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New York and the ACA’s Medicaid expansion

Over 7.3 million New Yorkers enrolled in Medicaid; more than 2.2 million are covered under Medicaid expansion

Key takeaways

ACA’s Medicaid eligibility expansion in New York

New York has long been a healthcare reform front-runner, creating a guaranteed issue individual health insurance market decades ahead of the Affordable Care Act (ACA), and also expanding Medicaid to cover many low-income parents and childless adults long before the ACA reformed the nation’s health insurance system.

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The state accepted the ACA’s provision to use federal funding to expand Medicaid in New York as of January 1, 2014, and between the fall of 2013 and July 2021, the state’s total Medicaid enrollment grew by 21%, to nearly 7 million people. (The state reported a higher enrollment total at that point, with 7.1 million people enrolled. New York State of Health, the state-run health insurance exchange, noted that 4.7 million of those people had enrolled through the exchange).

As of late 2020, New York’s Medicaid expansion was covering more than 2.2 million people. But New York’s eligibility guidelines were already so generous that fewer than 286,000 of those people were newly eligible as a result of the ACA’s expansion of Medicaid. The rest — nearly 1.8 million people — were already eligible for Medicaid prior to 2014 under New York’s rules. But the federal government pays the bulk of the cost for the entire Medicaid expansion population (the federal share of the cost will never drop below 90%). So the expansion of Medicaid in New York under the ACA has been particularly beneficial to the state from a financial perspective.

For New York Medicaid enrollees who continue to be eligible based on pre-ACA guidelines, the state and federal government split the cost (since New York is a relatively wealthy state, they receive the lowest possible federal match, which is normally 50%, but states are receiving an additional 6.2% federal match during the COVID public health emergency period, under the terms of the Families First Coronavirus Response Act). The state expected to spend $27.5 million of its revenue on Medicaid in 2021 (in addition to federal funding), and is consistently the state that spends the largest share of its revenue on Medicaid.

New York has the majority of its Medicaid population enrolled in managed care programs, under an 1115 waiver that dates back to 1997. Total New York Medicaid enrollment, including both pre-ACA eligibility categories and ACA Medicaid expansion categories, was almost 7.4 million as of January 2022.

New York has accepted federal Medicaid expansion

  • 7,386,139 – Number of New Yorkers covered by Medicaid/CHIP as of January 2022
  • 1,706,722 – Increase in the number of New Yorkers covered by Medicaid/CHIP fall 2013 to September 2021
  • 56% – Reduction in the uninsured rate from 2010 to 2019
  • 21% – Increase in total Medicaid/CHIP enrollment in New York since Medicaid expansion took effect

Governor pushed back against GOP efforts to repeal the ACA

In January 2017, as President Trump was poised to take office and it was clear that GOP lawmakers were going to push hard for ACA repeal, New York’s then-Governor Andrew Cuomo announced that 2.7 million people were at risk of losing Medicaid coverage in New York if the ACA was repealed and not replaced with something equally robust, and that the state budget impact would be $3.7 billion.

Although most of New York’s Medicaid enrollees were already eligible under the state’s pre-2014 guidelines, the state estimated that several million Medicaid enrollees would have lost coverage if the ACA had been repealed. That’s because the state was using 1115 waivers to expand coverage eligibility in the years prior to ACA implementation, and the federal government was splitting the cost with the state as called for in the waivers.

But those waivers expired after Medicaid expansion was implemented. If the ACA’s Medicaid expansion had been repealed, eligibility would have reverted to much lower thresholds: parents with dependent children would have been covered with income up to 94% of the poverty level (which is still much more generous than most states absent the ACA’s Medicaid expansion), and childless adults wouldn’t have been eligible at all. The state would have been allowed to spend its own money to extend those guidelines, but it would have been fiscally challenging without the federal match.

Ultimately, the ACA survived the legislative onslaught in 2017 and a Supreme Court case that upheld the law in 2021.

Medicaid expansion in New York

New York’s progressive stance on access to health care meant that much of the state’s low-income population were already eligible for Medicaid or Family Health Plus for many years prior to the ACA.

In 2000, New York began implementing Family Health Plus, which was designed to insure up to 600,000 of the state’s low-income working adults. The pre-2014 New York Medicaid program covered childless adults with incomes up to 50% of the poverty level, and Family Health Plus expanded coverage up to 100% of poverty. For parents with dependent children, the existing eligibility rules allowed Medicaid coverage up to 75% of poverty level, and Family Health Plus increased that threshold to 150%.

The ACA’s Medicaid provisions allowed New York to utilization federal funding to expand Medicaid to everyone with incomes up to 138% of poverty.

New York went a step further than most other states by implementing the ACA’s Basic Health Program, which covers people with income a little too high for Medicaid. The Essential Plan became available in January 2016, and it covers New York residents with income up to 200% of the poverty level. There is no longer a premium for The Essential Plan. For more information, read here.

Who is eligible for Medicaid in New York?

Adults in New York with incomes up to 138% of poverty level are now eligible for Medicaid. Pregnant women and children under the age of one are eligible with an income of up to 218% of poverty level (for Medicaid eligibility determinations, a pregnant woman counts as two people for household income calculations).

Children from age one to eighteen are eligible for Medicaid with a household income up to 149% of poverty, but the state also has separate CHIP (Children’s Health Insurance Program) coverage available for children with household incomes up to 400% of poverty level – the highest threshold in the country.

How does Medicaid provide financial assistance to Medicare beneficiaries in New York?

Many Medicare beneficiaries receive Medicaid financial assistance that can pay for Medicare premiums, lower prescription drug costs, and cover expenses not reimbursed by Medicare – such as long-term care.

Our guide to financial assistance for Medicare enrollees in New York includes overviews of these benefits, including Medicare Savings Programs, long-term care coverage, and eligibility guidelines for assistance.

How do I enroll in Medicaid in New York?

New York offers several options for enrolling in Medicaid:

New York Medicaid enrollment numbers

In an enrollment report published in September 2021, NY State of Health announced that Medicaid enrollment through the exchange had reached 4.7 million people, out of the total 7.1 million people who were enrolled in New York Medicaid at that point.

During the 2016 open enrollment period, 96% of the people who were newly enrolled in Medicaid through NY State of Health reported that they were uninsured prior to enrolling (as opposed to just 57% of the people who were newly enrolled in subsidized private plan QHPs through the exchange). Medicaid has clearly played an important role in reducing New York’s uninsured rate from 10.7% in 2013, to 5.2% in 2019.

As of January 2022, New York Medicaid enrollment was almost 7.4 million. This was an increase of 1.3 million people enrolled since early 2020, right before the COVID-19 pandemic. The increase in unemployment during the pandemic and Families First Coronavirus Response Act contribute greatly to this increase in enrollment. The FFCRA provides additional federal Medicaid funding for states, but on the condition that states not disenroll anyone from Medicaid for the duration of the COVID public health emergency. The public health emergency has been extended numerous times, most recently in January 2022, pushing it out through mid-April 2022.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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Apply for Medicaid in New York

CHIP and Medicaid enrollment can both be completed through NY State of Health.

Eligibility: Adults with incomes up to 138% poverty level.  Pregnant women and infants with income up to 218% of poverty level.  Separate CHIP is available in NY for all children with income up to 400% of poverty level.

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