If you live in New York City and get health insurance through Medicaid or the Essential Plan, there’s something big you need to know: a new federal law called the One Big Beautiful Bill Act (OBBB) is making cuts to how health care is covered.
Passed on July 4, 2025, OBBB makes sweeping changes to how the government funds and regulates healthcare, including deep cuts to Medicaid and restrictions that threaten the Essential Plan — a New York–only program that helps 1.5 million people afford health coverage.
Let’s walk through what Medicaid and the Essential Plan are, what OBBB is changing, and what this all means for people living in NYC.
What is the difference between Medicaid and the Essential Plan?
If you live in New York and need health insurance but can’t afford a private plan, the state offers two major options for low- and moderate-income residents: Medicaid and the Essential Plan. While both programs are designed to make health care more accessible and affordable, they serve different groups and offer slightly different benefits.
Medicaid in New York
Medicaid is a public health insurance program that provides free or low-cost coverage to people with very limited income. The program is funded by both the federal and state governments. To be eligible, your income must fall below a certain level, which is updated annually. For example, in 2025, a single adult in New York can qualify with an annual income of $21,597 or less.
For those who qualify, Medicaid has no monthly premiums, no deductibles, and very low or no copays. Coverage includes doctor visits, hospital stays, emergency services, prescription drugs, mental health and substance use treatment, lab tests, preventive care, and more. In New York, Medicaid also includes dental and vision coverage, which is not standard in every state.
Also Read: How to Cover Emergency Medical Care in NYC if You’re Uninsured
The program is open to U.S. citizens and many immigrants. If you are a green card holder, refugee, asylee, or have another qualifying immigration status, you may be eligible for full Medicaid benefits.
Undocumented immigrants are not eligible for full Medicaid coverage, but New York does offer Emergency Medicaid for undocumented individuals who need urgent or life-saving medical care. There are two exceptions: pregnant women, regardless of their immigration status, can also receive prenatal care and delivery through Medicaid. Besides, undocumented adults aged 65 and older may be eligible for Medicaid if they meet the program’s specific eligibility requirements.
What’s changing for Medicaid recipients under the One Big Beautiful Bill?
The One Big Beautiful Bill is introducing a wide range of changes to Medicaid that will significantly impact how people in New York access and maintain their health coverage. Here’s a breakdown of the most significant changes:
Mandatory work requirements
Most adults aged 19 to 64 will now be required to demonstrate that they are working, in school, volunteering, or enrolled in job training for at least 80 hours per month to maintain their Medicaid coverage. Unless you’re disabled or caring for a child under 14, you must regularly report your hours, and missing even a single submission could lead to your coverage being terminated. This requirement will be implemented prior to 2027.
More frequent eligibility verifications
Since 2023, Medicaid enrollees have to renew their eligibility once a year. Under OBBB, many will be required to reverify their status every six months, and some might face even more frequent checks. This means more paperwork, more deadlines, and a greater risk of losing coverage due to administrative errors or delays, even if you’re still eligible. This requirement will be implemented prior to 2027.
Reduced retroactive coverage
Previously, Medicaid could pay for medical bills incurred up to three months before your application date. Under OBBB, no later than 2027, adults in the Medicaid expansion group will be covered for only one month retroactively; most others will be limited to two months. If you need emergency care and apply for it afterward, you may still be responsible for the bill for earlier services.
New cost-sharing rules
Beginning in October 2028, some Medicaid recipients may have to pay up to $35 per medical visit for non-essential services. Primary care visits and prescription drugs are expected to be exempt.
Expanded waiting periods for immigrants
The new law imposes a mandatory five-year waiting period for lawful permanent residents (green card holders) to access Medicaid, even in states like New York that previously waived this delay. This federally enforced change means newly arrived immigrants will face significant gaps in coverage, regardless of state policies. This new rule will take effect in October 2026.
Restriction on eligibility for qualified immigrants
Medicaid eligibility for certain qualified immigrants will be restricted starting October 2026. Refugees, individuals granted asylum, certain abused spouses and children, and victims of human trafficking — currently eligible as qualified immigrants — will no longer be included.
What can Medicaid recipients do to prepare for the change?
Log into your NY State of Health or local Medicaid account every few months to check for updates. Make sure to open all mail and emails from Medicaid — even if you were recently renewed — as eligibility reviews now happen twice a year. If you receive any communication, respond within the deadline (typically 10 to 30 days), or your coverage may be at risk.
You should keep a detailed record of your monthly work or qualifying activities. This includes pay stubs, schedules, attendance sheets, or letters from supervisors confirming participation in approved activities like employment, job training, or volunteering. Be prepared to submit this documentation monthly or whenever your state requests it. If your hours drop or you lose a job, notify Medicaid within 10 days to determine whether you qualify for a temporary exemption from the work requirement.
Pro tip: Ask your healthcare provider in advance whether a scheduled visit or procedure will result in a co-pay.
To reduce costs, consider visiting community health centers, which may offer discounted or free care. If the co-pays become unaffordable, you can apply for a financial hardship exemption through your Medicaid program.
Also Read: Free and Affordable Healthcare for Asylum Seekers and Undocumented Migrants
The Essential Plan – only available in New York
The Essential Plan is a special health insurance program only available in New York. It’s for adults aged 19 to 64 with low to moderate incomes who are not eligible for Medicaid. To qualify, your annual income must fall within a specific range. In 2025, that typically means earning between $21,594 and $39,125 for an individual, with higher income limits for larger households.
The plan provides comprehensive coverage similar to Medicaid, covering doctor visits, hospital care, prescriptions, dental, and vision services — all at little to no cost. Most enrollees pay between $0 and $20 per month in premiums, with minimal fees for doctor visits or medications. Importantly, there is no deductible.
Undocumented immigrants are not eligible for New York’s Essential Plan. That program is only available to lawfully present individuals, such as citizens, green card holders, DACA recipients, or those with other valid immigration status.
What does the One Big Beautiful Bill mean for Essential Plan recipients?
The One Big Beautiful Bill brings significant changes to who can obtain health coverage through New York’s Essential Plan, particularly for immigrants. One major change is how the bill defines an “eligible alien”, which is a government term for certain immigrants who are lawfully living in the U.S. and are eligible to receive public benefits, such as health insurance.
Currently, many immigrants who are here legally can receive coverage through the Essential Plan. That includes people with work permits, humanitarian protections, or those waiting on green cards. However, under this new bill, that list gets significantly shorter.
The bill excludes a large number of immigrants who are currently eligible, especially those who have been in the U.S. for fewer than five years, individuals here on temporary visas, and DACA recipients. It also prevents lawfully present immigrants with incomes up to 138% of the federal poverty level — equivalent to $21,597 annually for a single adult in 2025 — from accessing Essential Plan coverage.
If you’re already enrolled and not part of the immigrant groups affected by these changes, your health insurance isn’t expected to change, for now.
But for many legal immigrants, the picture could look very different. Starting as early as January 1, 2026, and by no later than January 1, 2027, many people could lose their coverage. Some may qualify for Medicaid if their income is low enough, but around 225,000 people are stuck in the middle — they make too much for Medicaid but won’t be eligible for help paying for coverage under this new law. That means they could lose their insurance altogether.
Also Read: What To Do If You Can’t Pay Your Medical Bill in NYC
What can Essential Plan recipients do to prepare for the change?
Log into your NY State of Health account and ensure that your current immigration status is accurately recorded. If you obtain permanent residency or experience any change in immigration classification, report it right away. Be prepared to provide official documentation, such as copies of green cards, I-94 arrival/departure records, work permits, or government-issued letters, to maintain or adjust your eligibility.
In late 2025, check your Essential Plan eligibility to see if you’re affected by the upcoming federal restrictions. If your eligibility is ending, explore Qualified Health Plans (QHPs) through the marketplace, which offer income-based subsidies. Compare each plan carefully, looking at monthly premiums, deductibles, co-pays, and which doctors or hospitals are included. For personalized guidance, reach out to an enrollment navigator or healthcare advocate.
If you are removed from the Essential Plan due to a change in eligibility, you will qualify for a Special Enrollment Period (SEP) and must apply within 60 days of losing coverage. Begin gathering your proof of income, immigration status documents, and household information in advance so you’re ready to apply without delay. If you’re not eligible for full coverage, consider applying for Emergency Medicaid or low-cost care at community health clinics.
