◆ The sponsor's argument

Why Sam Sutton says this is needed

For every 38 babies born in New York State one is diagnosed with a congenital anomaly. There are a variety of different congenital anoma- lies New York's children are born with, ranging from atrial septal defect with 11,316 cases annually to trisomy 21 with 2,790 cases annual- ly. Two of the most commonly recognized congenital anomalies are cleft lip and cleft palate. A child would be diagnosed with cleft lip and/or cleft palate where the child is born with an unclosed lip and/or with an unclosed roof of the mouth. Basically, there is a gap in facial struc- ture due to incomplete fusion of skin, muscle and bone. This defect occurs during fetal development. Uncorrected, the defect causes severe eating, breathing, speaking and hearing difficulties and presents gross facial deformities. With appropriate surgical treatment, bone grafts, orthodontic, prostho- dontic and dental treatment as well as speech, physical and occupational therapies, individuals can gain nearly full function and approximate normal facial appearance. There is currently no New York State require- ment for full coverage (medical, dental and related therapies) for-cleft lip, cleft palate or any other congenital anomaly. Currently, health insurance coverage varies by insurer both as to what is offered and as to how coverage is applied when covering costs related to congenital anomalies. While initial surgeries to close the structural gap for cleft lip and/or cleft palate are often covered, subsequent surgeries, bone grafts, follow up treatment and orthodontic, prosthodon- tic and related care are often not covered at all, are severely restricted in coverage or are subject to individual negotiation or confrontation with insurers. This lack of coverage consistency is the same when dealing with other congenital anomalies. For example, a 6 month old male with sagittal craniosynostosis (premature closing of a baby's skull) who had to wear a prescribed helmet to protect post-operative treatment was denied cover- age for a second helmet as he continued to grow. New York law should be clear, comprehensive and consistent. This is a matter of fairness to the citizens of, New York. Children should be covered for all procedures and therapies from infancy until they are no longer eligible to be covered on their parents' health insurance. Correcting this gap in insurance coverage would provide a prudent investment in our most important resource: our children. Passage of the bill would also provide equity to insurers who are now forced to compete with each other on a field where they are forced to guess how their competitors will apply coverage for congenital anomalies. Other states currently mandate comprehensive coverage for all congenital defects diagnosed by a doctor. Among them, Louisiana, Colorado, New Hampshire, Indiana, and North Carolina have laws specifically requiring comprehensive coverage for any congenital anomaly. New York should join these states and make sure everyone receives comprehensive coverage.

This is the sponsor's own case for the bill, quoted from their memorandum. It is not Agora's description of what the bill does.