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Essential Plan Changes (Effective July 1, 2026)
New York is ending the Essential Plan (EP) coverage for individuals with incomes between 200% and 250% of the federal poverty level, effective June 30, 2026, due to federal policy changes. Starting July 1, 2026, people in this group will no longer be eligible for the Essential Plan and will instead be automatically evaluated for other coverage options, most commonly Qualified Health Plans (QHPs) with financial assistance, or Medicaid if eligible. No new enrollments in this category will be allowed after the end date. Some individuals, such as pregnant or postpartum members, may temporarily remain in the Essential Plan or transition to Medicaid depending on their circumstances. For DACA recipients, those who are pregnant will transition to Medicaid, while those who are not pregnant and do not qualify for Medicaid may lose eligibility for coverage entirely. Affected members will receive notices in April and May 2026 explaining their new eligibility and next steps. As people transition to new coverage, insurers are expected to help minimize disruption by prorating cost-sharing and, where possible, carrying over certain out-of-pocket costs.
Medicaid Changes in New York (Effective January 1st, 2026)
Starting January 1, 2027
What You Need to Know
Some New Yorkers with Medicaid will need to meet new work or activity requirements to keep their health coverage.
This is part of a new federal rule called Medicaid Work Requirements.
What Are the Requirements?
If this applies to you, you must complete:
At least 80 hours per month of approved activities:
- Working (paid job)
- Going to school (half-time or more)
- Job training programs
- Volunteering
- Or a combination of these
Will This Affect You?
Many people do NOT need to meet these requirements.
You may be exempt if you:
- Are under 18 or 65+
- Are pregnant or recently pregnant
- Have a disability or health condition
- Are a caregiver
- Have Medicare
- Receive SNAP or TANF (and meet their rules)
- Are in substance use treatment
- Are a disabled veteran
You may need to show proof of your exemption.
What Should You Do Now?
Update Your Contact Information
Make sure New York State can reach you with important updates.
You can:
- Log into your account at NY State of Health
- Call customer service
- Get help from an enrollment assistor at NSHC
Stay Covered
Before 2027, you’ll get instructions explaining exactly what to do.
Watch your mail, email, and phone messages.
Frequently Asked Questions (FAQs)
1. What happens if I don’t meet the requirements?
If you’re required to participate and don’t complete 80 hours/month, you could lose your Medicaid coverage.
2. When do these changes start?
These rules begin January 1, 2027.
3. Do I need to do anything right now?
Not yet, but you should update your contact information now so you don’t miss important notices.
4. How do I prove I qualify for an exemption?
You may need to provide documents during your Medicaid renewal, such as:
- Medical records
- Proof of caregiving
- Enrollment in SNAP/TANF
5. What counts as “work activities”?
Approved activities include:
- Paid employment
- School attendance
- Job training
- Volunteering
6. Where can I get help?
Free help is available through:
- NY State of Health
- Enrollment assistors at NSHC
- Local social services offices