New York's Essential Plan underwent a major eligibility cut on July 1, 2026. The income threshold dropped from 250% of the Federal Poverty Level to 200% FPL. Roughly 450,000 New Yorkers at 200-250% FPL lost their Essential Plan coverage on June 30, 2026. Essential Plan enrollees paid $0 in monthly premiums and had minimal cost-sharing. Qualified Health Plans at the same income range, even with ACA premium tax credits, carry monthly premiums and deductibles of several thousand dollars. The reason for the cut: federal H.R. 1 signed in July 2025 eliminated premium tax credit eligibility for most lawfully present immigrants, making the expanded Essential Plan financially unsustainable for New York State under its Section 1332 waiver structure. CMS approved New York's waiver termination request and authorized return to Basic Health Program authority, preserving coverage for the 1.3 million enrollees under 200% FPL while requiring those at 200-250% FPL to transition to Marketplace Qualified Health Plans. New Yorkers losing their Essential Plan or Medicaid due to a renewal redetermination in 2026 have 90 days from coverage loss to enroll in a new plan through NY State of Health at nystateofhealth.ny.gov.
Separately, many New Yorkers lost full Medicaid during the 2023-2025 Medicaid unwinding after the end of the COVID public health emergency continuous-enrollment protections. Ongoing 2026 Medicaid redeterminations continue to remove some enrollees from Medicaid for procedural reasons, income changes, or household changes. Loss of Medicaid in New York also triggers the same 90-day Special Enrollment Period for Qualified Health Plans. Both situations (Essential Plan loss and Medicaid loss) feed into the same enrollment pathway at NY State of Health. This guide covers what to check first (can you stay on Medicaid or Essential Plan at a lower income tier?), what documents to gather, and how to enroll in an ACA Marketplace Qualified Health Plan before your 90-day window closes. Use NY State of Health at nystateofhealth.ny.gov as your primary enrollment portal, not healthcare.gov, since New York runs its own state-based Marketplace and all NY coverage options flow through the state portal.
7 Steps to Get Coverage
Common Mistakes That Cost People Thousands
The costliest mistakes people make after losing NY Medicaid or Essential Plan coverage in 2026:
- Using healthcare.gov to enroll instead of NY State of Health. New York is a state-based Marketplace. All Medicaid, Essential Plan, and QHP enrollments for New York residents must go through nystateofhealth.ny.gov or 1-855-355-5777. Healthcare.gov will not process your application.
- Assuming your income is too high for the Essential Plan without checking. The Essential Plan threshold is 200% FPL ($31,920 for a single person in 2026). Many people at 200-250% FPL lost the 250%-tier Essential Plan on July 1, 2026, but those who had a drop in income may now re-qualify at the 138-200% FPL tier with $0 premiums.
- Waiting until after August 30, 2026 to enroll in a Marketplace QHP for the July Essential Plan cut. NY State of Health set August 30, 2026 as the practical enrollment deadline for July 1 coverage transitions. Applications after that date may still qualify through September 29, 2026 under the full 90-day window, but start dates push to October 1.
- Not checking children's Child Health Plus eligibility. New York's Child Health Plus covers children under 19 at incomes up to 400% FPL ($132,000 for a family of 4 in 2026) with $0 to $60 per month in premiums. Parents who lost Essential Plan coverage can still enroll their children in Child Health Plus year-round regardless of the parents' own coverage status.
- Reporting annual income from last year's 1040 when current-year income is lower. Medicaid and Essential Plan eligibility uses Modified Adjusted Gross Income (MAGI) projected for the current year. If your income dropped in 2026, report your projected current-year income, not your 2025 tax return figure.
- Going uninsured and assuming the gap will not matter. A hospital visit during an uninsured gap can result in thousands of dollars in medical bills. Use the 90-day SEP window. Medicaid and Essential Plan applications can often be processed within days.
What Changed on July 1, 2026: Essential Plan Income Limit Cut
New York's Essential Plan operated under a Section 1332 State Innovation Waiver that allowed the state to expand Essential Plan eligibility up to 250% of the Federal Poverty Level, covering roughly 1.75 million New Yorkers by late 2024. Federal law H.R. 1, signed in July 2025, eliminated premium tax credit eligibility for most lawfully present immigrants. This eliminated the federal funding stream that made the 250% FPL expansion financially viable. CMS approved New York's application to terminate the Section 1332 waiver and return to Basic Health Program (BHP) authority in March 2026. Under BHP authority, Essential Plan eligibility is capped at 200% FPL. The transition preserves coverage for approximately 1.3 million New Yorkers at or below 200% FPL under BHP, while removing the roughly 450,000 enrollees at 200-250% FPL from Essential Plan eligibility effective July 1, 2026.
People at exactly 200% FPL face no change: their Essential Plan coverage continues under the BHP authority. People between 200% and 250% FPL ($31,920 to $39,900 for a single person in 2026) lost their plans June 30, 2026. Those individuals must now enroll in Marketplace Qualified Health Plans through NY State of Health. ACA Marketplace premium tax credits are available at that income range, but the subsidy cliff at 400% FPL and the absence of enhanced premium tax credits means net premiums are higher in 2026 than they would have been in 2024 or 2025. NY State is working with insurers to offer mid-year reduced deductibles for Essential Plan to QHP transitions so that new enrollees do not face a full-year deductible starting mid-year.
NY Medicaid Renewal Redeterminations in 2026: Who Gets Removed and What to Do
Medicaid unwinding from the COVID continuous enrollment protections officially ended December 31, 2025. Beginning January 1, 2026, New York Medicaid operates under normal redetermination cycles. New York processes annual Medicaid renewals for most enrollees, with notice mailed 60-90 days before the renewal due date. Enrollees removed from Medicaid in 2026 may be removed for procedural reasons (outdated address, did not return renewal paperwork, income not verified) or substantive eligibility reasons (income increased above 138% FPL). Federal H.R. 1 also requires Medicaid redeterminations for expansion-eligible adults to occur twice per year starting December 31, 2026, meaning New Yorkers could face semi-annual renewal checks starting in 2027.
New Yorkers removed from Medicaid for procedural reasons should appeal immediately. New York Medicaid allows enrollees to request a fair hearing within 60 days of a termination notice and to continue benefits while the hearing is pending. Medicaid fair hearings in New York are administered through the Office of Temporary and Disability Assistance (OTDA). Call 1-800-342-3715 or visit otda.ny.gov to request a hearing. If removal was for substantive income reasons, the 90-day SEP for Marketplace QHP enrollment applies. Medicaid re-enrollment remains year-round if income drops back below 138% FPL.
State-Specific Rules: NY Essential Plan, Child Health Plus, and Marketplace Brands
New York runs several distinctive coverage programs not found in most other states. NY State of Health (nystateofhealth.ny.gov) is New York's official ACA Marketplace and enrollment portal for all coverage types including Medicaid, Essential Plan, Child Health Plus, and Qualified Health Plans. New Yorkers should never use healthcare.gov to enroll; it cannot process New York applications. Child Health Plus is New York's branded CHIP program covering children under 19 at incomes up to 400% FPL with premiums on a sliding scale from $0 to $60 per month. Enrollment is year-round. The Essential Plan is New York's Basic Health Program covering adults at 138-200% FPL with $0 premiums; enrollment through NY State of Health. Medicaid in New York is administered by the Department of Health through county social services offices and through NY State of Health online.
Key enrollment carriers for Qualified Health Plans on the NY State of Health Marketplace in 2026 include EmblemHealth, Healthfirst, MetroPlus Health Plan, Excellus BlueCross BlueShield, MVP Health Care, and others depending on region. Carriers differ by county: New York City has more plan choices than upstate regions. When selecting a Qualified Health Plan after losing Essential Plan coverage, check whether your current providers are in-network before enrolling, as Essential Plan networks and QHP networks may differ even within the same insurer. NY State of Health enrollment assisters and Navigators are available at no cost. Find a local assister at nystateofhealth.ny.gov/legallyQualifiedNavigators or call 1-855-355-5777.
Documents You Need and Why: A Deeper Look
The Medicaid or Essential Plan termination letter is the most critical document for accessing the 90-day SEP. This letter establishes the qualifying life event date. Without it, NY State of Health may require additional proof that you had coverage and lost it involuntarily. If you did not receive a termination letter, call 1-855-355-5777 or log in to your NY State of Health account to download a coverage history record. The Social Security number for each household member is required for identity verification and to check for other programs you or household members may qualify for (including Child Health Plus for children). Proof of current income matters because Medicaid and Essential Plan use Modified Adjusted Gross Income (MAGI) based on the current year's projected earnings. Use pay stubs from the last 30 days. If you are self-employed, NY State of Health may accept a signed statement of projected income. Immigration documents are required for lawfully present immigrants who are not yet US citizens; New York Medicaid and Essential Plan serve many immigration categories including DACA recipients, lawful permanent residents, and refugees.
Frequently Asked Questions
What is the SEP window if I lost NY Medicaid or Essential Plan coverage?
Loss of Medicaid or Essential Plan coverage triggers a 90-day Special Enrollment Period (SEP) at NY State of Health. For example, if your Essential Plan ended June 30, 2026, your SEP runs July 1 through September 29, 2026. NY State of Health confirmed August 30, 2026 as the enrollment deadline for the July 1 Essential Plan coverage transition to secure a July or August coverage start date. The 90-day window is longer than the standard 60-day SEP that applies to most other qualifying events.
How do I document the loss of my NY Essential Plan or Medicaid for the SEP application?
Your Medicaid or Essential Plan termination letter is the primary documentation. This letter shows the coverage end date and the reason for termination. Log in to nystateofhealth.ny.gov or call 1-855-355-5777 to request a coverage termination notice if you did not receive one by mail. You will select 'lost Medicaid or Essential Plan coverage' as your qualifying life event when applying for a Marketplace Qualified Health Plan. You may also be asked to submit your termination letter by uploading it to your NY State of Health account.
What if I miss the 90-day SEP window for my lost NY Medicaid or Essential Plan?
Missing the 90-day SEP means you cannot enroll in a Marketplace Qualified Health Plan until the next ACA Open Enrollment Period, which runs November 1 through January 15 each year for coverage starting January 1 of the following year. However, Medicaid and Essential Plan enrollment remain year-round for those who qualify. If your income dropped below 138% FPL ($22,025 for one person in 2026), apply for Medicaid at any time at nystateofhealth.ny.gov. If between 138% and 200% FPL, apply for the Essential Plan year-round.
Will I get retroactive coverage if I enroll during the SEP after losing Essential Plan coverage?
For Marketplace Qualified Health Plans, coverage is prospective, not retroactive. Your new QHP coverage typically starts the first of the month following your enrollment date. For the July 1, 2026 Essential Plan transition, NY State of Health set an August 1 coverage start for those enrolling by August 1, and a September 1 start for those enrolling August 2 through August 30. Medicaid in New York can in some cases provide retroactive coverage for up to 3 months before the application date if you were eligible but not enrolled, though this depends on income documentation and county review.
What options do I have if my income is between 200% and 400% FPL after losing my Essential Plan?
Income between 200% and 400% FPL ($31,920 to $63,840 for one person in 2026) qualifies for ACA premium tax credits in a Marketplace Qualified Health Plan through NY State of Health. Silver plans provide the best value for most people in this income range because Silver plans unlock Cost-Sharing Reductions for incomes under 250% FPL. Gold plans make sense if you have high medical needs. The 400% FPL subsidy cliff returned in 2026 after enhanced premium tax credits expired, so incomes above $63,840 for one person receive no federal subsidy. Check your net premium estimate at nystateofhealth.ny.gov before selecting a plan.
What state-specific rules apply in New York for Medicaid and Essential Plan enrollment?
New York operates its own state-based Marketplace called NY State of Health at nystateofhealth.ny.gov. All Medicaid, Essential Plan, Child Health Plus, and Marketplace QHP enrollments must go through this portal or by calling 1-855-355-5777. Do not use healthcare.gov for New York coverage. New York also offers Child Health Plus (its CHIP program) for children under 19 at up to 400% FPL. New York Medicaid expanded under the ACA and covers adults up to 138% FPL. The Essential Plan covers adults 138-200% FPL under BHP authority as of July 1, 2026.
Do I qualify for Medicaid after losing my NY Essential Plan in 2026?
Medicaid eligibility in New York requires income at or below 138% of the Federal Poverty Level: $22,025 for one person, $29,863 for two people, $37,702 for three, or $45,540 for a family of 4 in 2026. If your income falls at or below these thresholds, apply for Medicaid at nystateofhealth.ny.gov any time during the year with no SEP deadline. Medicaid covers a broader benefit package than the Essential Plan and costs nothing. If your income is above 138% FPL but at or below 200% FPL ($31,920 for one person in 2026), you qualify for the Essential Plan with $0 premiums.
What happens to my children's coverage if I lose my NY Essential Plan or Medicaid?
Children under 19 in New York may qualify for Child Health Plus (New York's CHIP program) at incomes up to 400% FPL ($132,000 for a family of 4 in 2026). Child Health Plus premiums range from $0 to $60 per month depending on income. Enrollment is year-round. Children may also qualify for full Medicaid if household income is under 138% FPL. The child's eligibility is evaluated separately from the parent's. Even if you as a parent must enroll in a Marketplace QHP, your children may still qualify for Medicaid or Child Health Plus at no cost or low cost. Call 1-855-355-5777 to check children's eligibility.
