President Donald Trump’s “One Big Beautiful Bill Act” (OBBBA) has passed the Republican-controlled House and is now awaiting a vote in the Senate. If enacted, the bill could have sweeping effects on Medicaid nationwide—particularly in states like New York, where a large portion of the population depends on the program for healthcare. Some of the biggest introductions individuals can expect are a new strict work requirement, the removal of coverage for gender-affirming care for transgender individuals, and the implementation of frequent eligibility checks that can clog up your inbox and delay the care you deserve.
Below is a comprehensive overview of the major changes residents in New York can face if this legislation is signed into law.
Individuals Under Age 65
This group of individuals will experience the most significant changes under the new legislation, with perhaps the greatest change being the introduction of new work requirements: to maintain Medicaid coverage, adults aged 19 to 64 are required to work or participate in community service for at least 80 hours per month. Failure to meet this requirement may result in the termination of benefits. While exemptions are available for individuals who are pregnant, have disabilities, or serve as caregivers, the authority to grant these exemptions ultimately rests with the state, creating ambiguity in how the policy is applied.
The bill also mandates much more frequent checks for individuals. New York will be required to verify a person’s citizenship within a specified time frame; additionally, the state must regularly collect updated address information and other key identifiers, such as Social Security numbers. Eligibility redeterminations must be conducted every six months to ensure continued qualification. Although this will prove especially difficult for non-citizens, the excessive paperwork can hinder enrollment and increase the likelihood of losing coverage if certain deadlines are missed.
Medicaid currently allows for retroactive coverage of medical expenses that occurred up to three months before the application date, and in New York, you are required to request for this coverage when applying. However, under this bill, the window for reimbursement will be shortened to one month, limiting the past care that can be reimbursed. The OBBBA will also introduce changes to copays for those covered by Medicaid expansion: while you won’t have to pay monthly premiums, certain services will require out-of-pocket payments capped at $35. Services such as emergency care, pregnancy care, mental health treatment, abuse support, and primary care will remain free, but fees may be introduced for other services.
Funding for gender-affirming care (also referred to as 'gender transition procedures') will be banned from Medicaid, potentially limiting access to necessary healthcare for transgender individuals. Furthermore, the bill seeks to incentivize states like New York to stop using state funds to provide health care to undocumented immigrants by reducing the federal Medicaid funding from 90% to 80%. As a result, New York may be forced to shrink its health services for these individuals.
Individuals Over Age 65
Seniors living in New York will not be required to meet the 80-hour work requirement. However, they will still be subject to strict enrollment requirements, reduced retroactive coverage, and changes to Medicaid benefits. While monthly premiums will be eliminated, copays for expansion individuals will be capped at $35. Additionally, Medicaid funding will no longer be available for gender-affirming care. Overall, shrinking Medicaid funds for the state may lead to reduced or shifted services.
Impact on New York
If the bill is passed, an estimated 1.5 million residents across the state, including 800,000 in New York City, could lose their health insurance, as the city stands to lose over $3 billion in federal funding. With resources no longer being properly allocated, many rural hospitals may be forced to close. Consequently, it is important to take action now and ensure that your coverage is secure.
Looking Ahead: What This Means for You
House Speaker Mike Johnson has announced that the target date for passing President Trump’s proposed bill is July 4th, 2025. As this legislation looms ahead, individuals and their families must prepare for potential changes that may follow. The One Big Beautiful Bill Act could significantly alter Medicaid’s current access and affordability, which may, in turn, impact your life.
If you’re planning to apply for Medicaid, you should do so immediately to ensure your eligibility. For seniors who hope to avoid placement in a nursing home, early planning is particularly important, as arranging for home care aid can help ensure that you remain in control of your future living situation. To apply, you must first gauge your eligibility through the Modified Adjusted Gross Income (MAGI) rules, which will then allow you to submit your application to the correct organization, whether that be the NY State of Health, a Managed Care Organization (MCO), or more. For more information or if assistance is needed, it is recommended that you contact a trusted Medicaid planning expert, such as Inna Fershteyn, to ensure you receive your healthcare before it is too late.
It is also suggested that you take further steps to help safeguard your wealth, through asset protection strategies like establishing irrevocable trusts and transferring assets into wills. Effective estate planning can support your future aspirations and ensure that your generational wealth is preserved.
It can be difficult to navigate the complexities of how these upcoming policy changes may impact your family. It is recommended that you consult with a professional to make well-informed decisions tailored to your unique situation. Should you have any further questions or require assistance, please do not hesitate to contact the Law Office of Inna Fershteyn at (718) 333–2394.
FAQs
1. Will Medicaid coverage be taken away under these new rules?
Yes. It is estimated that approximately 1.5 million residents will lose their Medicaid coverage due to the new work requirements, stricter eligibility criteria, and overall funding cuts. Additionally, experts have predicted that the bill could lead to hospital shutdowns in rural areas, potentially leaving thousands of individuals without access to critical medical care.
2. Will these rules affect people who are currently receiving Medicaid home care in New York City?
Yes. As Medicaid home care programs rely partially on federal funding, the proposed slashes in funding can lead to longer wait times, fewer home health aides, and a decrease in the quality of service received by elderly recipients.
3. Is this bill already law, or can it still be changed?
While the bill has already passed the House, it is not yet law, as it is still in limbo in the Senate. The Senate has the ability to make amendments or block the bill entirely. Consequently, it is important to monitor new updates on the bill’s progress and its future.
4. What should I do now if I’m on Medicaid or plan to apply?
If you are planning to apply for Medicaid, it is recommended that you do so as soon as possible. If you’re currently on Medicaid, make sure to gather the necessary documentation to verify your eligibility, prepare for the new 80-hour work requirements, and stay up-to-date on enrollment deadlines. Please contact the Law Office of Inna Fershteyn at (718) 333–2394 for any guidance.
5. Will New York State try to challenge or delay these changes?
Democratic legislators in New York State are actively opposing the changes proposed by the bill. If the bill is passed, they will likely try to leverage state-level protections (such as lawsuits and alternative funding methods) to mitigate its effects, though it is uncertain how effective these solutions may be.
