Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.
A major tax and spending package President Donald Trump signed into law last year will slash federal Medicaid spending by nearly $1 trillion over the next decade and make sweeping changes to healthcare programs serving millions of Americans.
The Trump administration says the tax and spending cuts will eliminate waste, fraud, and abuse. Because of stricter eligibility requirements, shorter retroactive coverage periods, and more frequent eligibility verifications, an estimated 17 million Americans — many of them children, pregnant women, people with disabilities, seniors, and veterans — are expected to lose their coverage by 2034, according to KFF.
H.R. 1 — also called the One Big Beautiful Bill Act, the Working Family Tax Cuts Act, and the reconciliation package — will also affect the Supplemental Nutrition Assistance Program, or SNAP, and New York state’s Essential Plan, an insurance program for qualifying low-income New Yorkers. But its biggest healthcare impacts fall on Medicaid enrollees.
City officials and community health leaders have launched a push to inform enrollees about the Medicaid changes.
The city’s Health Department has held more than 40 training sessions for community organizations, hosted monthly webinars, and fielded more than 3,000 benefits-related calls last month. The city says it has also sent guidance to 35,000 providers.
On Wednesday, senior health officials held the first of three virtual sessions to explain the changes and answer questions, drawing more than 250 people. Additional webinars are scheduled for Oct. 21 and Nov. 18.
“We’re going to act, take measures we’ve never taken before, and push ourselves to answer the call to make sure we are keeping our city’s residents covered in every way that we can,” Health Commissioner Dr. Alister Martin said in his opening remarks.
Healthcare systems are ramping up direct outreach, too. Sun River Health, with centers in New York City, the Hudson Valley, and Long Island, is running text and mailing campaigns to notify patients before their coverage lapses, said Allison Dubois, the organization’s chief operating officer and executive vice president.
“We’re worried about them getting the correct information in the right amount of time,” Dubois said.
Here’s a look at how H.R. 1 will change healthcare coverage and who is especially vulnerable.
When do the work requirements take effect?
Beginning Jan. 1, 2027, enrollees ages 19 through 64 must show that they are working, attending school at least part time, volunteering, or participating in a job-training program for at least 80 hours per month to keep their coverage. Enrollees who earn at least $580 a month, which is 80 times the federal minimum wage, can also meet the requirement.
Some adults will also need to renew their Medicaid coverage every six months instead of annually. Eligible people who apply for Medicaid before Jan. 1, 2027, or renew before March 1, 2027, will get 12 months of coverage. People who apply after Jan. 1 or renew after March 1 will need to renew every six months.
Who is exempt from the Medicaid work requirements?
Women who are pregnant or were pregnant within the past 12 months, recipients with disabilities, and recipients enrolled in substance-use treatment programs are exempt.
How many New Yorkers could be affected?
At least 475,000 people statewide could lose their Medicaid coverage because of the new work requirements, according to the New York State Department of Health. The department also estimates that New York’s uninsured population could increase by 45%, from approximately 1 million people to as many as 1.45 million after implementation.
New York has already seen a preview of this disruption. On July 1, 450,000 New Yorkers lost coverage through the Essential Plan after the state narrowed insurance eligibility for some of its low-income members. The Essential Plan offers a low-cost insurance plan to New Yorkers who earn too much to qualify for Medicaid but may struggle to afford private plans sold through the state health insurance marketplace. The program has been popular with gig workers.
As of Aug. 30, 41% of the affected members had not enrolled in another plan through the state marketplace, according to the state Health Department, potentially leaving some without insurance.
Those who no longer have insurance can turn to NYC Care, a healthcare access program that guarantees low-cost and no-cost services for New Yorkers.
What parts of New York City will most likely be affected?
A Healthbeat analysis of Medicaid enrollment data found that the Bronx could bear the brunt of the Medicaid changes. New York’s 15th Congressional District, which includes parts of the Bronx, has 510,000 Medicaid enrollees, the highest number of any congressional district in the country. They account for 71% of the district’s population.
The Bronx is “ground zero for what H.R. 1 means in practice,” Urban Health Plan, a local community health center, said in a press release. Between 20,000 and 30,000 borough residents could lose their coverage through Medicaid or the Essential Plan, the organization estimates.
Queens and Brooklyn are also especially vulnerable. According to the United Hospital Fund, 1.1 million Brooklyn residents, or 45% of the borough’s population, and 973,091 Queens residents, or 42% of the borough’s population, are enrolled in Medicaid.
How might the H.R. 1 changes affect the city’s hospitals?
Health advocates point out that changes to Medicaid won’t affect just the enrolled population, but the broader healthcare system.
“If you think, ‘I got a job, I got insurance, I’m fine,’ you are completely misunderstanding the way that this is a complete ecosystem,” state Sen. Gustavo Rivera, whose district includes parts of the Bronx and who chairs the Senate Health Committee, told Healthbeat.
Those who are uninsured, he said, are “going to be landing in emergency rooms, pushing institutions that are safety nets into further crisis, potentially getting some of them to close.”
That pressure could be especially acute for NYC Health + Hospitals, the largest municipal healthcare system in the United States, which operates 11 public hospitals across the city.
According to Deborah Brown, senior vice president and chief external affairs officer of NYC Health + Hospitals, it’s also the city’s largest provider of healthcare to homeless New Yorkers. Nearly 70% of its adult patients are enrolled in Medicaid or uninsured. Medicaid covers 97% of the babies born in the system and 70% of its patients younger than 18.
“The populations that we serve continue to be the most marginalized populations in NYC,” Brown wrote in a July letter to Dr. Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services. “We are heavily reliant on Medicaid revenue to keep our doors open.”
How has New York pushed back against federal Medicaid changes?
In June, New York Attorney General Letitia James, 24 other states, and the District of Columbia filed a lawsuit against the Trump administration challenging a separate federal rule that they say makes it harder for Medicaid enrollees to demonstrate their eligibility. For example, if a Medicaid enrollee is being treated for cancer, they may need to provide additional paperwork demonstrating the severity of their illness.
Visit nyc.gov/MedicaidHelp for resources and guidance, or call 347-665-0214 to speak with a New York City Health Department counselor.
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.
