What’s changing with Medicaid in New York?

Changes are coming to Medicaid in New York that will affect how often you renew your coverage, whether you need to show you're working, and who qualifies for coverage at all.

These new rules won’t all start at the same time, so make sure your Medicaid office has your current mailing address and contact information so you never miss a notice about renewing your coverage and work requirements (also called “community engagement”). New immigrant eligibility rules begin in October 2026, while new work requirements begin in January 2027.

If you're on the Essential Plan, you may need to act by August 30, 2026 to avoid a gap in coverage. Here's what's changing, when it starts, and what you can do to stay covered.

What are the new rules for Medicaid in New York?#what-are-the-new-rules-for-medicaid-in-new-york

1. Work or community engagement requirements#1-work-or-community-engagement-requirements

Starting in 2027, most adults ages 19 to 64 will need to show that they’re working or doing approved activities, like going to school or volunteering, to keep their Medicaid coverage.

This is similar to, but separate from, the updated SNAP work requirements, but if you’re already meeting SNAP work requirements, you shouldn't need to provide documentation that you are meeting the Medicaid rules (if you get a request for information, you should complete it or let the agency know you’re already complying with SNAP work requirements).

You'll need to complete at least 80 hours of qualifying activities a month, or earn at least $580 in monthly income. You can also combine activities, so working part time while going to school counts too.

2. More frequent renewals#2-more-frequent-renewals

If you're in the Medicaid expansion group (which covers adults with incomes up to 138% of the federal poverty level), you'll need to renew your coverage every six months instead of once a year starting in 2027. Your exact timeline depends on when you applied or last renewed.

• If you applied for Medicaid before January 1, 2027, or renewed before March 1, 2027, you'll get 12 months of coverage if you're eligible. After that, you'll renew every six months.
• If you apply for Medicaid after January 1, 2027, or renew after March 1, 2027, you'll renew every six months if you still qualify.

3. Limited retroactive coverage#3-limited-retroactive-coverage

Previously, Medicaid could cover medical bills from up to 90 days before your coverage started once your application is approved.

Starting in 2027, the window for backdated coverage shrinks. Most adults will get one month of retroactive coverage for medical expenses before your application date.

Children, seniors, people with disabilities, and pregnant people will get two months. This means it's even more important to not let coverage lapse, and keep up with your renewals to avoid unwanted medical bills or expenses.

4. Restrictions on immigrant eligibility#4-restrictions-on-immigrant-eligibility

Some groups of immigrants who currently qualify for Medicaid will lose eligibility starting in October 2026: refugees, parolees and asylees, and domestic violence and trafficking survivors.

Other groups will remain eligible, including Green Card holders, Cuban and Haitian entrants, citizens of the Freely Associated States (COFA), and lawfully residing children and pregnant adults. If you’re an immigrant, check with your Medicaid office to confirm your status.

What’s changing with the Essential Plan?#whats-changing-with-the-essential-plan

Starting July 1, 2026, New Yorkers with incomes between 200% and 250% of the federal poverty level (about $31,920 to $39,900 a year) are no longer eligible for the Essential Plan.

If you received a notice in April that your coverage would end on June 30, 2026, you can enroll in a Qualified Health Plan with financial help. The average silver plan costs around $220 a month after tax credits.

If your income is below 200% of the federal poverty level (below $31,920 a year), this change doesn't affect you.

Pregnant enrollees stay covered no matter what. If your due date is before January 1, 2027, you'll stay on the Essential Plan. If it's after, you'll move to Medicaid. When you stay on the essential plan, copays are waived during pregnancy and for 12 months postpartum.

Who will be affected by the new Medicaid rules?#who-will-be-affected-by-the-new-medicaid-rules

Here’s who needs to be aware of the new changes to Medicaid:

• Adults ages 19 to 64 who aren’t exempt from work requirements: if you fall in this age range and don't qualify for an exemption, you'll need to meet the new work requirements starting in 2027.
• Expansion adults with new renewal timelines: If you're part of the Medicaid expansion group (adults with incomes up to 138% of the federal poverty level), you'll be renewing more often. This means more paperwork and deadlines to keep track of. Mark your calendar for renewal dates.
• New applicants and people who have to reapply will get less retroactive coverage: If you have unpaid medical bills from before you applied, a shorter retroactive coverage window means less of that will be covered.
• Certain immigrants: Refugees, parolees, asylees, and domestic violence and trafficking survivors will lose coverage fall 2026.

Who’s exempt from Medicaid work requirements?#whos-exempt-from-medicaid-work-requirements

There are two groups of people who don't have to meet the new Medicaid “community engagement” requirements.

Group 1: Permanently exempt#group-1-permanently-exempt

You're permanently exempt if you're already meeting SNAP or Cash Assistance work requirements, or if you fall into any of these groups:

• Under 18 or 65 and older
• Currently pregnant or pregnant in the last 12 months
• Enrolled in Medicaid because of a disability
• Diagnosed with a physical or mental health condition that makes it hard to work
• Entitled to Medicare Part A or enrolled in Part B
• Parent, guardian, or caregiver to a child under 14
• Parent, guardian, or caregiver to someone with a disability
• Currently in foster care, or under 26 and formerly in foster care
• American Indian or Alaska Native
• Veteran with a total disability rating
• In drug or alcohol rehabilitation
• Currently incarcerated or formerly incarcerated and released in the last 90 days

Group 2: Temporarily exempt#group-2-temporarily-exempt

You'll get a short-term exemption, until your next renewal, if you're:

• Receiving inpatient care in a hospital (including psychiatric), nursing facility, intermediate care facility, or similar setting
• Living in a county with a federally declared disaster or emergency
• Living in a county with a high unemployment rate (at least 8% or 1.5 times the national rate)

If you qualify for an exemption, you'll need to show proof when you apply or renew for Medicaid. Some exemptions (like medical frailty) may require a health screening from a doctor, or documented proof that you can’t work.

For pregnancy, you can simply declare it at application. For temporary exemptions, your state will verify your circumstances when you renew.

What do I need to do to meet Medicaid work requirements in New York?#what-do-i-need-to-do-to-meet-medicaid-work-requirements-in-new-york

You can meet the 80-hour monthly requirement through any combination of:

• Paid work of any kind
• Community service, meaning unpaid volunteer work
• Job training or work programs)
• Education (at least half-time enrollment)
• Seasonal work (if your average monthly income over the last six months equals $580)
• A combination of any of the above

You don't need traditional working hours to qualify. As long as you’re making at least $580 a month through work (or if your activities add up to 80 hours a month) you're meeting the requirement.

Timing matters too. If you're a new applicant, you'll need to show compliance for the month before you apply. If you're renewing, you'll need to show compliance for any one month within the previous six months.

Start tracking your hours or income now, even before the requirement takes effect. Get written documentation from supervisors or work contacts, and save receipts or letters showing your work or volunteer activities. You'll need this proof when you renew, or if your state asks for it.

Who is most likely to lose Medicaid?#who-is-most-likely-to-lose-medicaid

If you're between 19 and 64, don't meet the work requirement, and don't fall into an exempt group, you're at risk of losing coverage.

If New York State or HRA (for NYC residents) sends a notice saying you're not in compliance, you'll have 30 days to show you're meeting the requirement or that you qualify for an exemption. Your benefits will continue during that 30-day period. If you don't respond with documentation, your Medicaid coverage will end.

More frequent renewals also raise the risk of losing coverage by accident. Instead of renewing once a year, you'll need to renew every six months, which means more opportunities to miss a deadline. Check your mail regularly, and mark your calendar with your renewal dates as soon as your state confirms them.

People with temporary exemptions won't lose coverage until their exemption ends. As long as you renew on time and provide any required documentation, you can keep your coverage.