Governor Kathy Hochul this week revealed that the state will be forced to revert 1.3 million low-income New Yorkers who don’t qualify for Medicaid to an older program, and potentially leave hundreds of thousands more without coverage.
The state will move those 1.3 million individuals off its Essential Plan and onto the previous model, known as the Basic Health Plan, by July 1, 2026. Individuals who will be impacted are low-income New Yorkers who don’t qualify for Medicaid, and many of those covered by the program are legally present immigrants.
It’s a move the state says is an effort to be “proactive” in managing the fallout of federal cuts stemming from the Trump administration’s policy bill, and for advocates, it’s a troubling sign of turbulence ahead as they look ahead to pushing their priorities across the finish line in next year’s state budget.
The Healthcare Association of New York State is among countless advocacy and policy groups gearing up for a potentially perilous state budget process next year, and Amy Nickson, senior vice president for state policy, stressed this is a troubling step.
“HANYS appreciates that the loss of significant federal funding for New York’s Essential Plan will impose coverage risks for millions of New Yorkers, levy untenable new costs to the state, and have a destabilizing impact on many hospitals and health systems. Even with the state’s action, 450,000 New Yorkers will lose their eligibility for the Essential Plan. HANYS stands ready to partner with federal and state policy leaders on solutions to minimize coverage losses and disruptions in care,” she said.
The Department of Health says the move will result in uncompensated care which providers will have to foot the bill for, and those in the industry say that will impact services across the board well beyond those who are on the Essential Plan.
While it was initially expected that the state legislature would have to return to Albany for a special session to address federal cuts, the full impact of spending reductions is not expected to be felt until late 2026 and early 2027. Now, the expectation is that the 2026 legislative session will be the beginning of the truly tough decisions for state leaders.
Last week, Assembly Speaker Carl Heastie made clear that while Hochul is looking for “creative ways” to address cuts, concerns among health care advocates are valid.
“The state budget is 70 percent Medicaid and education. It’s hard to reduce spending without touching those areas,” he said.
Nickson is imploring the governor and state lawmakers to find ways to ensure the health care system doesn’t bear the brunt of any shortfall from federal cuts
“Look across the full spectrum of the budget to figure out and suggest ways they can absorb those new state costs without further destabilizing the health care system,” she said.
Blair Horner, senior policy advisor for NYPIRG, told Spectrum News 1 that while the state will ideally be able to find ways to spread the impact across its massive budget, health care systems in New York have structural deficiencies which are at least partly to blame for the level of impact they are concerned about feeling.
“We have, according to independent experts who look at Medicare data, one of the least safe hospital systems in the company,” he said. “We’re paying more and getting substandard care. Why don’t we make that better? Better care means less money.”
Like those in the health care field, education leaders are bracing for a potentially tough year after years of increases in Foundation Aid under Hochul, and the promise of a revised funding formula.
“If there are impacts to the broader state budget, I think it’s difficult for school districts to escape that conversation,” said Brian Fessler, chief advocacy officer for the New York State School Boards Association.
Fessler points out there is one glaring difference between this situation and previous financial crises the state has weathered in recent years, like the COVID-19 pandemic and the Great Recession: In those cases, the federal government stepped in to help the state manage the shortfall.
“This circumstance is certainly quite different at this point. Right now, a lot of the risks that we see on the horizon are stemming from conversations at the federal level,” he said.
Comptroller Tom DiNapoli recently released numbers showing that the state faces a $34.3 billion cumulative budget gap through 2029, which he says could create budget conditions not seen since that time.
Even beyond those top line spending items, advocates are concerned. Liz Moran of climate group Earth Justice said she’ll be keeping a close eye on funding for the Environmental Protection Fund and the clean water infrastructure act, and other indications that state leaders are reeling in funding on climate-related issues.
“Remarkable programs that provide investments directly into communities, create good jobs, and ensure we have access to safe drinking water, safe places to recreate in,” she said.