06/04/2026
Big Changes to Medicaid- What you need to know and about the Essential Plan and turning 18 on SSI
What Happened and What It Means for New York
Shared for Our Community | June 2026
Please read this. It may affect you.
The rules for Medicaid are changing. Many people who still qualify could lose their health coverage just because they miss a letter or some paperwork. We do not want that to happen to you. Please read this, share it with your family, and take the simple steps at the end.
What Happened
On July 4, 2025, a new federal law was signed. Its full name is the One Big Beautiful Bill Act. Most people just call it the new health law.
This law made the biggest cuts to health programs in our country's history. It cut close to one trillion dollars from Medicaid over the next ten years. That is a huge amount of money. Experts believe that somewhere between 10 and 17 million Americans could lose their health insurance because of it.
Here is the part many people miss: Medicaid is paid for by two groups working together, the federal government and each state. When the federal government sends less money, the state is left to fill the gap. New York now has to make hard choices: find new money, cut services, change who qualifies, or pay hospitals and clinics less.
The law does not get rid of Medicaid. But it changes three big things: who qualifies, how often you must prove you qualify, and how much money the state gets to run the program. Any one of these can affect whether you keep your coverage and whether your doctor's office or clinic stays open and able to see you.
We are sharing this now for one simple reason. People often think a change like this will never reach them. Then a letter comes, a deadline is missed, and the coverage is gone. We do not want anyone in our community to be caught by surprise.
The Four Big Changes
1. Work Rules (Starting January 1, 2027)
If you get Medicaid through the expansion program and you are between 19 and 64 years old, you will have to show that you do at least 80 hours each month of one of these things:
• A job (one or more jobs counts)
• Job training or a work program
• School or job classes, at least half time
• Volunteer work or community service (you must keep proof)
Eighty hours a month is about 20 hours a week. You will have to send in paperwork to prove it. If you do not, you can lose your coverage even if you are doing everything right.
2. Checking In More Often (Starting December 2026)
Right now, most people only have to prove they qualify for Medicaid once a year. Starting in December 2026, people in the expansion program will have to do it twice a year, every six months.
That means more letters, more income checks, and more paperwork. If you miss one of these letters, even when you still fully qualify, you can lose your coverage. This is the most common way people lose Medicaid: not because they don't qualify, but because they missed a letter.
3. Changes for Some Immigrants (Starting Fall 2026)
The law makes the rules tighter for some immigrants who are here legally. Some people who used to qualify for Medicaid will no longer qualify starting in the fall of 2026. This includes some green card holders in their first five years here. In some cases it also affects the children's health program.
New York has a large number of immigrant neighbors on Medicaid, so this is an important change for our community to understand. We should make it clear that Our immigrant neighbors are not a drain on New York. They help pay for it. Immigrants in New York State pay about 24 billion dollars a year in state and local taxes, and roughly 61 billion dollars a year once you count federal taxes too. There are about 4.4 million immigrant residents in the state, with around 138 billion dollars in spending power that goes right back into local businesses. Most of these taxpayers are here legally, including green card holders, visa holders, and people who have become citizens. Undocumented immigrants alone pay about 3 billion dollars a year, a small part of the total. In plain terms, the very people this law puts at risk are people who pay into the system year after year.
4. Less Money for Hospitals and Clinics (Starting 2027 to 2028)
The state will lose a lot of the money it used to send to hospitals and clinics. When hospitals and clinics get paid less, some may decide to take fewer Medicaid patients, or cut back on services. This change comes a little later, but it is one to watch closely.
This Was Tried Before, Here's What Happened
These rules may sound fair on paper. But we do not have to guess how they will work, because some states already tried them. The results were not good.
Arkansas
Arkansas was the first state to try work rules, back in 2018. In just a few months, about 18,000 people lost their Medicaid, nearly 1 in 4 of the people the rule applied to.
Here is the part that matters most: studies later showed that more than 9 out of 10 of those people already met the rules or should have been excused. They lost coverage anyway. Why? Many never knew about the rule, got confused by the website, or missed the paperwork. The rule did not get more people working, it just took health coverage away from people who already qualified. Many of them ended up with no insurance at all, and some fell into medical debt.
Nebraska
Nebraska started its work rules on May 1, 2026, the very first state to do it under the new law, months before it was even required. About 70,000 people in Nebraska have this kind of Medicaid. Experts warn that tens of thousands could lose coverage, again mostly from paperwork and confusion, not because they don't qualify.
The Truth About Who Is on Medicaid
There is a common belief that lots of people on Medicaid are cheating the system or just don't want to work. The facts say something very different. Study after study shows that the great majority of adults on Medicaid, around 9 out of 10, are already working, or are in school, caring for family, or have a health condition that excuses them.
In other words, there is very little fraud in Medicaid. So a work rule does not really catch people who are gaming the system, because there are very few of them. What it actually does is create a pile of new paperwork that trips up honest people who already qualify. That is the real risk for our community, good people losing coverage by accident.
What This Means Here in New York
New York runs one of the largest Medicaid programs in the country, covering about 6.9 million people.
New York is one of the states that expanded Medicaid years ago. Because of that, all four of the changes above apply to us. But New York's biggest problem is money.
Over the next ten years, New York is set to lose about 63 billion dollars in Medicaid funding. That is the second largest loss of any state in the country, only California loses more.
Why so much?
It is not mainly about who qualifies. It is about how New York pays its hospitals and clinics. New York uses special funding tools to help pay for care, and the new law cuts those tools back. When that money shrinks, the hospitals and clinics that treat Medicaid patients feel the squeeze. And usually, special or harder to find care is the first to feel it.
So for New York, the danger has two parts. First, the new paperwork, the work rules and the renewals every six months, could cause people to lose coverage by accident. Second, even people who keep their coverage may find it harder to get care if their clinic is under money pressure.
New York at a Glance
Question
New York
Did NY expand Medicaid?
Yes
Money we will lose over 10 years
About $63 billion, second most in the country
Main concern
Big cuts to the money that pays hospitals and clinics
Who is affected
Adults 19 to 64 in the expansion program face new work rules and check ins every 6 months
Bottom line
Most people who lose coverage will lose it from missed paperwork, not because they no longer qualify
One More New York Change: The Essential Plan
There is another change happening in New York that is not Medicaid, but it affects many of the same families, so we want you to know about it. It is called the Essential Plan.
The Essential Plan gives free or very low cost coverage to about 1.7 million New Yorkers who do not get insurance through work and do not qualify for Medicaid. For years it covered people earning up to 250 percent of the federal poverty level. Because of the same federal law described above, New York is lowering that limit to 200 percent, starting July 1, 2026.
Here is what that means in plain terms. If your income is above 200 percent of the federal poverty level, which is roughly a bit over 31,000 dollars a year for one person and higher for a larger household, you may no longer qualify for the Essential Plan. As many as 450,000 New Yorkers are expected to lose Essential Plan coverage and be moved into a marketplace plan.
This is the part to watch. A marketplace plan can cost more each month and carry higher out of pocket costs than the Essential Plan. Most people will not lose coverage completely, but the plan they move to may be more expensive. About 1.3 million New Yorkers will still keep the Essential Plan.
What to do: keep your income, household size, and contact information up to date in your NY State of Health account at nystateofhealth.ny.gov, or call NY State of Health at 1-855-355-5777. Watch for any notice that your coverage is changing. If you get one, start looking at marketplace options early, and ask for free help rather than sorting it out alone.
Good News: Not Everyone Is Affected
The work rules and the check ins every six months only apply to adults in the Medicaid expansion program. They do NOT apply to these groups:
• Children under 18
• Pregnant women, and new mothers for up to 12 months after the baby is born
• People on Medicare (including people who have both Medicare and Medicaid)
• People in regular Medicaid (not the expansion program)
There are also exceptions for people who cannot work because of a health condition or disability, people caring for a young child or a disabled family member, and several other groups. If this might be you, it is worth asking your Medicaid office how to prove it. You will probably need a note from your doctor.
Not sure which program you are in? Check your Medicaid approval letter or renewal letter, or log in to your New York Medicaid account online. If you are unsure, call the New York Medicaid number at the end of this letter and ask.
A Note for Families With a Child on SSI or Children's Medicaid
If your child gets SSI or Medicaid as a child with a disability, there is an important review that happens when they turn 18. It is not new, but it catches many families by surprise, so it belongs in this letter.
When a child on SSI turns 18, Social Security reviews their case as if they were applying as an adult for the first time. This is called the age 18 redetermination. The catch is that the adult rules for disability are stricter than the rules used for children. Roughly a third or more of young people lose their SSI at this review. And because Medicaid often comes automatically with SSI, losing SSI can mean losing that Medicaid too.
You will usually get a written notice from Social Security around the time your child turns 18. Do not wait for it. Start getting ready before the birthday.
A few things that help:
• Gather your child's medical records and doctor's reports now.
• If your child is in school, job training, or vocational services, tell Social Security. There is a protection called Section 301 that can keep benefits going for young people ages 18 through 21 who stay in an approved program.
• If the decision goes against you, you can appeal. If you appeal quickly, usually within 10 days of the notice, benefits can keep coming while you wait for the answer.
• For children's Medicaid, you will also get a renewal notice as your child nears 18, and the state will check whether they still qualify as an adult. Open it right away and respond before the deadline.
How to Protect Your Coverage: Simple Steps
Remember the most important fact: most people who lose Medicaid lose it because they missed a letter, not because they stopped qualifying. These steps are here to keep that from happening to you.
1. Find out which Medicaid program you are in. Check your letters or your online account. If you are not sure, call and ask. This tells you whether the new rules even apply to you.
2. Update your address and phone number today. This is the single most important thing you can do right now. All the important letters get mailed to the address the state has on file. If that address is old, you will never see the letter, and you can lose coverage even though you still qualify. Log in to your New York Medicaid account, or call, and make sure your address, phone, and email are correct. Sign up for text or email alerts if they offer them.
3. Open every letter the moment it arrives. Do not set it aside. Read it right away, or ask a family member or friend to help. Do what it asks before the deadline. Keep a copy of everything you send in.
4. If you have a health condition, gather your papers now. If a health problem keeps you from working, ask your doctor for a short letter that explains it. Having it ready means you can answer quickly if you are asked.
5. If you get a notice that you may lose coverage, do not panic, and do not ignore it. Your coverage is usually not cut off right away. The notice will give you a window of time, often about 30 days, to respond and prove you still qualify before anything actually changes. Send in your paperwork before that deadline and you can stay covered. If your coverage is being ended, you also have the right to appeal (sometimes called a fair hearing). In most cases you must ask within 30 to 90 days of the notice, and while you wait for the answer you may be able to keep your coverage, so ask. You can also apply for Medicaid again at any time.
6. If you cannot get Medicaid, look at other options. You may qualify for a low cost plan through the health insurance marketplace. If you just left a job, you may be able to keep your old work plan for a while. Call the New York Medicaid office and ask what is available to you.
Who to Call in New York
To update your information, ask about your coverage, or get answers about the new rules, contact New York Medicaid:
Phone: 1-800-541-2831
Website: health.ny.gov/medicaid
You do not have to figure this out alone. If you have questions or need a hand, reach out, we are neighbors helping neighbors.
About this letter
This letter was prepared using public research from groups that study health policy, along with state Medicaid information. It is for general information only and is not legal or medical advice. Medicaid rules can change. Always check your own situation with the New York Medicaid office. June 2026.
Information about Medicaid, including what it is and who qualifies for it.
