Federal healthcare cuts and Medicaid eligibility changes that went into effect July 1 left nearly half a million New Yorkers without healthcare. One month into that shift stemming from President Trump’s One Big Beautiful Bill enacted last year, here’s what healthcare lawyers say people should be looking out for, where they can seek new coverage, how immigrants are disproportionately impacted and who’s at risk of losing their healthcare next.
Lawyers in New York say they are most concerned about the eligibility change that, on July 1, kicked about 450,000 New Yorkers off what’s called the Essential Plan, which provided very low or no-cost federally funded healthcare with $0 premiums and deductibles for those ineligible for Medicaid. About 200,000 of those people have found healthcare since, many through their employer, but the majority of those people are without coverage.
Those who were kicked off include people making between 200% and 250% of the federal poverty line, or about $32,000 to $39,000/year ($31,920 as a household of one is now the upper income to be eligible for this plan). Lawyers and healthcare experts, including Elisabeth Benjamin, attorney and vice president of The Community Service Society of New York, say the situation is incredibly troubling and “very destabilizing” to providers and patients alike.
“It’s a very serious situation that we are confronting as a society, as a result of this bill,” said Benjamin during a New York City Bar Association meeting. “We can expect an increase of about 42,500 deaths annually due to coverage loss. There’s very robust medical research: not having access to health insurance or having access to poor quality health insurance, with more expensive out-of-pocket costs, leads to death.”
Many people who lost coverage on that plan were younger people without stable incomes – like freelancers – and those who remain without coverage are primarily those who don’t have access to good, affordable, or any employer-funded healthcare, Legal Aid attorney Lillian Ringel told amNewYork.
If you have lost coverage, Ringle said, you can see your options to purchase a new plan on the state’s healthcare marketplace. But the options are prohibitively expensive for many low-income New Yorkers who were previously on the Essential Plan: Some of the cheapest options are about $200/month, but some families of four will have to pay $10,000 more a year in healthcare costs.
“These people make between $31,000 and $39,000 a year, so to be asked to spend thousands of dollars on health insurance is really not possible for many of these New Yorkers, and it’s a real travesty for these folks,” Benjamin said. “We run a live answer helpline, and our call volume has doubled and tripled. We are just being inundated by the half million people that lost coverage on July 1st, they’re going to the marketplace and their choices in the marketplace are not good.”
And, the bill will change who’s eligible to purchase much of the subsidized healthcare on that state marketplace. By 2027, only U.S. citizens, green card holders, some Cuban and Haitian immigrants and people from a group of Pacific Island countries known as the Compact of Free Association, which includes the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau, will be able to seek healthcare that way.
In October, federal Medicaid funding will be lost for many categories of lawful immigrants, such as refugees and asylees, Benjamin said, taking away federal assistance to participate in the state’s marketplace.
“All other immigrants, refugees, asylees, including people who’ve applied for a green card but haven’t yet gotten it, will no longer be eligible to participate in marketplace coverage,” Benjamin said. “That will really impact well over 600,000 people in New York State.”
There are some exceptions, including people under 19 years old, people deemed medically frail, or those who have been incarcerated in the past three months.
A potential solution for immigrants losing access to this care may exist in what’s known as the basic health program. Benjamin said New York State has an $8 billion stockpile of funds that can be used to provide some healthcare coverage to this group of legal immigrants losing it because the state’s run the program “so efficiently for years.”
She added that the state’s been doing all it can to maintain coverage for people in light of the federal cuts. Lawyers note it’s worse in other states: New York has put a large amount of funding into filling the gap left by the federal government pulling out, and a Court of Appeals decision requires the state to provide state-funded Medicaid in the absence of federal funding.
This litany of new eligibility requirements and alterations for the various plans makes it difficult for people to figure out exactly where they fall. Benjamin and Ringel said they encourage people to reach out to help, whether it’s to a state-run program where they can be connected with a healthcare navigator, calling up the state marketplace yourself, or reaching out to a legal advocate, like Legal Aid, to receive personalized guidance.
“It’s so complex that you have to be a real expert to help people enroll in coverage,” Benjamin said. “I encourage you, if you know anybody who wants health insurance, please send them to an in-person assistor, called a navigator, and they can help you deal with how complex this has become.”
Ringel’s concerned all of this will make people – particularly immigrants – forego medical care. She urges them not to.
“If you are sick, if your family member is sick, it is really important you seek care,” Ringle said. “Your health is really, really important.”
“And many groups of people are still eligible for health coverage, even if they hear talk that may not be,” Ringle added. “Even if you are undocumented and ineligible for comprehensive Medicaid, you are still eligible for emergency Medicaid and for all sorts of other healthcare access programs throughout New York City and New York State. I just want to reiterate that people need to be accessing healthcare, and there are places where they can do so.”
Who will lose coverage next?
When 2027 rolls around, a workplace eligibility requirement for Medicaid will kick in: Everybody between the ages of 19 and 64 will have to prove they work either 80 hours a month or earn $580 a month.
“It’s 2 million people who are subjected to this,” said Frederic Riccardi, the president of the Medicare Rights Center, also addressing the New York City Bar Association. “That’s going to be a huge hit to that group of folks.”
Adults will have to prove every six months that they’re meeting these requirements, and children and their families will have to prove this every 12 months. If you can’t prove it, you’ll lose your coverage.
There are again exceptions: People under 19 years old or over 65 years old, people deemed medically frail, and people who are pregnant or are less than 12 months postpartum.
26 states, including New York, are suing over the restriction. The suit remains pending in Massachusetts federal court.
“All these key Medicare changes that were included set a dangerous precedent because it changed who is eligible for Medicare,” Riccardi said. “It’s a departure from a longstanding policy that connected Medicare eligibility to individuals who’ve paid sufficient Social Security and Medicare taxes.”
Free and low-cost healthcare options
There are other community-based, city and state-run options for healthcare if you lose coverage, Ringle said, and she emphasized that people should seek them out.
“People who lose coverage entirely may need to seek care through programs like New York City Care through NYC Health and Hospitals,” Ringle said. “That’s a low- or a no-cost healthcare access program.”
There are also community clinics offering care on a sliding scale across the city, Ringle said.
Additionally, if you are anywhere in New York State, hospitals have to offer something called Hospital Financial Assistance for people under 400% of the federal poverty level. But, Ringle said, some hospitals may elect to offer that assistance for people who make more than that limit, regardless of their immigration status.
“People shouldn’t be afraid of going to the hospital for fear of not being able to afford their care, because New York has a really robust hospital financial assistance program,” she said.
What to do if you aren’t sure if you’ve lost coverage
People really need to be hyperaware of their mail, Ringel told amNewYork. She emphasized that that’s where they’ll be receiving notices about eligibility changes and new options.
“It’s so important for people to be checking their mail and staying up to date,” Ringle said. She emphasized that that’s where people will receive information on whether and how they’ll need to comply with the new work requirements as well.
Additionally, it’s important to respond to those notices and ensure the state is aware of your current income.
“It’s so important for people who receive notifications or who have received notification about their coverage to respond and to ensure that all of their information, their income, their other eligibility information, their addresses, etc. are up to date with New York State,” Ringle said. “If someone got a notice about losing Essential Plan coverage, if they have had a decrease in their income that makes them eligible for Medicaid or the Essential Plan, then they want to make sure that they are letting the state know about that.”
Beyond that, she advised people to simply call up the state marketplace or a legal advocate, such as Legal Aid, to receive guidance.
“If you think that your Medicaid or other coverage has been cut off without notice, maybe you’ve gone to the doctor and the doctor is telling you you don’t have coverage,or your coverage isn’t active right now, I would recommend that you call the New York State of Health,” Ringle said. “That phone number is 855-355-5777.”
Impact on state finances and hospital systems
Benjamin and Ringel said the depletion of federally funded healthcare will likely result in hospitals not being able to pay their bills because they will lose out on expected revenue, leading to hospital closures, tens of thousands of healthcare providers being laid off and higher care costs across the board.
The full slate of changes will mean the state’s healthcare system loses out on about $13 billion annually, Benjamin said, and deliver about $8 billion in losses to hospital care providers and $300 million for health center providers.
“We will continue to see hospitals close over the next decade, that’s for sure,” Benjamin told the attorneys gathered for the bar association’s talk. “They’re projecting 34,000 hospital job losses and 29,000 other healthcare-related job losses.”
Thomas Quatroche, president of the Healthcare Association of New York State, said he’s hearing from hospitals that they’re struggling with the financial burden of being pushed to provide uncompensated care that would previously have been federally funded through a person’s Essential Plan.
“Access to services continues to be a problem due to low reimbursement, and it is the moral and legal obligation of our hospitals across New York State to see everybody that comes to them in the emergency room,” Quatroche said. “The emergency rooms have been very, very busy. Some have been overwhelmed with patients, and that’s because of the lack of access in our community and the lack of reimbursement for services, especially primary care and preventive services in our community.”
He said hospitals are particularly concerned about having to soon grapple with more people losing health insurance when the work requirements kick in.
“The hospitals are very concerned because any loss of coverage creates a lack of access,” Quatroche said. “We obviously have more concerns about coverage coming into next year with the new work requirements, which people may present themselves to the emergency departments across the state without coverage, and that creates more uncompensated care, which creates more financial burden for our hospitals across the state.”
Because hospitals are typically seen as a safety net people turn to in emergencies – which are happening more because people aren’t accessing preventative care due to the eligibility cuts – and they must provide care to all who walk in, the less health insurance that people have means the less chance for those providers to be paid.
“Not being able to be reimbursed for services that are provided creates financial strain,” he said. “We’ve seen hospitals close programs. We’ve seen hospitals both statewide and nationally have to lay off individuals.”