For a background document comparing MAGI Medicaid, Non-MAGI Medicaid, and the Medicare Savings Program, click here. For an example MECM notice showing Medicaid and MSP eligibility, click here. For an example MECM notice showing Medicaid and MSP ineligibility, click here. For the YouTube recording of NYLAG's December 17, 2025 webinar on MECM, click here. For a copy of the slides from NYLAG's December 17, 2025 webinar on MECM, click here.

MECM Alerts (newest information)

• Wave 2: Information about which populations will be in wave 2 of MECM, and when wave 2 will go live, has been announced! See Wave 2 and Updates from First Few Months of MECM below for additional information.

• The MSP issue: Since early 2026, advocates and families have learned about a major issue related to MECM and the Medicare Savings Program (MSP). In short, when someone has an existing Medicaid case at the LDSS/HRA, and then they are approved on MECM for an MSP case (either because they applied for MSP on MECM, or because they applied for the Low Income Subsidy or "LIS" program and in doing so that data was sent to MECM which led to an automatic evaluation for MSP and the creation of a MSP case on MECM), the MSP case in MECM is over-writing their Medicaid case at the LDSS/HRA, resulting in an inappropriate closure of their Medicaid case. The state is currently working to manually fix these cases before each one closes, but we know that some cases are still closes inappropriately. DOH on August 25, 2026 said a systemic fix to this issue is scheduled for March 2027.

• Scoop and Dumps from the LDSS to MECM: DOH decided on August 24, 2026, that it is going to pause the ROS (Rest of State) LDSS-to-MECM scoop and dump process (through which clients' cases are moved by DOH from the LDSS to NYSOH to MECM). Further, DOH is going to keep the pause that has been in effect for a few months for NYC. So the entire state will be on pause, and will remain on pause until Wave 2 goes live, which is currently scheduled for November 2027.

• Undocumented 65+ population: When this population all moves into Fee For Service Medicaid effective April 2027, they will stay in MECM even if they need homecare. In other words, their cases will not be sent back to the LDSS/HRA. DOH is currently figuring out a way for these individuals to receive FFS homecare through MECM, not through the local districts. When DOH shares additional information, we will share it here.

Introduction

The New York State Department of Health (“DOH”) has launched a new program to modernize how certain Medicaid applicants/recipients will apply for and renew their Medicaid benefits. This modernization project is called the Medicaid Eligibility and Client Management system (“MECM”). MECM will impact how people apply for, and renew, a variety of Medicaid benefits including non-MAGI Medicaid and Medicare Savings Program benefits (MSP).

Medicaid Modernization is a multiyear project for which planning began in 2023, and that is being phased in on a gradual basis from 2025 to 2032. The DOH’s Medicaid Eligibility Modernization website can be found here.

A soft launch of MECM began on September 30, 2025. Certain community-based organizations and the NYSOH call center can help individuals apply for certain types of non-MAGI Medicaid and MSP on MECM, discussed below. The public can access MECM to apply for certain non-MAGI Medicaid and MSP benefits as of December 1, 2025.

To help the public gain familiarity with MECM, this article will provide a brief overview of the ongoing changes. We will update this article periodically as the Medicaid Modernization process continues.

Overview of Health Insurance Programs in New York State

There are a variety of public health insurance programs in New York State. Some programs are housed on the New York State online health insurance marketplace called the New York State of Health (“NYSOH”). Weblink is at https://nystateofhealth.ny.gov/. Other types of coverage have long been and continue to be administered by the Local Departments of Social Services (“LDSS”), such as the Human Resources Administration (“HRA”) in NYC. Below is a list of which health insurance programs are currently administered by NYSOH and which by the LDSS.

The process for applying and renewing Medicaid and other insurance programs is very different depending on where the program is administered. NYSOH-administered public health programs are typically online, and individuals may seek assistance through a NYSOH Navigator or Certified Application Counselor. LDSS-administered Medicaid programs are administered through a system called the Welfare Management System (“WMS”) and applications and renewals are typically on paper.

NY Health insurance programs that are administered on the NYSOH marketplace include: 

1. MAGI Medicaid - coverage under the Affordable Care Act for individuals under age 65 who do not have Medicare, plus individuals who do have Medicare – who may be age 65 or more – who live with and are “caretaker relatives” of a minor child, grandchild, or other relative
2. Child Health Plus
3. The Essential Plan
4. Qualified Health Plan (QHP) and Premium Tax Credits to reduce costs
5. Small Business Options called SHOP (on NYSOH)

NY health insurance programs that are administered exclusively by the Local Departments of Social Services (“LDSS”) – until the MECM changes begin:

1. Non-MAGI Medicaid (for age 65+, blind, or disabled), including:
   1. Community Medicaid for home care, the Assisted Living Program, 1915(c) HCBS waiver programs (OPWDD Waiver, TBI Waiver, NHTD Waiver, and the Children’s Waiver), and other community-based long term care services, primary and acute care. See this fact sheet about non-MAGI Medicaid in NYS.
   2. Institutional Medicaid for nursing home care
2. Medicaid for residents of Adult Homes, OMH Community Residences and Residential Care Centers
3. Medicaid Buy-In for Working People with Disabilities
4. Medicaid Cancer Treatment Program (if not income-eligible for MAGI or non-MAGI Medicaid)
5. Medicare Savings Program (MSP) pays the monthly Medicare Part B premium for low-income Medicare beneficiaries and qualifies enrollees for the “Extra Help” subsidy for Medicare Part D prescription drugs. See New York Health Access Medicare Savings Program tab and DOH webpage on MSP.
6. Programs that pay private health insurance premiums if eligible:
   1. COBRA Continuation Coverage (enrollee pays the premiums)
   2. Health Insurance Premium Payment Program (HIPP)
   3. AIDS Health Insurance Program (AHIP)
   4. AIDS Drug Assistance Program (ADAP)'s Plus Insurance Continuation Program (APIC)
7. Children in Foster Care or those who are under age 26 and were in foster care on their 18^th birthday
8. Family Planning Benefit Program (FPBP)
9. Presumptive Eligibility for Pregnant Individuals
10. Individuals in receipt of cash assistance (also called Public Assistance or “PA”) and individuals in receipt of Supplemental Security Insurance (SSI) are automatically eligible for Medicaid and their cases are currently housed at the LDSS.

See also DOH  2013-ADM-04  Attachment: MAGI and Non-MAGI Eligibility Groups.

For a background document comparing MAGI Medicaid, Non-MAGI Medicaid, and the Medicare Savings Program, click here.

For more about MAGI Medicaid vs. non-MAGI Medicaid, see the following resources:

• The Benefits Plus Learning Center chapter on MAGI Medicaid vs. Non-MAGI Medicaid, by Community Service Society of New York (CSSNY)
• NYLAG Fact Sheet on Non-MAGI Medicaid Eligibility in NYS (2026)

MECM: Medicaid Modernization in 2025

Since the Affordable Care Act (“ACA”), MAGI Medicaid and other public health insurance programs have been administered by NYSOH, using the NYSOH online eligibility system which was developed in the 2010’s. Meanwhile, non-MAGI Medicaid cases have been administered by the Local Departments of Social Services (“LDSS”), using an older (legacy) eligibility system called Welfare Management System (“WMS”). As WMS was developed in the 1970’s, it is extremely outdated.

With MECM, eventually (over the course of multiple years) all non-MAGI Medicaid cases will be moved over to MECM, housed within NYSOH. This will be a big change. Prior to MECM, the only way to complete most non-MAGI Medicaid applications and renewals filed with the LDSS was to completed them on paper and then submit them by mail or in person at a LDSS office. LDSS staff had to make manual data entries into WMS using information in the paper applications. By contrast, MAGI applications are filed online on NYSOH, which is a faster and more efficient process that allows for back-end data matching to state and federal data sources.

Phase-in Schedule - Wave 1 Starting September 30, 2025

Below is a big picture timeline of a few of the major changes taking place.

MECM is taking a phase-in approach, in which certain non-MAGI Medicaid cases are permitted on MECM starting on September 1, 2025. Some refer to these initial types of cases as “Wave 1” of MECM. Additional types of cases will be permitted in MECM over time.

Because non-MAGI Medicaid is so complex, the first phase of MECM will only handle Medicaid and MSP for the simplest cases, also known as cases in “Wave 1." 

The “Wave 1” MECM group of cases is limited to the following:

1. Non-MAGI Medicaid cases for people age 65+, disabled or blind, who meet all of these criteria:
   1. Their income is under the Medicaid limit so that they have no spend-down, no Pooled Income Trust, and no spousal impoverishment budgeting (however, we have learned that MECM can handle cases with spousal refusal budgeting);
   2. They are not receiving Disabled Adult Child (DAC) benefits from the Social Security Administration (SSA);
   3. They are not in the Medicaid Buy In for Working People With Disabilities (MBI-WPD) program; and
   4. They are not* seeking long term care (see note below). This means they are not seeking personal care services or CDPAP, whether through Immediate Need or otherwise, through their Managed Long Term Care (MLTC) plan, which includes MLTC Partial Capitation (MLTCP), Medicaid Advantage Plus (MAP) and Program for the All-Inclusive Care for the Elderly (PACE). They also may not be seeking personal care services or CDPAP through the LDSS (which is where individuals with "Straight" Medicaid, also called "Fee for Services" Medicaid, seek homecare). Nor are they enrolled in a 1915(c) home-and community-based service waiver program, nor are they seeking Medicaid to cover a nursing home, an adult home, or the Assisted Living Program.
      1. *Note that Non-MAGI Medicaid cases for someone seeking homecare (such as personal care or CDPAP) from a Mainstream Plan are allowed on MECM. This includes, for example, people age 65+ who have not worked the required 40 quarters to qualify for Medicare, and so would be enrolled in a Mainstream plan. This also includes undocumented 65+ individuals enrolled in a Mainstream Plan, as undocumented 65+ individuals are included in wave 1 for MECM.
2. Medicare Savings Program cases for people who meet either of these criteria:
   1. People who are only seeking to enroll in an MSP-only and not Medicaid.
   2. Non-MAGI Medicaid applicants who meet the Wave 1 criteria above and are applying for MSP as well as non-MAGI Medicaid.

Here is the phase-in schedule for MECM:

• September 30, 2025 (“soft launch”) through November 2025:
  • *New* applications: NYSOH call center and MECM Assistors began using MECM to submit applications for people who meet the Wave 1 criteria above and are applying for non-MAGI Medicaid and/or MSP (alone or with non-MAGI Medicaid). Any other applications are referred to the LDSS. Note that from September through November 2025, the general public may not yet file applications on the MECM website themselves. Instead, applications are limited to the following sources:
    • People calling the NYSOH Call Center (1-855-355-5777) – They will be screened as to whether they meet the Wave 1 criteria above. Those who do will be guided through the application with the help of the NYSOH Call Center staff. Those who do not will be referred to the LDSS.
    • People assisted by a MECM Assistor – “MECM Assistors” are individuals who have been trained to help people apply for Medicaid and MSP on MECM. Staff at three organizations were chosen to be the initial MECM Assistors: Healthy Capital District Initiative, Public Health Solutions, and Community Services Society. Each of these organizations is already designated as a Facilitated Enroller for the Aged, Blind, Disabled (“FE-ABD”), meaning they already help individuals enroll into non-MAGI Medicaid across New York State. Staff at additional organizations will become MECM Assistors over time. Current MECM Assistors can be found by going to the NYSOH Find Local Help page, under “Types of Assistance” unchecking “Families and Individuals under 65” and instead checking “Individuals 65 or older, or those who are blind or disabled,” and then clicking “Show Results.”
• • Transfer of first batch of Non-MAGI Medicaid Cases that were in NYSOH from before COVID: On September 30, 2025, DOH transferred roughly 14,000 non-MAGI Medicaid cases from NYSOH to MECM. These consumers are a fraction of the larger group of roughly 140,000 consumers in the same situation: consumers who were originally in the MAGI group when they applied for Medicaid on NYSOH, and later became enrolled in Medicare (thus becoming “dual eligibles”), so they should have been transitioned to “non-MAGI” Medicaid. Before COVID, Medicaid for these new Medicare beneficiaries would have been transferred to the LDSS to be re-budgeted as non-MAGI Medicaid. However, because of policies during the COVID Public Health Emergency, these 140,000 Medicaid cases remained on NYSOH as MAGI cases, even though the Medicaid enrollees now qualified for non-MAGI Medicaid. Moving forward, due to MECM, MAGI recipients who become newly enrolled in Medicare, and thus become “dual eligibles,” will be transferred from NYSOH to MECM. However, in the initial roll-out of MECM, only those dual eligibles who meet the Wave 1 criteria above will be transferred from NYSOH to MECM, while the others will be transferred to the LDSS. DOH calls this population the "backlog" population, and will be bringing this population into MECM on a monthly basis starting in February 2026.
• November 2025:
  • DOH will assess the functionality of the MECM system, and onboard additional FE-ABDs as MECM Assistors.
• December 1, 2025: Public Launch for Wave 1 Only
  • *New* applications: The MECM website and application portal will become publicly available online, so that anyone who meets the Wave 1 criteria above can use MECM to apply for: non-MAGI Medicaid, and MSP (alone or with Medicaid).
• December 5, 2025:
  • Renewals for cases that were originally in NYSOH as MAGI Medicaid and then transferred to MECM because consumer got Medicare coverage: These ~14,000 cases were transferred from NYSOH to MECM on September 30, 2025 without verifying current eligibility, so beginning on December 5, 2025, MECM will conduct a renewal for these cases. MECM will conduct renewals very differently than the way the LDSS did. Instead of sending the consumer a paper renewal form to manually fill out and mail back, MECM will reach out on the back end to existing state and federal data sources to find information needed to renew Medicaid and MSP.
    • So long as the necessary information is available, the individual will be “administratively renewed” (also called “ex parte renewed”), which means the individual will not need to do anything and the MECM system will renew the individual. Hopefully, Medicaid benefits and MSP for most consumers will be administratively renewed. These Medicaid recipients will receive a notice (branded as NYSOH), telling them that their Medicaid has been renewed.
    • For anyone for whom MECM was not able to find all of the information needed for renewal using existing state and federal data sources, they will receive a notice (branded as NYSOH) instructing them to log-in to MECM, contact a MECM Assistor, or call the NYSOH Call Center to manually renew their Medicaid by no later than January 15, 2026. Consumers in this group who have not completed their renewal by January 15, 2026 will receive a notice that their Medicaid will be terminated at the end of January 2026.
    • Most people in MECM will receive notices (branded as NYSOH) in the mail, as paper notices is the default communication preference in MECM. However, if their communication preference is set to paperless notices, they will receive their notices via email instead. MECM will also send out text reminders for renewals.
    • If MECM identifies that any of these “wave 1” cases have a spend-down, NYLAG understands that MECM will transfer the case to the LDSS with Medicaid coverage and the LDSS will initiate a paper renewal process with the consumer.
• January 2026: Begin Monthly Transfers of Wave 1 non-MAGI Cases from LDSS to MECM
  • Transfer first batch of wave 1 Medicaid cases from the LDSS: In January, certain non-MAGI cases from the LDSS’s (those that meet wave 1 criteria) were transferred onto NYSOH for one month, and then into MECM. DOH has said that in January alone, 65,846 cases were transferred from downstate WMS (New York City), and 17,005 cases were transferred from Rest of State WMS.
  • Monthly transfers from LDSS begin: Starting this month, DOH will conduct monthly transfers of these non-MAGI cases from the LDSS's into MECM, until all have been transferred. DOH projects there are roughly 150,000 cases total to transfer from the LDSS's to MECM. DOH has said that these transfers are happening 5 months before renewal for downstate WMS cases, and 90 days before renewal for Rest of State WMS cases. Once transferred, the case will "tip toe" through NYSOH for one month, before ultimately landing in MECM. The case will then go up for renewal in MECM the same month that it would have gone up for renewal at the LDSS. NYLAG understands that DOH will only transfer those cases that have been fully processed by the LDSS; in other words, pending applications and pending renewals will not be transferred into MECM until the LDSS first processes the case.
• February 2026: Resume Monthly Transfers of Wave 1 non-MAGI Cases from NYSOH to MECM, Continue Monthly Transfers of Wave 1 non-MAGI Cases from LDSS to MECM
  • Transfer of second batch of wave 1 Medicaid cases that were in NYSOH as MAGI Medicaid from before COVID and then became non-MAGI Medicaid during COVID: Additional non-MAGI Medicaid cases were transferred from NYSOH into MECM.
  • Monthly transfers from NYSOH resume: Starting this month (after a brief pause since September 2025), DOH will resume the monthly transfer of these non-MAGI cases from NYSOH into MECM, until the roughly 140,000 cases formerly on NYSOH are all on MECM. The case will then go up for renewal in MECM the same month that it would have gone up for renewal in NYSOH.
  • Monthly transfers from LDSS continue: DOH will continue monthly transfers of these non-MAGI cases from the LDSS's into MECM, until all have been transferred.
  • Total cases transferred into MECM in February: Over 14,000 cases (a combination of those cases from NYSOH and those from the LDSS's) were transferred into MECM in the first week of February. The renewal cycle for these cases will start on 4/1/2026. If MECM cannot administratively renew their case, the client will be sent notice the first week of April notifying them that they must renew by 5/15/2026, otherwise their coverage will end on 5/31/2026. (However, see the section below titled "Late" and "Late Late" Renewal Option in MECM, explaining that MECM clients may renew within 1.5 months after the due date, and have their Medicaid case be re-opened retroactive to the date of closure.)
• March 2026: Continue Monthly Transfers of Wave 1 non-MAGI Cases from NYSOH to MECM and from LDSS to MECM
• April 2026: Continue Transfers and Bring onto MECM MSP cases Initiated by LIS (effective April 1, 2026)
  • As of April 1, 2026, DOH will start bringing the following cases onto MECM: MSPs initiated by a Low-Income Subsidy (also known as “LIS” or “Extra Help”) application. You can read more about this in the Local Commissioner's Memo: Transition of Low-Income Subsidy File Medicare Savings Program Determinations to the Medicaid Eligibility Client Management System (26 OHIP/LCM-01) released August 10, 2026. This LCM states "[e]ffective April 1, 2026, LIS file MSP determinations have been implemented in the Medicaid
    Eligibility Client Management (MECM) system. This change aligns with the Department’s continued takeover of eligibility determinations from the Welfare Management System (WMS) and will streamline enrollment into MSP for eligible individuals who have applied for LIS. As previously communicated to LDSS and HRA via email on April 8, 2026, local districts and HRA are not responsible for processing LIS files with dates of April 1, 2026, or later. LDSS and HRA staff are responsible for processing all LIS files with dates earlier than April 1, 2026, in accordance with their existing LIS file processes."
  • DOH will also start automatically putting up MSP benefits for eligible individuals who do not currently have MSP. These benefits will be retroactively dated to 4/1/26.
• May 2026: Continue Transfers and Bring onto MECM Medicaid cases for Presumptive Eligibility for Pregnant Individuals
  • DOH will start bringing the following cases onto MECM: Presumptive Eligibility for Pregnant Individuals. (Note that, as of late August, PE-PI has yet not launched in MECM. It is unclear when it will launch.)
• 2027 and beyond:
  • November 2027 is the "go-live" date for wave 2 cases. We do not yet know which populations DOH plans to bring onto MECM in wave 2.
  • As a reminder, in the upcoming years, DOH will eventually bring all other non-MAGI Medicaid cases from the LDSS (including MLTC enrollees, HARP enrollees, MBI-WPD program participants, nursing home residents, and others) and all other MAGI Medicaid cases from the LDSS (including Family Planning Benefit Program, Foster Care cases, and others) onto MECM.

Phase-in Schedule - Wave 2 Starting November 2027

MECM Wave 2 will be rolled out between November 2027 and February 2028. Wave 2 will include the following seven populations. The information listed below is copied/pasted from slides written by DOH, with screenshots pasted below.

1. Community coverage with CBLTC (community based long term care): Includes SSI-related individuals who are determined eligible for Community Coverage with Community-Based Long-Term Care (CBLTC), which includes all Medicaid-covered care including Home and Community Based Services (HCBS) waiver but not nursing facility services.
2. Three of the Four 1915(c) HCBS Waiver Programs: Children's Waiver, Nursing Home Transition and Diversion (NHTD) Waiver, and Traumatic Brain Injury (TBI) Waiver. (Note that the OPWDD Waiver is not a part of Wave 2.)
3. Nursing Home Care: Provided to eligible institutionalized individuals; Medicaid budgeting scenarios include community budgeting, chronic care budgeting, and spousal impoverishment budgeting
4. Office of Mental Health (OMH) population: Upon admission into an Office of Mental Health (OMH) psychiatric center, individuals who have Medicaid are suspended from coverage. Upon discharge, individuals’ coverage is typically reinstated, and they are provided five months of Medicaid coverage.
5. 1115 waiver authority - MLTC Program: Streamlines the delivery of LTC services to people who are chronically ill or disabled and who wish to stay in their homes and communities. These services are provided through Managed Long-Term Care (MLTC).
6. Medicaid Cancer Treatment Program (MCTP): New York State residents who have been screened and/or diagnosed through the Cancer Services Program Partnership (CSPP) (or a qualifying provider pathway) with breast, cervical, colorectal, or prostate cancer and are in need of treatment, but are not otherwise adequately insured.
7. Medicaid Buy-In for Working People with Disabilities (MBI-WPD): Medicaid Buy-In for Working People with Disabilities (MBI-WPD) helps eligible NY residents with disabilities who are working stay enrolled in Medicaid even if their earnings are above standard Medicaid limits. It is designed to support employment by preserving access to health coverage and related services for working adults with disabilities.

Updates from First Few Months of MECM (slides/stats from DOH)

Data on Applications and Renewals (organized from most recent to least recent):

DOH shared at an August 25, 2026 meeting the following slides about MECM, including information on wave 2:

DOH shared at a July 15, 2026 meeting the following slides about MECM:

DOH shared at an April 8, 2026 meeting the following updated statistics on MECM:

• 1. Total number of people in the MECM system: 95,247 people. Of those, just under 27,000 are Medicaid-only cases, roughly 11,300 are MSP-only, and roughly 57,000 are Medicaid and MSP.
  2. Total number of application-related approvals vs. denials (noting that the data is not perfect, because some people may have lost coverage and then come back and applied again): Roughly 99,000 approvals and 12,000 denials.
  3. Percent of renewals in MECM could be administratively renewed vs. percent went to "manual renewal" (meaning the Medicaid recipient had to log onto NYSOH or work with a MECM Assistor or call the NYSOH Call Center to renew their Medicaid case before the deadline): For individuals who received their renewal the beginning of April, 41% were administratively renewed and 59% went to "manual renewal."
  4. Number of cases DOH has transferred each month from NYSOH to MECM:
     1. October 2025 = 13,475
     2. February 2026 = 36,322 (this number included a "scoop and dump" population that went from WMS into NYSOH into MECM)
     3. March 2026 = 16,700
     4. April 2026 = 26,060

 Below is a slide from DOH, dated March 20, 2026, showing the MECM roadmap for 2026:

.

Below is a slide from DOH with data as of March 10, 2026.

Below is a slide from DOH with data as of January 23, 2026. 

Below is a slide from DOH with data as of December 5, 2025. Note that “admin renewed” describes the cases that the MECM system could fully renew using access to state and federal data sources, without any additional actions undertaken by the Medicaid recipient. The cases that were “moved to manual renewal” are those that the MECM system could not admin renew, and thus those consumers received a notice telling them they must manually renew by January 15, 2026. 

Challenges and Benefits of MECM

The transition of non-MAGI applications and renewals to a new online system poses several challenges as well as benefits.

Challenges of Designing and Implementing MECM: 

• Unlike MAGI Medicaid, Non-MAGI Medicaid has a strict limit on resources. Since MAGI Medicaid has no limit on resources, the existing system used on NYSOH for MAGI Medicaid needed extensive changes to process non-MAGI applications.
• Non-MAGI Medicaid has many special budgeting rules that do not exist in MAGI Medicaid. For example: people with excess income may use medical bills to “spend down” their income to the Medicaid limit or may use a pooled trust to eliminate the spend-down, spousal impoverishment budgeting and “spousal refusal” are unique to non-MAGI Medicaid, and nursing home Medicaid has an entirely different type of budgeting. Programming the MECM system to correctly apply these special budgeting rules is a challenge. This is why the MECM roll-out is starting with the simplest cases – people whose income is under the Medicaid income limits so they do not need to use a “spend down” or other special budgeting rules.
• Phased-in approach leaves multiple “doors” and complicated transitions between systems. Medicaid applicants and enrollees in New York State will now need to navigate between NYSOH, MECM, and the LDSS. People may be confused as to which “door” to use for their application or their renewal, and they may attempt to use the wrong “door.” Although these three systems should speak with one another, and people should receive transfers/referrals between them, some consumers’ Medicaid applications or cases may fall through the cracks during the transition.
• Fair Hearings for some non-MAGI Medicaid eligibility issues will change. Historically, all non-MAGI Medicaid eligibility Fair Hearings and service-related Fair Hearings were heard by Administrative Law Judges through OTDA (the New York State Office of Temporary and Disability Assistance). However, with the changes brought on by MECM, non-MAGI Medicaid cases on MECM will now have their eligibility Fair Hearings heard by Hearing Officers through NYSOH, not Administrative Law Judges through OTDA. Meanwhile, non-MAGI Medicaid cases at the LDSS/HRA will continue to have their eligibility Fair Hearings heard by Administrative Law Judges through OTDA. (Note that the process will remain the same for MAGI Medicaid cases on NYSOH: NYSOH Hearing Officers will hear their eligibility Fair Hearings as well as their service Fair Hearings.) This change will inevitably confuse some consumers, who will contact the wrong agency to request a fair hearing and Aid To Continue. It is unclear what the transfer/referral process will be between the Fair Hearing divisions at OTDA and NYSOH, and a smooth process is necessary to protect appellants’ due process rights.

Benefits of MECM:

• The MECM system, like NYSOH, can verify application-related income and assets instantly, using electronic state and federal data sources that could not be connected to the old LDSS system (WMS). This data connection will allow real time eligibility determinations and will reduce the paperwork burden on applicants. Users will be prompted to provide more information when the system can’t fully verify from existing data sources.
• Renewals will also check back-end state and federal data sources, and thus be automated. MECM will also automate the process of verifying ongoing eligibility for Medicaid, reducing the need for manual renewal paperwork and mailing delays. Online renewals with income and asset verification done on the back end holds the promise of minimizing interruptions in coverage. Automatic renewal (without the need for the Medicaid recipient to complete any paperwork) is called an “administrative renewal” or “ex parte renewal.”
• There should be “no wrong door.” Applications on MECM will be screened and should receive a transfer/referral to wherever their Medicaid/MSP case should exist, be it in MECM, NYSOH, or the LDSS/HRA.
• MECM is all-device friendly. Users can apply for and renew their Medicaid/MSP benefits using a phone, tablet, computer, via text message, over the phone, in person, or via paper application. The website is also responsive to different devices and screen sizes, facilitating better ease of use no matter what device someone uses to apply/renew.
• Higher MSP enrollment is expected. Nationwide, only 60% of MSP-eligible people are enrolled in MSP. The ability to apply online for MSP, and receive a same-day determination, will make applying for MSP easier, which should increase enrollment among eligible people.

On the Horizon:

As the new MECM system starts to accept and process new applications for non-MAGI Medicaid and MSP, the next challenges will be phasing in more complex Medicaid applications, such as those with special budgeting. Also, all 140,000 non-MAGI cases on NYSOH will be transferred onto MECM, and all non-MAGI Medicaid cases that now exist on the decades-old WMS system administered by the LDSS will be eventually transferred onto MECM as well.

Deloitte Retained as Consultant to Develop MECM

DOH hired Deloitte Consulting LLP (“Deloitte”) to design MECM. The Deloitte MECM contract (contract number C038860) is for nearly $1.2 billion, and extends from 8/1/23 to 6/30/29. As of 9/10/25, spending to date was a little over $250 million.

The original contract with Deloitte (for over $300 million) was set to expire on 9/8/26, but on 8/31/26, DOH extended the contract with Deloitte for an additional $866,115,422.61. This is about $10 million higher than the proposed amount.

Information about the proposed contract extension is available on the Higher Gov website: C038860 X-2: Medicaid Eligibility Client Management System with Deloitte Consulting LLP (ID: 2135072). The proposed contract extension, according to Higher Gov, was to "Add $856,728,863.00 to the contract" and "Extend the original contract term from 8/1/2023 9/8/2026 to a new end date of 6/30/2029." Further, according to the website, the contract amendment will:

• "Support the statutory requirement to centralize administration of all Medicaid programs
• Complete the migration of all Medicaid Complex Populations from the legacy Welfare Management System (WMS)
• Continue expanding eligibility and enrollment (E&E) functionality to onboard remaining Medicaid programs [and]
• Ensure the modernized system can respond to statutory changes and evolving customer needs."

Note that Deloitte has gained national press in recent years for issues with its Medicaid modernization systems, and three national advocacy groups (the National Health Law Program, Electronic Privacy Information Center, and Upturn) filed a formal complaint on January 31, 2024 urging the Federal Trade Commission to investigate Deloitte related to its Medicaid eligibility system errors. While we hope that similar issues will not occur in New York, it is important that the public is informed.

MECM Assistors

“MECM Assistors” are individuals who have been trained to help people apply for insurance on MECM. Staff at three organizations were chosen to be the initial MECM Assistors: Healthy Capital District Initiative, Public Health Solutions, and Community Services Society. Each of these organizations was already designated as a Facilitated Enroller for the Aged, Blind, Disabled (“FE-ABD”), meaning they already helped individuals enroll into non-MAGI Medicaid across New York State.

Since those initial three organizations, DOH has since reached out to get all FE-ABDs trained as MECM Assistors. In the coming months, additional organizations will be given the opportunity to become MECM Assistors as well.

Below is a slide from DOH, dated March 20, 2026, showing updates on MECM Assistors:

Current MECM Assistors can be found by going to the NYSOH Find Local Help page, under “Types of Assistance” unchecking “Families and Individuals under 65” and instead checking “Individuals 65 or older, or those who are blind or disabled,” and then clicking “Show Results.”

A quick note on NYSOH Assistors vs. MECM Assistors:

• NYSOH Assistor: This is the official umbrella term for the helpers for any type of NYSOH insurance (MAGI Medicaid, Child Health Plus, Essential Health Plan/Basic Health Plan, and Qualified Health Plan with APTCs). This term encompasses Navigators and CACs and Marketplace Facilitated enrollers (who work for health plans).
• MECM Assistor or MECM Certified Assistor: These are the official umbrella terms for helpers for any type of MECM insurance (right now: non-MAGI Medicaid and MSP, but eventually this list will be broadened). These terms encompass, for now, only FE-ABDs since no one else has been offered the training yet. But in the future, these terms will also include people from the LDSS's who have completed the training, HIICAP counselors who have completed the training, Navigators and CACs who have completed the training, and possibly others. We don't yet know exactly when these groups (beyond the FE-BDs) will be offered the training.

NYS Guidance and Information on MECM 

When DOH makes big policy changes, it must announce those changes through a policy directive, such as an Administrative Directive (“ADM”) or a General Information System ("GIS") message. You can find a list of ADMs and GISs, organized by per, on the DOH Library of Official Documents - Search by Year website. Although the MECM directive has not yet been released, we continue to monitor the DOH website for its release. We will update this article with the directive when it is available.

In the meantime, the DOH website on MECM is available here: Continuing The Medicaid Eligibility Modernization. The DOH website has some history of the modernization effort and the timeline, as well as other information.

Tips for Navigating MECM

Look for MECM Identifiers on Notices.

Although MECM notices will be branded as NYSOH, there are distinct identifiers for MECM cases that are different from NYSOH cases. Each MECM case number begins with the letters “MC” and has a Member ID beginning with the letters “PX.” See below for two examples of notices for MECM cases.

Meanwhile, each NYSOH case number begins with the letters “AC” and has a Marketplace ID beginning in the letters “HX.” See below for two examples of notices for NYSOH cases.

Caveat: Cases brought from the Local Departments of Social Services ("HRA" in New York City) into MECM, spend one month in NYSOH. For that one month in NYSOH, the consumer will receive notices with NYSOH identifiers. Subsequently, the consumer's case will be moved into MECM, at which point the consumer will receive notices with MECM identifiers.

If you miss the renewal deadline, don't forget the "Late" and "Late Late" renewal option in MECM!

Since 2016 (the early days of the ACA), DOH has permitted "late" and "late late" renewals for MAGI Medicaid cases on NYSOH. DOH has confirmed that it will also permit "late" and "late late" renewals for non-MAGI Medicaid cases on MECM, and DOH encourages people with cases on MECM to go into the system and try to renew their Medicaid even if the renewal date has passed.

Slide 16 of this DOH slide deck on the Public Health Emergency Unwinding describes how late renewals work: “Generally, renewals must be completed within a 30-day window as specified in the consumer's notice. [Medicaid] enrollees who do not renew timely, may still renew after their renewal window and through the end of the following month, after their coverage has ended. If they remain eligible for the same program and they enroll in the same plan that they had the previous year, then NY State of Health will provide coverage in the plan without any gaps. As always, [Medicaid] enrollees changing plans will have Fee-For-Service coverage while awaiting plan enrollment and will not have gaps in coverage.”

Here is the above information applied to a hypothetical Medicaid recipient in MECM named Bob. Bob has a (roughly) 30-day renewal window in MECM (meaning his renewal will be considered “timely” in MECM) of February 15, 2026 to March 15, 2026. If MECM cannot admin renew Bob’s Medicaid on February 15, 2026, Bob will receive a notice (branded as NYSOH but with the MECM identifiers shown above) telling him that he must manually renew his Medicaid by March 15, 2026, otherwise his coverage end date will be March 31, 2026.

• Scenario one ("late renewal"): If Bob forgets to manually renew by March 15, 2026, but he does manually renew between March 16 and March 31, 2026 (and if he remains eligible for Medicaid), then his Medicaid coverage will not end. Instead, he will have continuous coverage, because MECM will allow for his "late" renewal.
• Scenario two ("late late renewal"): If Bob forgets to manually renew by March 31, 2026, his Medicaid coverage will end on March 31, 2026. Let’s say that Bob then goes to his primary care doctor (a New York State Medicaid provider) for a doctor’s appointment on April 6, 2026. One week later, Bob realizes that his Medicaid coverage has ended. So long as Bob manually renews between April 1 and April 30, 2026 (and so long as he remains eligible for Medicaid), his Medicaid coverage will be turned back on retroactive to April 1, 2026, because MECM will allow for his "late late" renewal. Further, because his Medicaid coverage was turned back on retro to April 1, and there was no lapse in coverage, Bob’s primary care doctor (a New York State Medicaid provider) can resubmit the claim for the April 6, 2026 visit, and be reimbursed by Medicaid. Note that if Bob was previously in a Medicaid Managed Care Plan, he must choose to stay in that same Medicaid Managed Care Plan for the "late late" renewal option to work without any gap in coverage.

If you're going to appeal a MECM issue, check out the NYSOH Appeals FAQ.

On January 26, 2026, NYSOH updated its appeals and fair hearing FAQ page titled Questions about Appeals. The page now includes information about MECM and speaks to important Medicaid protections such as “Aid to Continue.” We encourage you to share this website widely with communities whose cases are, or may be, in NYSOH or MECM.

Remember that there are limits on where to apply for MSP.

NYLAG recently learned about a Medicaid recipient whose Medicaid case was at the LDSS, and when they went to apply for MSP on MECM, they were unable to do so. We’ve since learned that Medicaid recipients must apply for MSP wherever their Medicaid case currently is. This means if your Medicaid case is at the LDSS, and you want to apply for MSP, you must do so at the LDSS using the paper application. The only people who can apply for MSP on MECM are: (1) individuals who do not already have Medicaid and so are applying for Medicaid and MSP at the same time, and (2) individuals whose Medicaid case is already in MECM and now are wanting to apply for MSP.

You can bypass the Identity Proofing and email address requirement by working with a MECM Assistor.

Individuals who wish to apply for Medicaid or MSP in MECM directly on the New York State of Health must first create (or use an existing) My NY.Gov ID, which requires that they go through Experian Identity Proofing and also requires that they have an email address. (For more about the My NY.Gov ID, see the New York State government page, Get a My NY.Gov ID.)

However, any individual who works with a MECM Assistor (see more on them below) or works with the NYSOH Call Center to apply for Medicaid or MSP in MECM, does not need a My NY.Gov ID nor do they need an email address. For older adults, people with disabilities, and anyone else who may have difficulty navigating identity proofing and/or an email address, we recommend that they work with a MECM Assistor to apply for benefits in MECM.

​If your case is in MECM but should be moved to the LDSS/HRA, you have options.

Individuals with a case in MECM may need their case to be sent to the LDSS/HRA, because the MECM system cannot handle their case. Some examples of this include: an individual with Medicaid homecare who turns 65 years old and is enrolled into a MLTC plan, an individual who is found to have a spend-down at redetermination/renewal, and an individual who was in the process of applying to the MBI-WPD program or a waiver program and is finally accepted into that program.

If you need to move to the LDSS/HRA for homecare:

On July 7, 2026, DOH shared the following as the correct steps that a client should take if the client has a Medicaid case in MECM, but needs homecare (through a MLTC or through Straight Medicaid) and so needs their case sent back to the LDSS.

(Big caveat is that MECM processes and systems are constantly changing, so this may very well change in the future, but at least as of today, this is what we know to be true!)

1. The client must make sure that MECM knows they need homecare. They can do this in one of three ways: they can mark in their MECM casefile that they need LTC, they can ask a MECM Assistor to mark in their MECM casefile that they need LTC (this is what NYLAG recommends!), or they can call the NYSOH Call Center and say that they need LTC.

2. Next, the client must contact NYIAP (1-855-222-8350) to schedule the two assessments. The client should learn about their need to contact NYIAP in one or both of the following ways:

   1. 1. The client should receive a letter in the mail notifying them to contact NYIAP to schedule his two assessments.

      2. If the client reported their need for LTC on a phone call with the NYSOH Call Center, then the NYSOH rep should also verbally notify the client that they must contact NYIAP to schedule their two assessments.

3. After the NYIAP assessments are scheduled and conducted, the assessment outcome notice is sent to the NYSOH Call Center, which triggers a manual transfer of the client's case from MECM to the appropriate LDSS (still with code 20: community coverage without long term care). That said, we recommend the client follow up with the NYSOH Call Center to share the assessment results and to confirm that the manual process has started, since the ball might get dropped here.

4. After the LDSS gets the transfer, the LDSS will be able to see the client's attested resource amount from their MECM case, and will send a documentation request notice to the client asking them to document their resources. If the resources are below the limit, the LDSS will then upgrade the client's coverage to code 30 (community coverage with long term care).

5. The client can now enroll in a MLTC plan and start requesting services. Enrollment must be completed by the 18th of the month for services to start by the 1st of the following.

If you need to move to the LDSS/HRA for another reason that is not for homecare:

The individual (or their helper) can request that the case be transferred from MECM to the LDSS/HRA by working with an MECM Assistor, who can indicate a change on the MECM application (such as: the individual now has a spend-down) that should get the case transferred back to the LDSS/HRA.