Impact of H.R.1 Legislation on New York’s Essential Plan
Federal funding cuts have impacted New York’s Essential Plan program. New York State can no longer offer the expanded Essential Plan to people earning between 200% and 250% of the Federal Poverty Level after June 30, 2026. Some of these individuals will return to the New York State marketplace, others may choose employer-sponsored coverage, and some may become uninsured.
Who is affected?
- If your income is 200-250% FPL (about $31,920-$39,900 for individuals): You will lose your Essential Plan coverage as of July 1, 2026. You may be eligible to enroll in a Qualified Health Plan, with financial assistance.
- If your income is under 200% FPL (about $31,920 for individuals): Your Essential Plan coverage continues under the Basic Health Program with the same benefits.
Note:If you are pregnant or have been pregnant within the last 12 months, the new rules may not apply to you. Please read the sections below to learn more.
How do you know if you’re impacted?
- Formal eligibility notices will were issued at least 45 days prior to coverage ending, outlining next steps and alternative coverage options.
- Enrollees whose eligibility is ending received a notice from NY State of Health on April 1, 2026, as well as an additional notice sent in early May with information about new coverage options.
What new coverage is available?
- Most people affected by these changes can enroll in a Qualified Health Plan (QHP), with financial assistance. QHPs have monthly premiums and other costs that differ from the Essential Plan. The average silver plan costs $220 per month after tax credits.
- The enrollment window opens on May 16, 2026. Impacted enrollees will have until August 30, 2026, to enroll in new coverage without a gap in coverage.
What help is available to consumers?
- HWCLI is committed to preserving coverage for as many New Yorkers as possible and will work with consumers to provide affordable options for members who will no longer qualify under the current program. As of May 16th, consumers will have the opportunity to evaluate eligibility for Qualified Health Plans or other coverage options, with 90 days’ advance notice before changes take effect.
- Be sure to visit New York State of Health’s “Stay Connected” page for updates: https://info.nystateofhealth.ny.gov/stay-connected.
Pregnant Individuals
- All pregnant enrollees will stay continuously enrolled in coverage.
- Pregnant enrollees whose due date is before January 1, 2027 will remain enrolled in the Essential Plan.
- Pregnant enrollees whose due date is after January 1, 2027 will be transitioned to Medicaid on July 1, 2026.
Deferred Action for Childhood Arrivals (DACA)
- DACA recipients with incomes at or below 138% FPL will move to Medicaid on July 1, 2026.
- Higher-income DACA recipients who are pregnant will move to Medicaid on July 1, 2026.
- Under federal rules, higher-income DACA recipients who are not pregnant will no longer qualify for any NY State of Health program after July 1, 2026.
For More Essential Plan Resources:
Background on the Essential Plan:
- The Essential Plan has been operating since April 2015 under the Affordable Care Act Section 1331 Basic Health Program (BHP), originally for adults 19–64 with income up to 200% FPL.
- To expand coverage, NY State obtained a Section 1332 State Innovation Waiver, effective April 1, 2024, increasing eligibility to 250% FPL.
- This expansion provided $0 premium coverage to 450,000 individuals, saving them an average of $6,000 per year compared to Qualified Health Plans.
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Established in 1947, the Health and Welfare Council of Long Island (HWCLI) is a regional, nonprofit umbrella organization for health and human service providers dedicated to improving the lives of Long Island’s most vulnerable residents by responding to their needs through the promotion and development of public policies and direct services.
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