Insurance Changes FAQ
Basic information concerning how upcoming federal changes may impact your health insurance, including Medicaid.
What is changing?
As of January 1, 2027, some people with Medicaid health insurance coverage will need to show proof that they are working, going to school, volunteering, or in job training to keep their health insurance coverage. This is a new federal rule called Work Requirements for Medicaid Coverage. This information may change or be updated. More information on all these areas can be found below.
What plans are impacted? Are all the plans called “Medicaid?”
Not all the plans impacted are recognized as Medicaid plans. The main plans impacted in New York are Medicaid, Child Health Plus, and the Essential Plan. It is possible you were enrolled automatically due to income or enrolled in a plan called something else that is covered or paid by the Medicaid program without your knowledge. You may also have been removed from a plan without your knowledge if you missed a letter or notice or it was mailed to an old address.
For specific information on each of these plans, see below or call 1-855-355-5777.
How do I verify my coverage? How do I know if I have Medicaid, Child Health Plus, or the Essential Plan?
You can find out which health insurance plan you have by checking your online account on the New York State of Health website (nystateofhealth.ny.gov) or by calling their customer service line at 1-855-355-5777. Child Health Plus is only for children up to age 18, the Essential Plan is for adults aged 19 to 64, and Medicaid is available for both children and adults of all ages.
Should I verify my coverage?
Yes, even if you think or know you have Medicaid, you should verify it and find out what you need to do to stay covered. You can find out which health insurance plan you have by checking your online account on the New York State of Health website (nystateofhealth.ny.gov) or by calling their customer service line at 1-855-355-5777.
How does the Work Requirement for Medicaid Coverage rule work?
You may need to show you are working, going to school, volunteering in the community, or participating in job training to keep your health coverage. You can do these things to meet the requirements:
- Earn an income of at least $580 per month
- Complete at least 80 hours per month of any of the following activities, or a combination of them:
- Work at a job
- Go to school at least half time
- Join a job training or work program
- Volunteer or help in your community
- Earn some income and complete some hours of approved activities each month. For example, if you earn $380 per month, that equals 52 hours when using the federal minimum wage of $7.25 ($380/$7.25 = 52). To meet the 80 hours of approved activities, you would need to do 28 more hours of any of the activities above
Are there exceptions to the Medicaid Coverage rule?
Yes. The following people do not have to follow this rule to retain coverage:
- 18 years old or younger
- 65 years old or older
- Pregnant, or were pregnant in the last 12 months
- Enrolled in Medicaid with a disability
- Diagnosed with a physical or mental health condition that makes it hard to work
- Entitled to, or enrolled in Medicare Part A or enrolled in Part B
- American Indian or Alaska Native
- A parent, guardian, caretaker relative, or family caregiver to a disabled individual
- A parent, guardian, caretaker relative, or family caregiver to a child under 14In a SNAP household, and subject to SNAP work requirements
- Enrolled in TANF and meeting TANF work requirements
- In a program to help with drug or alcohol use
- Currently in jail or prison, or released in the last 90 days
- Currently in foster care
- If you were formerly in foster care and discharged between the ages of 18–21, you are exempt until age 26
- A veteran with a total disability
You may need to meet certain conditions or show proof that you fit one of these exceptions when you renew your Medicaid coverage.
How often will I need to prove my eligibility?
Some people who have Medicaid will need to prove that they are still eligible every six months instead of every year starting on January 1, 2027. The time you need to prove your eligibility is six months after your enrollment date.
How does it affect people covered by the Essential Plan?
Anyone who is covered by the Essential Plan with low income (specifically, income over 200% of the Federal Poverty Level) will lose their coverage and will need to apply for a Qualified Health Plan. There will be no changes for anyone with income under 200% of the Federal Poverty Level.
How do I check whether I qualify based on income?
To qualify for the Essential Plan, you must have a lower income that does not qualify you for regular Medicaid – roughly below $39,900 for a single person. You can check if you qualify by visiting nystateofhealth.ny.gov or by calling the New York State of Health customer service line at 1-855-355-5777.
What are the new requirements? What is the new work or community service requirement?
Anyone covered by Medicaid or the Essential Plan between the ages of 19 and 64 will need to document that they are working or doing community service for 80 hours per month or have an exemption such as a disability, medically frail status, are a caregiver, participating in substance use treatment, or are already meeting SNAP/TANF work reporting requirements.
What if I am in school?
If you are in an education program for at least half of the 80 hours per month, you are exempt from the work or community service requirements.
What about income requirements?
You can also meet the work or community service requirements if your monthly income is at least $580.
What is the “look back” period?
New applicants must comply with the new work or community service requirement for at least one month before applying. Renewing members must have complied for at least one month in the previous six months.
What if I choose not to comply with the requirement?
If someone does not comply with the work or community service requirement, they will receive a notice of noncompliance and have 30 days to either show compliance or proof that the requirement does not apply to them.
What if I am not a citizen? Are there any changes for immigrant populations?
Coverage will only be given to immigrants who the following immigrant populations:
- Lawful permanent residents of the United States
- Refugees
- Parolees and asylees
- Certain abused spouses and children
- Certain victims of trafficking
- Certain Cuban and Haitian immigrants
- Citizens of the Freely Associated States (COFA)
- Lawfully residing children and pregnant adults
What are the dates these changes go into effect?
- July 1, 2026: EP 200-250 coverage ends, reversion to Basic Health Plan
- August 31, 2026: work and community service requirement notices go out
- October 1, 2026: immigrant eligibility restrictions for Medicaid begin
- January 1, 2027: work and community service requirements begin
What can I do now to prepare?
- Respond to all insurance renewal notices so that you do not have a gap in coverage
- Update all your personal information with the New York State Department of Health or your local Department of Social Services
- Get free assistance from an Enrollment Assistor
Where else can I get information?
For news and updates, you can:
Additional resources:
How can I tell what plan from my insurance card?
A Medicaid Managed Care plan insurance card will have a Client Identification Number (CIN). The CIN is always formatted as two letters, five numbers, and one letter (for example, AA11111A). The CIN may also be labeled as Program ID", "Member ID", or "ID# on your insurance card. Medicaid Managed Care plans include MVP, Fidelis, Healthfirst, MetroPlus, United Health Care, Molina, and Affinity.
How will I know if I need to meet the new work requirements for Medicaid coverage?
NY State of Health should send you a notice via email or mail if you need to meet this requirement. Be sure to confirm your NY State of Health account has your most up to date contact information so that you receive these renewal notices.
How will I know when it is time to renew my Medicaid coverage?
NY State of Health will send you a notice via email or mail when it is time to renew insurance for yourself or your family members. Be sure to confirm your NY State of Health account has your most up to date contact information so that you receive these renewal notices.
You can also sign up to receive text alerts from NY State of Health. These alerts will tell you when it is time to renew your insurance and other valuable information. To subscribe, text START to 1-866-988-0327.
