The US health system does not provide health care to the country's entire population.[1] Instead, most citizens are covered by a combination of private insurance and various federal and state programs.[2] Health insurance was most commonly acquired through a group plan tied to an employer.[3]
Essential health benefits (EHBs) are required for non-grandfathered individual and small group plans, meant to reflect benefits typically included in large employer-sponsored plans, but are not state-mandated for fully-insured large employer plans and do not apply to self-insured ERISA (often large employer) plans.[4][5] Since a majority of New Yorkers are enrolled in self-insured ERISA plans, EHBs cover a small minority of New Yorkers.[citation needed] There are no minimum coverage standards for dental plans, and routine adult dental services are not considered EHBs.[6][7] New York has enacted additional mandates that exceed federal EHB requirements, for example Timothy's Law requires that all fully-insured plans provide comparable coverage for mental health services as they do for physical health services to ensure mental health parity, including for substance use disorders.[8][9] Self-insured ERISA plans are exempt from state insurance mandates due to federal preemption but are subject to federal requirements like the Mental Health Parity and Addiction Equity Act.[10]
The Essential Plan offers essential health benefits for non-Medicaid-eligible residents with up to 250% of federal poverty level incomes with minimal or $0 monthly premiums and nominal or $0 copays.[19][20] It is the state implementation of the Affordable Care Act Basic Health Program. Its benefits include (but are not limited to) dental, vision, inpatient and outpatient hospital care, prescription drugs, and free preventive care like routine exams and screenings.[19]
The Centers for Disease Control and Prevention describes the public health infrastructure as three components: workforce capacity and competency: the recruitment, continuing education, and retention of health professionals; organizational capacity: the consortium of public health agencies and laboratories, working with private and nonprofit organizations; and information and data systems: the up-to-date guidelines, recommendations and health alerts, and the information and systems that monitor disease and enable efficient communication.[21]
New York State relies on a county-based system for delivery of public health services.[22] The New York State Department of Health promotes the prevention and control of disease, environmental health, healthy lifestyles, and emergency preparedness and response; supervises local health boards; oversees reporting and vital records; conducts surveillance of hospitals; does research at the Wadsworth Center; and administers several other health insurance programs and institutions.[22] 58 local health departments offer core services including assessing community health, disease control and prevention, family health, and health education; 37 localities provide environmental health services, while the other 21 rely on the state's Department of Health.[22]
At the local level, public health workers are found not only in local health agencies but also in private and nonprofit organizations concerned with the public's health.[21] The most common professional disciplines are physicians, nurses, environmental specialists, laboratorians, health educators, disease investigators, outreach workers, and managers, as well as other allied health professions.[21] Nurses represented 22% of the localities' workforce (and 42% of full-time equivalent workers in rural localities), scientific/investigative staff represented 22%–27% of the workforce, support staff represented 28%, education/outreach staff represented 10%, and physicians represented 1%.[22]
Hospitals
A general hospital is a standard acute-care hospital with inpatient beds and 24/7 physician coverage.[23]
A psychiatric hospital is explicitly excluded from the definition of a hospital.[24] As more psychiatric emergencies are being pushed into emergency departments, many patients are "boarded" (held after a decision to admit/transfer) for hours to days.[25]Comprehensive psychiatric emergency programs (CPEPs) are meant to provide a single entry point for psychiatric emergencies, including crisis intervention in an emergency room setting, mobile crisis outreach, crisis residence beds, extended observation beds (up to 72 hours), and triage/referral.[26][27]
The American Hospital Directory lists 261 active hospitals in New York State in 2022. Two hundred and ten of these hospitals have staffed-beds with a total of 64,515 beds. The largest number of hospitals are in New York City.[28] The January 1, 2022 listing by the New York Health Department of general hospitals covered by the New York Health Care Reform Act show 165 hospitals 63 closed hospitals, and 51 hospitals that had been merged with other hospitals.[29] The oldest hospital in New York State and also oldest hospital in the United States is the Bellevue Hospital in Manhattan, established in 1736. The hospital with the largest number of staffed beds is the NewYork-Presbyterian Hospital in Manhattan with 2,678 beds in its hospital complex.
An adult home is a type of ACF that provides non-medical, long-term residential care—including room, board, personal care, and supervision—to five or more adults who are not related to the operator.[31][32] Adult homes are regulated by the Department of Health.[36] A transitional adult home, sometimes referred to as an impacted adult home, is an adult home with a capacity of at least 80 beds where at least 25% of residents have a serious mental illness (SMI).[37][38] An assisted living residence (ALR) is a licensure category created in 2004 to standardize the use of the term "assisted living" and establish consumer protections.[39] An assisted living program (ALP), established earlier under Medicaid waivers, enable ACF residents to receive Medicaid-funded home care services.[40] Facilities with at least 55% ALP beds are excluded from Justice Center oversight, much like nursing homes, but are otherwise little different from regular adult homes.[41][42] Many facilities operate both ALRs and ALPs concurrently.
A family type home is a type of ACF that provides non-medical, long-term residential care to four or fewer adults.[43] Family-type homes are regulated by the Office of Children and Family Services.[36]
Nursing homes
A residential health care facility (RHCF) is a nursing home.[44] RHCFs are residential care facilities providing medical, long-term residential services to adults who are substantially unable to live independently, with clinical-level staffing and oversight. RHCFs are mostly funded through Medicaid.[45]
Public health
Immunization
Licensed pharmacists with a certificate of administration, and certified pharmacy interns under certified pharmacist supervision, can administer vaccines under physician or nurse practitioner prescriptions or standing orders.[46][47][48][49]Nurse practitioners can issue prescriptions or standing orders to pharmacists, and standing orders to registered nurses to execute.[50] Certified pharmacists may immunize adults against influenza, pneumococcal, zoster, hepatitis A/B, HPV, MMR, varicella, COVID-19, meningococcal, tetanus/diphtheria/pertussis, and additional ACIP-recommended immunizations authorized by the commissioner, and may immunize minors (ages 2–17) only against influenza.[48] In September 2025, the governor issued an executive order temporarily authorizing pharmacists to prescribe and administer COVID-19 vaccines, and physicians or nurse practitioners to prescribe and issue standing orders, for patients aged 3 and older.[51]
Map of Nurse Licensure Compact states. US nurses are not allowed to practice in New York without more.
NLC member
New York funds graduate medical education (GME) through the Department of Health with hospital rate add-ons, HCRA-based GME and professional education pool supplemental payments, and administering programs like Empire Clinical Research Investigator Program (ECRIP) and Doctors Across New York (DANY).[54][55][56][57] New York accounted for nearly half of the nation's total state Medicaid GME spending—$1.82 billion of the total $3.87 billion in 2012—and more than 10 times any other state.[58]
↑ Access to health care in America. Institute of Medicine, Committee on Monitoring Access to Personal Health Care Services. Millman M, editor. Washington: National Academies Press; 1993.
↑ Committee on the Governance and Financing of Graduate Medical Education; Board on Health Care Services; Institute of Medicine (24 October 2014), "GME Financing", Graduate Medical Education That Meets the Nation's Health Needs, PMID25340242, WikidataQ95619477
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