Medicaid Eligibility Resources in NYC — G&STC

Updates from the One Big Beautiful Bill

Originally posted on 10/19/2026, we will update this blog as needed.

Federal healthcare policy updates under the One Big Beautiful Bill (OBBB) will introduce changes to certain Healthfirst & Medicaid plans starting in late 2026 and 2027. We know that changes to health insurance can be confusing and overwhelming. You are not alone, and there is support. We are here to help you understand what to expect and guide you through every step. 

If you or a family member currently rely on Healthfirst, here are three steps you should take now:

1. Verify Your Contact Info: Make sure your mailing address, phone number, and email are updated with Medicaid, Healthfirst, and NY State of Health so you don’t miss crucial mail and emails

2. Open All Mail Immediately: Watch for official mail from NY State of Health, local departments of social services, and/or Healthfirst.

3. Submit Verification Early: Complete and return any eligibility or exemption forms well before the stated deadline to avoid a gap in care.

For details on the upcoming changes and more resources, please find your plan type below:

If you are on the Healthfirst Essentials Plan

What is changing: Effective January 1st, 2027, the income ceiling for the Essentials plan will be lowered to 200% Federal Poverty Level. This means if your income is 200% or higher than the Federal Poverty Level, you will be ineligible. Income limits can vary depending on disability status or pregnancy. This chart breaks down how much you can make and qualify in 2026. We will update this post with the 2027 chart when available.

What you should do: Please keep an eye out for official notices from Healthfirst and/or NY State of Health regarding your plan status. You can also log into your NY State of Health account here, or call them at (855) 355-5777. If you need to update your contact information, follow the steps outlined here.

Resources & Support:

• NY State of Health Navigators: Call 1-855-355-5777 to explore alternative low- or no-cost plans.

• Community Health Advocates (CHA): Guidance and enrollment support for transitioning plans. They’ve put together a guide for those losing medicaid coverage, which you can find here. They’re also holding a webinar addressing the changes on 10/29/26, which you can register for here. You can call 888-614-5400, option 3 or email cha@cssny.org to speak with a health care advocate. 

• Healthfirst Member Support: Contact Healthfirst directly to discuss personalized transition options.

If you are a Medicaid Managed Care Member

What is changing: Effective January 1st, 2027, there will be community engagement requirements to maintain eligibility. Adults ages 19-64 enrolled in Medicaid expansion plans will need to either:

• Complete 80 hours of qualifying activities per month. Qualified activities include work, school, job training, or volunteering;

• Earn at least 80 times the federal hourly minimum wage ($580/month at the time of writing); or

• Qualify for an exemption. Some exemptions include:

  • Pregnant or postpartum individuals

  • Individuals who enrolled in Medicaid with a disability

  • Individuals diagnosed with a physical or mental health condition that makes it hard to work

  • Individuals enrolled in active substance abuse disorder treatment programs

  • Individuals enrolled in SNAP

  • Primary caregivers for disabled folks or children under 14

  • For a comprehensive list of qualifying exemptions, please visit CMS.gov Fact Sheets.

• If you would like to request an exemption from the work requirements, you should be able to do so when you submit your re-enrollment paperwork. (This information was given to us by someone at the Medicaid Help Line on October 19, 2026. They are still figuring out the process as well. We will update this blog as more information becomes available.) 

• Eligibility will be redetermined every six months instead of annually. The state may have enough of your information on file to automatically renew your eligibility. If they do not, you’ll need to complete renewal paperwork to prove that you’re still eligible. HealthInsurance.org has put together a Medicaid guide for each state.

• When you enroll in a Medicaid plan, you can use Medicaid to retroactively pay for care you received in the last few months. Starting January 1st, 2027, retroactive coverage for new members will shift from 90 days to 30-60 days, depending on your plan.

What you should do (in addition to the above steps):

• Please be sure to open all official notices from Healthfirst and/or NY State of Health so you are aware of all renewal windows and action steps. You can log into your NY State of Health account here, or call them at (855) 355-5777.

• If you need to update your contact information (email and mailing address), follow the steps outlined here.

• Renew the exemption criteria if you are unable to meet the Community Engagement Requirements.

• Submit renewal notices as soon as they arrive. 

Resources & Support:

• Exemption & Policy Details: Learn about qualifying exemptions on the NY State of Health website and CMS.gov Fact Sheets.

• NY Medicaid Helpline: Call 1-800-541-2831 for general eligibility or exemption questions.

• Empire Justice Center: Free assistance with exemption disputes or coverage denials. Learn more here.

• Healthcare.org: Find a Medicaid guide for each state, as well as information on Medicaid renewals & eligibility redeterminations, here.

If you are a Marketplace (Leaf) Plan Member

What is changing: Temporary enhanced premium tax credits have expired, which may affect plan pricing in the new year.

What you should do: Please keep an eye out for any official notices from Healthfirst and/or NY State of Health, and review your renewal notice carefully for changes to your monthly premium or out-of-pocket costs. You can log into your NY State of Health account here, or call them at (855) 355-5777. If you need to update your contact information, follow the steps outlined here.

Resources & Support:

Qualified Immigrant Category Updates

What is changing: Effective October 1, 2026, federal guidelines remove refugees, asylees, and humanitarian parolees from certain qualified immigrant categories for federal Medicaid eligibility.

What you should do: If you or a family member fall into these immigration categories, consult an immigration or healthcare advocate immediately to explore state-funded coverage options or health safety-net programs. 

Resources & Support:

• NYC.gov: Click here to learn more about the healthcare options the city may have available. 

• NYC MOIA Immigration Legal Support Hotline: Call for trusted immigration legal help in NYC. Learn more here, or call at 800-354-0365

Community Health Centers

If you do lose coverage, there are several community health centers that will see patients regardless of their ability to pay. If you have a health emergency or need care, you can visit one of the following:

• Callen-Lorde Community Health Center: Callen-Lorde provides care regardless of patients’ insurance status or ability to pay. They offer a sliding fee scale discount. Learn more here.

• Community Healthcare Network: Provides affordable healthcare and does not typically turn anyone away. Learn more here. 

• The Door’s Health Center: Offers comprehensive healthcare services for those aged 12-24 years, regardless of insurance coverage or ability to pay. Learn more here. 

• NYC Care: A healthcare access program that guarantees low-cost and no-cost services to New Yorkers who do not qualify for or cannot afford health Insurance. Learn more here.

• The Institute for Family Health Immigration Health Initiative: Offers care regardless of immigration status or ability to pay. Learn more here.

If you are a current G&STC client, we can refer you to an insurance broker who can help you navigate these changes and enroll in a plan. If you would like their information, please reach out to us at admin@gstherapycenter.com.

Please remember that coverage is not ending immediately, and we are here to help you navigate these updates so you can stay covered without interruption. G&STC strives to provide affordable care, and we will continue monitoring updates relating to the new federal Medicaid requirements.