JULY 1, 2026  CHANGES - 450,000 People Will be Kicked Off Essential Plan because Income Limits will be  Reduced

Starting July 1, 2026, the NYS Essential Plan (EP) will have REDUCED eligibility levels - cutting eligibility from 250% of the Federal Poverty Level to 200% FPL.  This reverses the increases that started in April 2024 (see history here).  The new annual income limit is $31,300 for ONE person,  $42,300 for TWO people.    These cuts are a result of HR1 - also known as the One Big Beautiful Bill Act championed by the Trump Administration.   Aside from reducing the income limit to 200% FPL , the program reverts this program from the  1332 Waiver program. back to a Basic Health Plan under the Affordable Care Act.   This was the only way this important program could continue to provide affordable health coverage for 1.3 million New Yorkers whose incomes are over the Medicaid income limit (138% FPL) but under 200% FPL.  

• The Governor and Legislature passed the State budget late in May 2026 without  providing any  health coverage  for 480,000 New Yorkers who are losing coverage under the Essential Plan -    This was  despite strong advocacy - Click here for info.  

• Around April 1, 2026, 450,000 New Yorkers received notice from the State that their Essential Plan will end on July 1st.  They have the of  option to enroll in a Qualified Health Plan on the NYSofHealth exchange instead -- an option that will be unaffordable for many.   
• NYS INFO about the Essential Plan changes:
  •   Impact of H.R.1 Legislation on New York’s Essential Plan
  •  Impact of Essential Plan Changes by Congressional District
  • NYS Dept. of Health press release announcing final approval by the federal Medicaid agency of the state's proposal to keep the program but reduce the income limit to 200% FPL -New York State Department of Health Provides Update on Federal Approval to Preserve Health Coverage for 1.3 Million New Yorkers   (March 23, 2026).
  • DOH webpage - 3/23/26 Update: CMS Approval of New York's Request to Terminate Its Section 1332 Waiver and Revert to Basic Health Program Authority
•  What To Do If You’re Impacted By Changes to the Essential Plan - N Y Focus June 15, 2026
• Click HERE for where to get help.  
• See also Stay Connected with NY State of Health
• Changes to Medicaid Starting January 2027

Advocates are calling on the State to provide subsidized health coverage for these 450,000 New Yorkers.  See 

• Press Release: CSS Report Examines Proposals to Mitigate Heath Care Coverage Losses Under H.R. 1  (Community Service Society March 2026)
• Statement on Federal Approval to Shrink the Essential Plan  (Fiscal Policy Institute March 2026)

• Testimony: Protecting Health Coverage in the Face of Federal Cuts (CSS Sept. 2025) 

• Watch: Technical Briefing on Proposals to Protect the Essential Plan - Fiscal Policy Institute  Download the Slides 

• Share Your Story: Essential Plan Healthcare Cuts

What is the Essential Plan? 

The Essential Plan is comprehensive health insurance for people age 19-64 who do not have employer health coverage or Medicare, and who are not eligible for Medicaid or Child Health Plus.   

• See https://info.nystateofhealth.ny.gov/EssentialPlan.  This is on the NYState of Health website, which is where you apply for the Essential Plan as well as MAGI Medicaid and Child Health Plus for those under 65.  At the above webpage is more info  that has not yet been updated with the July 2026 changes.  

• There is no asset limit for the Essential Plan. 

• The income limit until July 1, 2026 is 250% FPL, when it will be reduced to 200% FPL.  

• Use the Plans by County Tool to learn what health plans are available in your county for the Essential Plan.

• Use the NYS Provider & Health Plan Look-Up tool when you are deciding which health plan to enroll in or when you are looking for a provider, for example a hospital or doctor, that works with your plan.

History of the Essential Plan:

• Section 1331 of the Affordable Care Act (ACA), created an option for states to offer a "Basic Health Program,"  with the goal of reducing rates of uninsured.  New York is one of just two states that offered a Basic Heath Program.  New York calls its Basic Health Plan the Essential Plan.  See 2016 issue brief by Kaiser Family Foundation.   Under the ACA, states offering a basic health plan like NYS receive significant federal funding for these programs. 

• NEW YORK LAW:  NY Social Services Law Sec. 369-gg.
• 2024 Expansion -
  • In 2023. New York sought to place its Basic Health Program on pause and filed a 1332 Waiver request to roll over NY’s BHP Essential Plan enrollees into a 1332 Waiver program. 
  • The 1332 Waiver program expanded income eligibility up to 250% of FPL (up from a cap at 200% of FPL) and include dmore immigrants (the DACA population).
• 2026 REDUCTION  -  
  • Federal funding for the Essential Plan is based on the number of enrollees who would otherwise qualify for Premium Tax Credits for Qualified Health Plans.  but -- H.R.1 reduces the number of people eligible for Premium Tax Credits under Qualified Health Plans -- largely by disqualifying many legal immigrants for these tax credits.  With this cut in federal funding, the State had to reduce the income limit from 250% to 200% FPL.  
• EP enrollees who become pregnant  -- are able to remain in EP instead of being switched to Medicaid for pregnant people.  They will experience no cost sharing and will remain continuously covered for the first 12 months after birth.

FOR HELP:

Contact Community Health Advocates 
https://communityhealthadvocates.org/contact-us/ 

•  (888) 614-5400 Monday to Friday, 9am to 4pm,
•  email cha@cssny.org.

This article was authored by the Evelyn Frank Legal Resources Program of New York Legal Assistance Group.