\u00a0<\/p>\n
Centers for Medicare & Medicaid Services Approves New York\u2019s Request to Transition Back to Basic Health Program\u00a0Authority\u00a0<\/p>\n
Approximately 450,000 New Yorkers\u00a0Will Become Ineligible for the Essential Plan Beginning July 1, 2026, and Will Instead Be Eligible for Qualified Health Plans\u00a0<\/p>\n
ALBANY, N.Y. (March 23, 2026) –\u00a0The New York State Department of Health provided an update following federal approval from the Centers for Medicare & Medicaid Services (CMS) of the State\u2019s request to terminate its Section 1332 State Innovation Waiver and return to Basic Health Program\u00a0(BHP) authority.\u00a0\u00a0<\/p>\n
The transition preserves Essential Plan coverage for approximately 1.3 million New Yorkers with incomes below 200 percent of the federal poverty level.\u00a0<\/p>\n
“Our priority is to ensure New Yorkers continue to have access to affordable, high-quality coverage,\u201d\u00a0State Health Commissioner Dr. James McDonald said. \u201cWe are focused on supporting individuals through this transition and making sure they understand their options and can maintain continuity of care.\u201d\u00a0\u00a0<\/p>\n
Danielle Holahan, Executive Director of NY State of Health, said,\u00a0\u201cNo New Yorker should have to choose between keeping the lights on and seeing a doctor. We are committed to doing everything within our power to support every affected member through this transition \u2014 connecting them with enrollment assistors, ensuring 90-day advance notices and making the path to new coverage as clear and accessible as possible.\u201d\u00a0\u00a0<\/p>\n
As a result of federal policy changes, most of the approximately\u00a0450,000\u00a0New Yorkers currently enrolled through the Essential Plan benefits will become eligible for Qualified Health Plans in the individual marketplace beginning July 1, 2026, where they may face higher\u00a0premiums, deductibles and out-of-pocket costs.\u00a0\u00a0<\/p>\n
The loss of coverage for\u00a0these low-income New Yorkers\u00a0is a direct result of H.R. 1 (Public Law No. 119-21), the federal budget legislation championed by\u00a0Congressional Republicans\u00a0that\u00a0eliminated\u00a0funding for the expanded Essential Plan.\u00a0<\/p>\n
For the 450,000 affected New Yorkers, the transition from Essential Plan to Qualified Health Plan coverage\u00a0represents\u00a0a\u00a0significant change. While Essential Plan enrollees currently pay $0 in premiums and face minimal cost-sharing, Qualified Health Plans may include monthly premiums and higher deductibles. Even with available federal tax credits, enrollees will incur monthly premiums and can face deductibles\u00a0of thousands\u00a0of dollars before coverage kicks in. This comes at a moment when New Yorkers are already navigating household budget pressures that have stretched family finances to the limit.\u00a0The state cannot make up for these devastating cuts but\u00a0is working\u00a0with insurers to ensure that anyone moving from the Essential Plan to a Qualified Health Plan mid-year will see their deductible cut in half.\u00a0\u00a0<\/p>\n
The affordability burden is compounded by the\u00a0expiration at the end of 2025\u00a0of enhanced premium tax credits that were first\u00a0established\u00a0under the American Rescue Plan Act of 2021\u00a0\u2013 credits that Congressional Republicans allowed\u00a0to\u00a0expire.\u00a0 Those credits significantly lowered QHP premiums for moderate and low-income consumers; without them, costs in the Qualified Health Plan market are nearly 40% higher than they would otherwise be \u2014 leaving the 450,000 transitioning New Yorkers in an even more financially precarious position.\u00a0\u00a0<\/p>\n
The State will\u00a0notify impacted enrollees\u00a0on\u00a0April\u00a01,\u00a0outlining their options and next steps. NY State of Health will expand outreach and in-person enrollment\u00a0assistance\u00a0to help members find the most affordable coverage available to them under the Qualified Health Plan market.\u00a0\u00a0<\/p>\n
New York’s Section 1332 State Innovation Waiver, approved by the federal government on March 1, 2024, expanded the Essential Plan to cover New Yorkers with incomes between 200 percent and 250 percent of the Federal Poverty Level \u2014 approximately 450,000 individuals and families who had previously been ineligible. Under the expansion, these enrollees received $0-premium, low-cost-sharing coverage that provided access to comprehensive health benefits.\u00a0\u00a0<\/p>\n
H.R. 1, signed into federal law in\u00a0July 2025,\u00a0eliminated\u00a0premium tax credit eligibility for most lawfully present\u00a0immigrants that\u00a0made the expanded Essential Plan financially\u00a0viable\u00a0for New York State. With\u00a0half of the program\u00a0funding eliminated, the State requested CMS approval to\u00a0terminate\u00a0the 1332 waiver, effective July 1, 2026. CMS has approved that request. The termination does not affect Essential Plan coverage for the approximately 1.3 million enrollees\u00a0with income\u00a0below 200 percent FPL, whose eligibility\u00a0is protected under the Basic Health Program\u00a0authority now in effect.\u00a0\u00a0<\/p>\n
Affected New Yorkers are encouraged to contact NY State of Health to understand their options and get free enrollment\u00a0assistance:\u00a0<\/p>\n
Contact: New York State Department of Health\u00a0\u00a0\u00a0<\/p>\n","protected":false},"excerpt":{"rendered":"\u00a0 Centers for Medicare & Medicaid Services Approves New York\u2019s Request to Transition Back to Basic Health Program\u00a0Authority\u00a0…\n","protected":false},"author":2,"featured_media":172586,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[38],"tags":[128,9,24,63,129,131,130],"class_list":["post-172585","post","type-post","status-publish","format-standard","has-post-thumbnail","category-the-bronx","tag-bronx","tag-new-york","tag-new-york-city","tag-nyc","tag-the-bronx","tag-the-bronx-headlines","tag-the-bronx-news"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/posts\/172585","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/comments?post=172585"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/posts\/172585\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/media\/172586"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/media?parent=172585"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/categories?post=172585"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/tags?post=172585"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}