A new work mandate is looming for about 1.9 million New Yorkers who are enrolled in Medicaid and will have to show they're working or engaged in another activity in order to keep their public health coverage.
The state Department of Health plans to notify by Sept. 30 all Medicaid recipients who may be subject to the federal work requirement, which takes effect Jan.1. New York has about 6.4 million residents in all who are covered by Medicaid, many of whom are children, senior citizens and people with disabilities who won't be compelled to work.
The requirement was a key part of the "One Big Beautiful Bill Act," the giant package of tax and spending cuts that President Donald Trump and Republicans in Congress enacted over Democratic opposition
last year. The law's Medicaid changes are expected to cut nearly $1 trillion in federal spending from the program over the next decade.
Unless they qualify for an exemption, adults under age 65 who are applying for or renewing Medicaid coverage must show they are working at least 80 hours a month, or else be enrolled in school or a job training program or doing volunteer service for those same hours. Among those who will be spared that mandate are people with disabilities and pregnant women.
Anyone bound by the requirement who fails to comply will be denied coverage.
How is the state rolling out the new Medicaid work requirement?
New guidelines about the approaching work mandate were posted online on Aug. 10 by NY State of Health, the Department of Health division that oversees Medicaid and other health plans. The office is sending out notices by mail and email explaining to recipients how to comply and possible reasons they could be declared exempt.
The requirement kicks in for new sign-ups right away when it takes effect on Jan. 1. Those enrolled before then will have to show they're in compliance the next time they renew their coverage. For some, that could come as early as March 1.
The 2025 federal law also mandated more frequent Medicaid renewals to check if recipients still qualify. Starting Jan. 1, most adults under age 65 must renew their coverage every six months — instead of once a year — to verify that they meet the program's eligibility requirements, including the new work mandate.
Court fight over "medically frail" exemption
The law excluded those deemed "medically frail" due to physical or mental conditions that prevent them from working, including those undergoing complex medical treatment. But the Trump administration has set rules for proving that exemption that prompted a lawsuit in June by New York and 24 other states.
The states are trying to force changes, arguing the rules are excessive and will make it harder for states to identify people who qualify as "medically frail" and harder for recipients to prove they are. They warn that people who need Medicaid and can't work may lose coverage solely because they couldn't secure the necessary paperwork.
The case is pending in federal court in Massachusetts. In an announcement of the case in June, New York Attorney General Letitia James' office said the Department of Health had estimated at least 475,000 New Yorkers could lose Medicaid coverage due to the work requirement and more frequent eligibility checks.
Federal law forced rollback in NY's Essential Plan
The Medicaid changes enacted last year have already were expected to cost about 450,000 New Yorkers their health coverage through another program known as the Essential Plan. Facing a huge funding loss due to the 2025 federal law, state officials were forced to shrink Essential Plan enrollment by undoing the expanded eligibility they had put in place just two years earlier.
The Essential Plan offers full coverage with no premiums and some copays to New Yorkers with low incomes just above the cufoff to qualify for Medicaid. Nearly 1.4 million are enrolled now after the income eligibility was lowered on July 1.
Those who lost their coverage due to federal cuts have until Aug. 30 to enroll in a private plan through the state-run insurance exchange — if they could afford it — and be covered retroactively back to July 1.
According to a recent breakdown of the Essential Plan fallout by the Department of Health, 183,000 people who were set to lose coverage either wound up staying in the Essential Plan or qualifying for Medicaid instead because their incomes dropped. Another 59,000 lost coverage and are buying private insurance through the state-run marketplace, most of them with federal subsidies to lower the premiums.
That left 192,000 former Essential Plan enrollees who now had no coverage through any of those programs.
“The Department is committed to using every resource at its disposal to help individuals who have not enrolled through NY State of Health or found alternate coverage options," state officials told the USA TODAY Network in a statement.
Chris McKenna covers government and politics for The Journal News and USA TODAY Network. Reach him at CMcKenna@usatodayco.com.
This article originally appeared on Rockland/Westchester Journal News: Medicaid work mandate nears for 1.9M in NY as details come into focus
