Three Questions About Medicaid for New York Officials

What will the Essential Plan look like this year, and how will the state fund the program?

Some federal funding for the program expired on January 1, leaving the free or low-cost health care plan in financial limbo.

In September, the state sought federal approval for a change to the Essential Plan that could save coverage for an estimated 1.3 million New Yorkers, but it has yet to receive it. The state had anticipated a decision by the end of 2025, but November’s government shutdown has led to an indefinite delay. It’s unclear what will happen if the Trump administration rejects the proposal.

When New York Focus asked about a backup plan last month, state health officials said only that they continue to wait for a decision from the federal government.

Even if New York’s maneuver to revamp is successful, hundreds of thousands of New Yorkers would lose coverage under changes to the plan’s eligibility guidelines as soon as July. Health care advocates have pointed out that with premiums on the rise, many of those residents would not be able to afford coverage through the state’s health care exchange.

Does the state have a plan to offer coverage to New Yorkers excluded under new federal eligibility guidelines?

Come October, federal funding for certain immigrant populations will be pulled back. And in 2027, new Medicaid work rule requirements will go into effect, threatening coverage for an estimated 500,000 to 1.2 million New Yorkers.

“Denying health insurance to this population will not cause their healthcare costs to simply disappear,” wrote Michael Kinnucan, from the left-leaning Fiscal Policy Institute, in a briefing. “Thus, the policy question confronting New York is not really whether to increase state health spending to compensate for federal cuts, but how to do so.” 

State Senator Gustavo Rivera is once again backing the New York Health Act, a decades-old proposal that seeks a state-run, single payer health care system. Health care advocates are also urging the state to consider alternatives such as state-funded premium assistance programs and extending coverage to newly excluded immigrants.

How will the state ensure treatment options are accessible to as many New Yorkers as possible?

Medicaid cuts are projected to disproportionately impact health care facilities that primarily serve low-income patients, such as safety net hospitals and substance abuse treatment centers. That could worsen existing racial and geographic disparities in health care access throughout the state.