Last updated: May 22, 2026 | By Inna Fershteyn, Esq. | Reading time: ~9 minutes
Several federal and New York changes are reshaping Medicaid and Essential Plan eligibility through 2026 and into 2027, following the passage of the One Big Beautiful Bill Act (H.R.1). The most significant changes include new work requirements for adults receiving Medicaid, shorter renewal cycles, the end of the Essential Plan 200–250 tier, and updated eligibility rules for some immigrant categories. This article explains what is changing, who is affected, and what individuals and families should do now to keep their coverage.
Key facts at a glance
- June 30, 2026: Essential Plan 200–250% FPL coverage ends; affected enrollees must transition to other coverage.
- September 1, 2026: Notices about new work requirements mailed by the New York State of Health.
- October 1, 2026: Updated immigration-based Medicaid eligibility rules take effect.
- January 1, 2027: New work requirements for some Medicaid recipients begin.
- March 1, 2027: Renewal-cycle rule begins applying after this date for some adults aged 19–64.
- Who is affected: adults 19–64 on Medicaid (with exceptions), Essential Plan members in the 200–250% FPL band, and certain immigrant categories.
What Are the New Work Requirements for Medicaid Eligibility?
Starting on January 1, 2027, some adults in New York who receive Medicaid will need to meet new work requirements for Medicaid coverage. The requirement is generally 80 hours of approved activities each month, or at least $580 in monthly earned income. The approved activities include:
- Working at least 80 hours a month at a paid job
- Going to school at least half-time
- Joining a job training or work program
- Volunteering or helping out in the community
- A combination of the above activities also satisfies the requirement
People who will be affected by these new requirements are expected to receive a notice by mail or email from the New York State of Health by September 1, 2026.
Who is Exempt From the New Work Requirements?
These new requirements generally apply to adults with Medicaid coverage, with several categories of exceptions:
- People ages 18 or younger
- People ages 65 or older
- Pregnant individuals, or individuals who were pregnant in the last 12 months
- People enrolled in Medicaid with a disability
- People diagnosed with a physical or mental health condition that makes it hard to work
- People entitled to or enrolled in Medicare Part A or enrolled in Medicare Part B
- American Indians or Alaska Natives
- Parents, guardians, or caregivers of a disabled individual
- Parents, guardians, or caretakers of a child under 14
- People in a SNAP household who are subject to SNAP work requirements
- People enrolled in TANF and meeting TANF work requirements
- People in a program to help with drug or alcohol use
- People currently in jail or prison, or who were released in the last 90 days
- People in foster care (those formerly in foster care and discharged between ages 18–21 are exempt until age 26)
- Veterans with a total disability
For those who qualify for Medicaid under the new work requirements or have an exemption, proof of eligibility (for example, proof of school attendance, proof of volunteering, or proof of paid employment) or proof of exemption may be required.
How Will New York Medicaid Renewal Change in 2027?
For some adults aged 19–64, Medicaid may need to be renewed more frequently than before. Under the previous policy, Medicaid was generally renewed once a year. The new rules may require Medicaid-qualifying recipients in this age group to renew their Medicaid every 6 months.
If Medicaid was applied for before January 1, 2027, or renewed before March 1, 2027, the recipient will receive 12 months of Medicaid coverage if eligible. After these 12 months, the renewal cycle becomes every 6 months. For recipients who apply for Medicaid after January 1, 2027, and renew after March 1, 2027, the every-6-months renewal cycle applies from the start. Because these dates are critical, it is important to keep track of them so Medicaid is renewed on time.
What Are the Asset and Income Limits for Medicaid Eligibility for People Under 65?
For New Yorkers under the age of 65, Medicaid eligibility is generally determined by the Modified Adjusted Gross Income (MAGI) rules. The qualification generally applies if the household income is at or below 138% of the Federal Poverty Line (FPL).
2026 Medicaid Eligibility: Adults Under 65, Parents/Caretakers, and 19–20 Year Olds Living Alone
| Household size | Yearly household income (138% FPL) |
|---|---|
| 1 | $22,025 |
| 2 | $29,864 |
| 3 | $37,702 |
| 4 | $45,540 |
| 5 | $53,379 |
| 6 | $61,217 |
| 7 | $69,056 |
| 8 | $76,894 |
| Each additional person | +$7,839 |
2026 Medicaid Eligibility: Children Ages 1–18 (154% FPL)
| Household size | Yearly household income |
|---|---|
| 1 | $24,579 |
| 2 | $33,326 |
| 3 | $42,073 |
| 4 | $50,820 |
| 5 | $59,568 |
| 6 | $68,315 |
| 7 | $77,062 |
| 8 | $85,809 |
| Each additional person | +$8,748 |
2026 Medicaid Eligibility: 19 and 20 Year Olds Living With Their Parents (155% FPL)
| Household size | Yearly household income |
|---|---|
| 1 | $24,738 |
| 2 | $33,542 |
| 3 | $42,346 |
| 4 | $51,150 |
| 5 | $59,954 |
| 6 | $68,758 |
| 7 | $77,562 |
| 8 | $86,366 |
| Each additional person | +$8,804 |
2026 Medicaid Eligibility: Infants Under 1, Pregnant Women, and the Family Planning Benefit Program (223% FPL)
| Household size | Yearly household income |
|---|---|
| 1 | $35,591 |
| 2 | $48,258 |
| 3 | $60,924 |
| 4 | $73,590 |
| 5 | $86,257 |
| 6 | $98,923 |
| 7 | $111,590 |
| 8 | $124,256 |
| Each additional person | +$12,667 |
It is important to note that for MAGI Medicaid for people under the age of 65, there is generally no asset test, which is very different from nursing home/long-term care Medicaid for seniors over the age of 65. This means that:
- Savings accounts often do not count
- Retirement accounts may not count
- Primary residences are generally not an issue
What Is the Essential Plan and What Changes Are Happening in 2027?
The Essential Plan is affordable health insurance for New Yorkers of moderate income under a certain threshold who don’t qualify for Medicaid. It is very popular among community members because it offers:
- $0 monthly premiums
- Low copays
- Broad healthcare coverage
- Low prescription costs
- Dental and vision benefits
- Free preventive care like routine exams and screenings
- Year-round enrollment
Since the Essential Plan is far more affordable than traditional Marketplace insurance, many families who were unable to qualify for Medicaid heavily relied on it. However, because of federal funding cuts in the H.R.1 legislation, New Yorkers with household incomes above 200% of the Federal Poverty Level (FPL) will no longer qualify for the Essential Plan. Individuals enrolled in the Essential Plan 200–250% FPL categories — about 450,000 New Yorkers — will lose eligibility, and their plans are expected to end on June 30, 2026.
To see whether someone still qualifies for the Essential Plan, the household needs to check whether its income is over 200% of the Federal Poverty Level. In 2026, the household income amounts are:
2026 Essential Plan Income Threshold (200% FPL)
| Household size | 200% FPL annual income |
|---|---|
| 1 | $31,920 |
| 2 | $43,280 |
| 3 | $54,640 |
| 4 | $66,000 |
How Might Changes Impact Some Immigrants in New York?
Starting on October 1, 2026, some adults might no longer qualify for Medicaid due to changes in the eligibility rules based on immigration status. If these changes apply to an individual or family, the New York State of Health will send a notice describing what coverage is available. After October 1, 2026, the immigrants whose Medicaid qualifies for federal reimbursement are:
- Immigrants with Lawful Permanent Residence status (Green Card Holders) for more than 5 years
- Cuban and Haitian entrants
- People from the Compacts of Free Association States (citizens of Micronesia, Palau, and the Marshall Islands)
These new rules do not mean that immigrants who previously qualified but are not in one of the above groups will lose Medicaid entirely. While they may not qualify for federal Medicaid, it is still possible for them to qualify for state-funded Medicaid.
What Should Community Members Do in the Wake of These Changes?
Community members should be aware of the changes with New York Medicaid and check whether they are still eligible for Medicaid or the Essential Plan. They should also stay informed about the new renewal timelines so their Medicaid coverage can be renewed on time if they remain eligible. It is important to make sure that personal information — including home address, phone number, and email — is up to date so the New York State of Health can send important notices and updates regarding coverage.
For families who previously qualified for Medicaid or an Essential Plan but are no longer eligible, exploring other coverage options is the next step. Qualified Health Plans with financial assistance may still be available. Families should look into Marketplace plans if transitioning becomes necessary. Marketplace plans are generally divided into four metal levels:
Marketplace Plan Metal Levels Compared
| Metal level | Cost structure | Best fit for |
|---|---|---|
| Bronze | Lowest monthly premium; highest deductible; highest out-of-pocket exposure | Healthy individuals who rarely use healthcare; risk of large bills before insurance fully pays |
| Silver | Moderate monthly premiums; moderate deductibles; access to federal subsidies and cost-sharing reductions | Individuals needing balanced coverage; expected to become the most common transition option for former Essential Plan members |
| Gold | Higher monthly premiums; lower deductibles; lower copays | Chronic medical conditions, frequent doctor visits, ongoing prescriptions |
| Platinum | Highest monthly premiums; lowest deductibles; lowest out-of-pocket exposure | Extensive medical treatment needs; families with significant healthcare expenses |
Frequently Asked Questions
Is there a $5,000 copay caused by changes to New York Medicaid in 2027?
There is no $5,000 copay that will happen due to the changes to New York Medicaid in 2027. When people talk about a $5,000 copay, they are often referring to the possible additional out-of-pocket costs that someone may have to pay after losing eligibility for the Essential Plan. People often confuse deductibles, out-of-pocket maximums, and coinsurance obligations in Marketplace plans with a copay.
What is Fidelis?
Fidelis is one of New York’s largest health insurance providers. It is one of the providers administering several New York healthcare programs, including Medicaid Managed Care, Essential Plans, Child Health Plus, and Marketplace Qualified Health Plans. A common misconception is that Fidelis creates the Medicaid eligibility rules. This is not true: how the programs are funded and how eligibility is determined are set by New York State and the federal government.
What are the differences between MAGI Medicaid and non-MAGI Medicaid?
MAGI Medicaid and non-MAGI Medicaid apply to different groups of people. MAGI population groups include pregnant women, dependent children under the age of 19, parents and caretaker relatives of children under 19, and singles or childless couples ages 19 through 64 who are not entitled to or enrolled in Medicare. The non-MAGI population includes seniors aged 65 or over, people with disabilities who have Medicare, and people who are blind and have Medicare.
What is U4U and how might U4U families be affected by the changes to Medicaid in 2027?
U4U is the Uniting for Ukraine program, which allowed many Ukrainian nationals displaced by war to enter the United States under humanitarian parole. The program gave many Ukrainian beneficiaries eligibility for Medicaid, Essential Plan coverage, Marketplace subsidies, and temporary federal benefits. However, due to the changing immigrant eligibility categories and new Essential Plan requirements, some Ukrainian beneficiaries may no longer be eligible for the Essential Plan or Medicaid. This does not mean that all Ukrainian beneficiaries will lose their Medicaid and Essential Plan. It is still possible for some beneficiaries to remain on their Medicaid or Essential Plan, as cases differ from one another.
Talk to a New York Medicaid Planning Attorney
The right coverage depends on the family, not the headline.
The Law Office of Inna Fershteyn and Associates, P.C. has been guiding families through Medicaid planning, irrevocable trusts, and estate administration since 1998. The firm serves clients across Brooklyn, Manhattan, Queens, Long Island, Westchester, and New Jersey, and works with English-speaking, Russian-speaking, and Ukrainian-speaking families.
Call: (718) 333-2395 • Office: 1517 Voorhies Avenue, 4th Floor, Brooklyn, NY 11235
Inna is fluent in English, Russian, and Ukrainian — Наша команда говорит по-русски и по-украински.