Healthbeat

New Medicaid work rules put NYC enrollees and hospitals at risk. Here’s who will be hit the hardest

2026-08-19T12:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

Of the estimated 67 million people in the United States who will likely be affected by Medicaid cuts, about 3.6 million recipients live in New York City, and more than 1.3 million are concentrated in three congressional districts.

Those districts cover parts of the Bronx, northern Manhattan, and Queens, according to a Healthbeat analysis of district data and KFF, a nonprofit organization focusing on health care issues.

New Yorkers rely on Medicaid programs for everything from HIV treatment to home healthcare. The new changes to Medicaid — the public health insurance program for millions of low-income Americans that’s paid for by the federal government and individual states — are the result of H.R.1, the budget package that passed last summer and will slash $1 trillion from the Medicaid program over the next decade. As of Jan. 1, enrollees between ages 19 to 64 must prove that they are working, going to school, volunteering, or participating in a job-training program for at least 80 hours per month to keep their coverage. The rules are intended to push more people into the workforce and reduce what Republicans have described as waste and fraud in government programs.

The New York State Department of Health estimates that at least 475,000 New Yorkers could lose their Medicaid coverage because of the new work requirements. The health department also estimates that New York’s uninsured population could jump by 45%, from approximately 1 million people to as many as 1.45 million people after implementation. A new rule for cancer patients stipulates that a diagnosis is not sufficient for a work exemption; they must officially prove they are unable to work.

The Bronx leads the United States with the highest number of Medicaid enrollees, with 510,000 in Congressional District 15. People walk inside the NYC Human Resources Administration, part of the Department of Social Services, in the Bronx. The social service agency provides assistance to New Yorkers, including Medicaid enrollees.

Health advocates say the Medicaid changes won’t be limited to enrollees and will have a cascading effect in communities and their hospitals. New Yorkers who lose coverage will likely forgo check-ins with their primary care physician, if they have one, causing preventable ailments to worsen and require emergency room visits. Hospitals are required by law to treat uninsured patients and will have to absorb the costs, which will likely accumulate. They’ll receive an influx of newly uninsured patients that will exacerbate overcrowding, forcing facilities to scale back on services that are expensive or aren’t lucrative, like pediatrics or primacy care, said Johanna Lister, policy director for the HealthySteps program at ZERO TO THREE, a nonprofit group focusing on early childhood.

“They need to cut based on how they need to protect their remaining incoming revenue,” Lister said.

Some hospitals will be forced to close.

“The financial impact of hospitals is going to be huge, particularly for safety net hospitals, like in the Bronx,” Lister said about the healthcare facilities that provide treatment regardless of the patient’s ability to pay or insurance status. “There’s absolutely no doubt that hospitals will close.”

A coalition of more than two dozen attorney generals and governors, including New York, filed a lawsuit in June against the Trump administration challenging the new

work requirements.

‘Canaries in the coal mines’

In a recent interview with Healthbeat, New York City Health Commissioner Dr. Alister Martin said he was particularly concerned about three areas: the south Bronx, East Harlem, and the Brownsville neighborhood in east Brooklyn.

“These are some of the areas that I think are really critical for us to watch and to see, almost as canary in the coal mines,” said Martin, whose department has brought on specialists to help Medicaid enrollees navigate the new requirements and has hosted public meetings to answer inquiries. His press office couldn’t say how many Medicaid enrollees the counselors have supported.

A Healthbeat analysis of Medicaid data from congressional districts in New York City reveals the following:

The Bronx leads the United States with the highest number of Medicaid enrollees, with 510,000 in Congressional District 15. That’s 71% of the district’s population. According to the Urban Health Plan, a community health center in New York State, the Bronx is “ground zero for what H.R.1 means in practice.” Between 20,000 to 30,000 residents in the borough could lose coverage on Medicaid and a separate plan for working-class New Yorkers, and up to $211 million could be pulled out of the Bronx food economy, says the Urban Health Plan.
Congressional District 13, which includes northern Manhattan and parts of the Bronx, is also in the top 10 districts in the United States whose residents rely on Medicaid. That is 426,200 residents, or 59% of the population. The district also has the highest number of seniors in the city enrolled on Medicaid, with 69,900.
Congressional District 14 has 57% of its population enrolled on Medicaid, or 423,800 residents. The U.S. representative for the district that includes the eastern Bronx and north-central Queens, Alexandria Ocasio-Cortez, said in a social media post earlier this month she was meeting with Deputy Mayor Helen Arteaga Landaverde to work on a strategy for combatting the cuts and expanding healthcare. Her office, and other offices for the New York City congressional delegation, did not respond to a list of questions about Medicaid.
New York City’s 11th Congressional District, which includes Staten Island and part of Brooklyn, is in the top 10 of districts with Republican congressmembers, with 304,100 Medicaid enrollees, or 40 percent of its population. It’s the only New York City congressional seat represented by a Republican, Nicole Malliotakis.

Unaware and unprepared: New requirements endanger coverage for millions

Health advocates fear that Medicaid enrollees may overlook important notices or be unaware of the new requirements or not understand them, either because of a language barrier or because the instructions are hard to understand, and then miss important deadlines and fall off.

Bronx resident Frances Bueno might be among them. The 62-year-old Puerto Rican woman said she was unaware of the changes to Medicaid.

“Yeah, I read something like that,” Bueno said after stepping out of a community health center in the Mott Haven neighborhood in the south Bronx. A Medicaid recipient since last year, she had just paid a visit to her neurologist, who canceled the appointment, she said, and she was on her way to buy meat with food stamps.

“It’s going to be rough on a lot of people out here,” she said.

A sign outside the NYC Human Resources Administration in the Bronx directs visitors to a Medicaid office. The Bronx leads the United States with the highest number of Medicaid enrollees, with 510,000 in Congressional District 15.

The Bronx, Queens, and Brooklyn are especially vulnerable. According to the United Hospital Fund, an independent nonprofit analyzing health policy in New York, 843,415 people in the Bronx, or 60% of the borough’s population are enrolled on Medicaid; 1.1 million in Brooklyn, or 45% of the population; 973,091 people in Queens, or 42% of the population, 421,264 people in Manhattan or a quarter of the population; and 171,290 people in Staten Island, or 35% of the population, are enrolled on Medicaid.

With this in mind, New York State Senator Gustavo Rivera, whose district includes the Bronx, has introduced the New York Health Act, a piece of legislation that aims to establish a single-payer healthcare system at the state level.

“I’m convinced that this is the way that we need to go,” Rivera, chair of the Senate Health Committee, told Healthbeat. “Taking insurance companies out of the equation means giving better care, having it cost less, and providing it to more people.”

New Yorkers with questions about their coverage can call the New York State Medicaid Helpline at 800-541-2831.

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

NYC public health system braces for federal grant cuts under proposed OMB revision

2026-07-30T22:30:44+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

New York City’s public health system is bracing for possible funding cuts from a federal budget rule change the Trump administration is considering.

A proposed revision from the Office of Management and Budget would give the Trump administration broad discretion over how federal grants are awarded, managed, and terminated. Currently, such grants can’t be canceled without cause, but the new OMB rule would permit termination with minimal explanation or opportunities for appeal.

Though a range of federal agencies could be potential targets of the revisions, known as “Uniform Guidance,” the city’s Department of Health and Mental Hygiene and community-based health centers are particularly vulnerable.

Health officials say about $500 million, or 20% percent of the city’s budget for the Health Department, comes from the federal government. This money is earmarked for emergency preparedness and disease surveillance.

The Health Department has already been a mark. Last year, the Trump administration tried to withhold funding across the United States, including some $100 million earmarked for the city’s Health Department, but a coalition of attorneys general sued. A federal judge halted the effort for now.

“It would not necessarily completely disrupt what they’re doing, but it would maybe destabilize the core functions of the Health Department,” Dr. Oni Blackstock, a primary care physician based in New York City who specializes in HIV treatment, said of the proposed rule.

Blackstock is also the founder and executive director of Health Justice, a consulting firm that aims to promote equity initiatives in healthcare and public health. She previously was an assistant commissioner at the New York City Health Department, leading the city’s response to the HIV epidemic.

The OMB changes could be far-reaching, from the states to counties nationwide. According to the National Association of Counties, a nonprofit group advocating for county government across the United States, the proposed rule is the “most significant overhaul of federal grants regulations in more than a decade.” County programs such as transportation, public safety, housing, and disaster recovery could be affected.

According to the department, “OMB is proposing revisions that would improve transparency, accountability, and oversight for Federal awards across the Federal Government.”

A spokesperson could not be reached for further comment.

Russell Vought, the OMB director, is one of the main architects of Project 2025, the 900-page blueprint that articulated a broad conservative vision for the second Trump administration.

The final version of the rule could take effect on Oct. 1. Until then, the OMB is required to consider every public comment it has received since the rule was announced in late May and address or respond to substantive critiques. The agency received nearly 500,000 comments until the comment period ended on July 13.

The topic of the Trump administration possibly withholding funding from the city’s Health Department has come up before. At a March budget hearing, City Council Health Committee Chair Lynn Schulman asked about contingency plans.

“We are currently in active discussions with (the city’s) OMB, with the law department in the mayor’s office, to come up with plans if there are cuts to specific activities,” Health Commissioner Dr. Alister Martin said at the March hearing. “We will assess and make decisions around what will protect New Yorkers’ health and safety the best.”

A Health Department spokesperson didn’t respond to questions about plans for potential cuts.

Blackstock says the proposed OMB rule could target Health Department funding for outbreak responses, HIV prevention, substance use services, emergency preparedness, and chronic disease prevention.

“All of these programs receive federal dollars through discretionary cooperative agreements,” she said.

In the past, the Centers for Disease Control and Prevention or the U.S. Health Resources and Services Administration would evaluate grant applications, but now political appointees will be making key decisions, she said.

“They’re going to be using their own independent judgment and lack of knowledge and expertise to decide whether these discretionary federal awards are granted,” Blackstock said.

Dr. Oni Blackstock

Community-based groups that receive federal funds could also be affected. That means the pot of money will grow smaller, and nonprofits have cut back on hiring, reduced services, postponed raises, and resorted to layoffs. Nonprofits are also looking at ways to forge alliances and share resources.

A preview of the abrupt withdrawal of federal funding played out earlier this year. Community nonprofits working on substance abuse issues experienced the sudden loss of funding — and ensuing chaos — in January when an agency in the Department of Human and Health Services suddenly revoked roughly $2 billion in funding, only to restore the money the following day because of bipartisan lobbying.

Given that the Trump administration has issued executive orders that target health care services for groups serving LGBTQ+ communities, some nonprofits may decide to pass on federal support.

“If it’s a trans-led organization, they may be discouraged from actually applying for any federal funding because they don’t want to be a target of this administration and have their funds withdrawn,” Blackstock said.

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

16 U.S. state attorneys sue Trump administration over $1 billion cut to school mental health funding

2025-07-02T12:30:08+00:00

Public health, explained:Sign up to receive Healthbeat’s free New York City newsletter here.

A Trump administration directive terminating more than $1 billion in federal funding for school-based mental health services is the latest ruling being challenged by a group of 16 Democratic attorneys.

Led by New York Attorney General Letitia James, the lawsuit filed this week calls on the court to reinstate the grants, calling the cut unlawful, unconstitutional, and ideologically driven.

The grants were created by Congress under a bipartisan law passed after the 2022 school shooting in Uvalde, Texas, when an 18-year-old gunman killed 19 elementary school children and two teachers. The money was used to hire staff, diversify the mental health profession, and prepare educators to work with kids from diverse backgrounds — specifically in high-need, low-income, and rural schools — but with President Donald Trump’s attempts to root out programs incorporating diversity, equity, and inclusion, his administration pulled the funding for many states and schools two months ago.

Without offering evidence that the cuts were based on grantees’ performance standards, the lawsuit says the administration instead applied an ideological litmus test after terminating the program. The administration sent grantees boilerplate language, according to the lawsuit, which claims it was an “arbitrary and capricious” move that did not account for any individualized reasons for the change, nor consider the harmful impact to children dependent on the mental health services or the effect on the pipeline for the chronically understaffed mental health workforce across the nation.

“The cost to our children’s safety, well-being, and academic success is incalculable,” the lawsuit stated. “These grants were designed to respond to America’s school shooting crisis and fill a critical need in schools. Without them, many children in rural and lower-income schools will go without mental health services and will suffer the attendant consequences: short- and long-term health problems; lower grades; increased absenteeism, suspensions, and expulsions; and a higher risk of suicide and drug overdose.”

In the grant program’s first year, nearly 775,000 students received mental or behavioral health services, according to the lawsuit. The grants helped hire more than 1,200 school-based mental health professionals, and student wait times for services dropped by 80%. A sample of projects reported a 50% reduction in suicide risk at high-need schools, improved attendance, and stronger student-staff relationships.

The federal Department of Education did not respond for comment.

Among the decimated programs, Teachers College at Columbia University had begun training five graduate students to provide mental health services in Harlem and East Harlem schools serving large populations of newly arrived immigrants and families struggling to find stable housing. The program was in the process of sending out acceptance letters to eight more students when the funding was cut.

The $4.9 million, five-year grant aimed to prepare mental health professionals, many of whom were bilingual or first-generation students who couldn’t have afforded graduate school otherwise and planned to commit to working in school-based mental health for their careers. The cuts not only affected the program’s short-term ability to provide high-needs schools with critical services for free, said Prerna Arora, an associate professor of psychology and education at Teachers College who was overseeing the grant, but also decimated the future pipeline of professionals dedicated to this kind of work.

If the lawsuit is successful, restarting the grant would not be impossible, Arora said, but it would take time to scale services back up, and the program and the schools are on a typical school calendar, which could affect timelines.

“The funds are definitely needed to address the mental health workforce shortage in our school,” she said in an email. “However, because of the cuts, which were effective immediately, additional time would be needed to rehire staff, recruit and admit students to the training program, and restart the formal partnership with our community schools.”

In all, New York stands to lose at least $19 million in previously approved funding as a result of these cuts, including more than $7.6 million for the State University of New York system, James’ office said.

Chalkbeat senior national reporter Kalyn Belsha contributed reporting.

Amy Zimmer is the bureau chief for Chalkbeat New York. Contact Amy atazimmer@chalkbeat.org.