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How Will Federal Medicaid Changes Affect My Health Coverage in New York?

  • November 11, 2026
    • Fact Sheet
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What is Medicaid?

Medicaid is a federal and state health insurance program for eligible low-income adults, children, pregnant individuals, older adults, and people with disabilities. Medicaid covers doctor visits, medications, hospital care, medical tests, transportation to appointments, and other services. It can also cover home care and long-term nursing care when medically necessary.

Each state runs its own Medicaid program, and coverage does not transfer between states. If you move, you must close your Medicaid case in your current state and apply in your new state. To use your benefits, show your Medicaid or managed care plan card at your doctor’s office, hospital, or pharmacy. Some services may require small copayments or prior authorizations.

Why is Medicaid changing?

In July 2025, the federal government passed a law known as H.R. 1, also called the One Big Beautiful Bill Act. The law makes significant changes to Medicaid funding and eligibility, along with other public benefit programs.

New York State is implementing these changes on different timelines. Some changes affect who can qualify for coverage, while others affect how often people must renew their coverage and what they must do to remain eligible.

To stay up to date on these changes, visit NYS of Health’s site here.

What is changing and when? 

Starting in 2026:

  • Essential coverage remains available, but the income limit is reduced. New Yorkers can still apply and remain in the Essential plan but their income has to be below 200% FPL. 
  • New Yorkers who are over the income limit for Medicaid and/or the Essential Plan may be able to enroll in Qualified Health Plan (QHP). Unlike the Essential Plan, QHPs have monthly premiums and other out-of-pocket costs. The average Silver plan costs approximately $220 per month after tax credits. Some individuals may qualify for financial assistance towards their premium. 
  • While H.R. 1 changed how much the federal government pays New York State towards the Medicaid program and its coverage of noncitizens, New York State will continue to offer health insurance coverage to all New Yorkers who are eligible. Learn more about noncitizen eligibility for Public Benefits & Medicaid here.
  • As a general reminder, all individuals are required to provide accurate information about their income, household, and where applicable, their resources when applying or renewing Medicaid coverage.

Starting January 1, 2027:

Medicaid will not offer as much retroactive coverage to pay for past medical bills

Starting on January 1, 2027, Medicaid will NOT offer as much retroactive coverage to pay for past medical bills. Here’s how the new rules will work: 

  • If you are an adult aged 19-64: Medicaid coverage can start 1 month before you apply. For example, if you are in this group and apply for Medicaid in March 2027, the state might help pay for medical bills from February if you have them.  
  • If you are aged 65 and older or disabled: Medicaid coverage can start two months before you apply. For example, if you are in this group and apply for Medicaid in March 2027, the state might help pay for medical bills from January and February if you have them.  

New York State advises residents to apply for Medicaid as soon as you think you qualify. If you wait until after a medical bill, Medicaid might not cover it.

6-Month Medicaid Renewals

Starting on January 1, 2027, some adults ages 19–64 will need to renew their Medicaid every 6 months instead of once a year. 

If you apply for Medicaid before January 1, 2027, or renew before March 1, 2027, your next renewal will be in 12 months if you remain eligible. After that, you will renew every 6 months.   

New Work Requirements for Medicaid Coverage

Starting January 1, 2027, adults aged 19-64 will be required to engage in work, education or volunteer activities of at least 80 hours per month to maintain Medicaid eligibility.

Qualifying activities include:

  • Work from a job, including self-employment and gig work;
  • SNAP-defined work program;
  • Community service; and/or
  • Part-time education (at least half time)

Individuals can also qualify by earning or receiving $580/month. To find out what kind of income will count towards the $580, review this information (scroll to the FAQ).

At renewal, NYSOH will verify compliance with Medicaid work requirements for at least one month within every six-month period.  If you are applying or reapplying, you will have to verify that you met the Medicaid work requirements the month before you applied.

Who is exempt from the Medicaid work requirements?

  • 18 years old or younger;
  • 65 years old or older;
  • A parent, guardian, caretaker relative, or family caregiver to a child under 14;
  • A parent, guardian, caretaker relative, or family caregiver to a disabled individual;
  • Pregnant or were pregnant in the last 12 months;  
  • Currently in foster care or aged out and under 26 years of age; 
    American Indian/Alaska Natives;
  • Veterans with a disability rated as total;
  • Currently incarcerated or released in the last 3 months;;
  • Enrolled or entitled to Medicare;
  • Receiving SNAP and subject to SNAP work requirements;
  • Receiving Cash Assistance and meeting their work requirements;
  • Participating in a substance abuse program;
  • Are blind or have a physical or mental health conditions that makes it hard to meet the Medicaid work requirements (to be further defined by NYS)
  • Timelimited, short term exemptions:
    • Living in a county with a high unemployment rate;
    • Living in a county impacted by a federally declared emergency or disaster; 
    • In hospital care, nursing facility, or psychiatric care; or
    • Traveling for medical care. 

I am already enrolled in Medicaid? How will I know that I have to meet the  Medicaid work requirements?

In September 2026, NYS of Health sent letters to 1.3 million New Yorkers who would be subject to the Medicaid work requirements. If you are between the ages of 19 and 64 and don’t recall receiving this letter, you can call the NYSOH Medicaid work requirements hotline 855-329-8850. You can review a sample notice here.

Temporary Assistance (Cash Assistance) will no longer be accepted as joint applications for Medicaid health insurance

Beginning January 1, 2027, applications for Temporary Assistance (Cash Assistance) will no longer be accepted as joint applications for Medicaid health insurance for most New Yorkers aged 19 to 64 years. This means that TA/CA applicants will have to apply separately for Medicaid health insurance. To get assistance with an application for Medicaid locate a navigator program, or search the directory. You can also apply directly by calling NYSOH 855-355-5777.

I already receive Cash Assistance. What will happen to my Medicaid case? 

In October 2026, NYSOH sent text messages to clients receiving Cash Assistance in NYC to notify them about changes to their Medicaid case. NYSOH will send a letter with additional information about how your Medicaid case will be moved from the Human Resources Administration (HRA) to NYSOH. Current FAQ available here.

What resource are availabile to me and where can I find more information?

Health Care Resources

Other Documents & Resources

Legal Help Resources

For free legal help, call Legal Services NYC at 917-661-4500 Monday through Friday from 9:30 a.m. to 4 p.m. Learn more about our intake process here.

* The information does not constitute legal advice. You should always consult an attorney regarding your matter. Legal help subject to capacity and location.

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