Medicaid Unwinding in New York: What You Need to Know If You Lose Coverage
Key takeaways:
Medicaid renewals in New York are changing because of the end of the COVID-19 public health emergency (PHE) on May 11, 2023. This is being called the unwinding of Medicaid, and some people will lose coverage during this process.
During the PHE, Medicaid renewals were automatic, and enrollees had continuous coverage. As part of the unwinding process, automatic renewals for Medicaid and the Children’s Health Insurance Program (CHIP) stopped nationwide on March 31, 2023.
New York State Medicaid — known as NY State of Health — has started reviews to see who is eligible to continue receiving coverage. Make sure the New York State Department of Health (DOH) has your current contact information. If they can’t reach you, or if you’re no longer eligible for Medicaid, you could lose coverage as early as July 1, 2023.
The U.S. Department of Health and Human Services declared a public health emergency (PHE) for COVID-19 in January 2020. The PHE was renewed a dozen times by February 2023.
People who were eligible for Medicaid during the COVID PHE were able to keep their coverage throughout the pandemic without having their eligibility reviewed. This is because all states, including New York, were required to provide continuous coverage during the PHE.
But the PHE ended on May 11, 2023. And that marked the end of most COVID provisions, like automatic Medicaid renewals, which stopped nationwide in March. These changes could cause 5 million to 14 million Medicaid enrollees across the country to lose coverage.
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New York State Medicaid and Children’s Medicaid, which is what the state calls its Children’s Health Insurance Program (CHIP), fall under NY State of Health. In addition to NY State of Health enrollees, New York also extended pandemic continuous coverage to enrollees in other state-based public health insurance programs, including Child Health Plus (CHP) and the Essential Plan.
As of April 2023, NY State of Health and the state’s expansion programs covered nearly 6.9 million individuals — or about 1 in 3 people in the state. But eligibility reviews have resumed for enrollees in all of these programs. During this redetermination process, renewal deadlines will range from June 30, 2023 through May 31, 2024. So some residents who no longer qualify for coverage could be disenrolled as early as July 1, 2023.
Here’s what you need to know about Medicaid changes in New York, and what to do if you lose coverage.
Why is Medicaid changing nationwide?
Now that the PHE has come to an end, COVID will remain a public health priority — just not an emergency. As part of this process, Medicaid renewals will no longer be automatic. This is being referred to as the unwinding of Medicaid.
The unwinding will affect Medicaid in every state, Washington, D.C., and five U.S. territories.
What’s happening with Medicaid renewal in New York?
The New York State Department of Health (DOH) is responsible for overseeing the state’s Medicaid program, which is known as NY State of Health.
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If you have coverage through NY State of Health, it’s important for you to confirm or update your contact information with the DOH by:
Logging in to your account on the NY State of Health portal
Calling NY State of Health Customer Service Center at 1-855-355-5777
Contacting an enrollment assistor
Contacting your county's Medicaid office or the New York City Human Resources Administration if this is how you enrolled in Medicaid
New York has launched a robust public outreach campaign to alert enrollees about renewals resuming and to make sure they take action when required. These efforts include notices by:
Text message (which can be signed up for by texting “START” to 1-866-988-0327)
Paid advertising
Direct mail
New York state officials are also warning residents about Medicaid renewal scams. For instance, some people have received phone calls telling them that they must pay to maintain their coverage, which is not true.
What to expect during the renewal process
The state has enough eligibility information from other programs to renew some NY State of Health enrollees automatically. If more information is needed to review your eligibility, you will receive a renewal packet.
Renewal packets began going out in the spring based on residents’ enrollment dates. These notices include a deadline, giving enrollees 60 days to provide the information needed to renew. The earliest batch of packets, which were sent in April, are due June 30, 2023.
The steps enrollees have to take to renew depend on their Medicaid enrollment agency. The possible agencies include:
New York City Human Resources Administration (HRA), which covers residents of New York City counties
Local Department of Social Services (LDSS), which covers residents of counties outside of New York City
If you are no longer eligible for Medicaid, you will receive a letter explaining your other coverage options. If you need to reach the DOH’s Medicaid helpline, call 1-800-541-2831.
Tribal health and Medicaid unwinding
State liaisons are reaching out to people who are enrolled in Medicaid and are also members of or affiliated with Native American tribes.
The National Indian Health Board estimates that as many as 236,000 American Indians and Alaska Natives (AIs/ANs) could lose coverage during the unwinding process. That estimate includes up to almost 12,000 AI/AN residents of New York.
What should I do if I lose my Medicaid coverage in New York?
In order to receive Medicaid in New York, you must meet all of the following criteria:
You must be a New York resident.
You must be a U.S. citizen, permanent resident, or legal resident.
You must need assistance with access to healthcare or insurance coverage.
Your annual household income before taxes are withheld must be below the limit for your household size.
In New York, you may also qualify for reasons other than income, including if you are:
Pregnant
A child or teenager
Responsible for the care of a child who is 18 years old or younger
Blind or have another disability
A household member of someone who has a qualifying disability
65 years old or older (and meet certain criteria)
A former foster child
In need of nursing home care
HIV positive
In need of treatment for breast or cervical cancer (and have been screened or are still undergoing treatment)
If you no longer qualify for Medicaid or eligibility reviewers can’t reach you, you will no longer be able to use your benefits — which could leave you temporarily uninsured. You should reapply for Medicaid if you lose coverage and believe you still qualify, however. Just keep in mind that you may have a coverage gap while you wait to be approved.
If you choose not to reapply for Medicaid coverage, or if you’re no longer eligible, you may qualify for other low-cost or free healthcare options. You can also use GoodRx coupons to save on your prescription medications.
In addition, you may be able to enroll in an alternative health insurance plan, such as:
Affordable Care Act (ACA) marketplace plan: You may be able to enroll in an ACA health plan on the NY State of Health exchange, which is the state’s ACA marketplace. You could find a plan for $10 or less per month if you qualify for a premium subsidy. If you lose Medicaid, you can purchase a plan through NY State of Health during the unwinding special enrollment period from March 31, 2023 to July 31, 2024.
Employer plan: If you have a job, you may be able to get employer-sponsored health insurance.
Medicare: If you have a qualifying disability or condition — such as end-stage renal disease or ALS (amyotrophic lateral sclerosis), commonly referred to as Lou Gehrig’s disease — you can enroll in Medicare at any age.
Partner’s plan: If you have a spouse or domestic partner who has insurance, you may be able to join their plan during an open enrollment or special enrollment period.
Special plans: Short-term insurance can be a great choice if you anticipate a better option, like job-based health insurance, to be available soon. You may also consider alternative and limited-benefit plans, such as fixed indemnity, accident, cost-sharing, and catastrophic insurance plans.
Student health plan: If you’re enrolled in a college or university, you may be eligible for a campus health plan.
U.S. Department of Veterans Affairs (VA) benefits: If you are an active-duty service member or a veteran, you may qualify for TRICARE coverage or VA benefits and services.
New York Medicaid resources
Here are some resources where you can learn more about Medicaid in New York and upcoming changes related to the end of the PHE:
New York Medicaid office: The New York State DOH oversees and administers the state’s Medicaid program.
New York Medicaid self-service portal: You can log into your account on the NY State of Health site 24/7 to confirm or update your contact information.
New York Medicaid unwinding: Read more about the changes to New York’s Medicaid program.
New York Medicaid office phone assistance: You can call the DOH’s Medicaid helpline at 1-800-541-2831.
The bottom line
Automatic Medicaid renewals stopped on March 31, 2023, in advance of the COVID-19 public health emergency coming to an end on May 11, 2023.
New York State agencies that enroll residents in Medicaid will spend the next year conducting eligibility reviews. If the agency you enrolled with is unable to contact you or you are deemed ineligible, you could lose coverage as early as July 1, 2023.
It’s important to update your contact information so that you can be reached when it’s your turn to renew. You’ll want to watch for mail from your enrollment agency; you may be receiving a notice of automatic renewal or a renewal packet requesting information.
If you lose your Medicaid coverage because you are no longer eligible, you may qualify for another state health insurance program. If not, your other options may include a plan through the NY State of Health marketplace, the state’s Affordable Care Act exchange. You also may be eligible for Medicare, job-based insurance, or another type of plan.
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References
Administration for Strategic Preparedness & Response. (2020). Determination that a public health emergency exists.
Administration for Strategic Preparedness & Response. (2023). Renewal of determination that a public health emergency exists.
Kaufman, M. (2023). Planning for the end of pandemic-era Medicaid coverage. Politico.
Medicaid.gov. (n.d.). Unwinding and returning to regular operations after COVID-19.
National Indian Health Board. (2023). Medicaid unwinding webinar: Unwinding updates and best practices for tribal enrollment assisters.
New York State Department of Health. (2023). Important changes to New York Medicaid, Child Health Plus and the Essential Plan.
New York State Department of Health. (2023). New York State Medicaid.
NY State of Health. (n.d.). Important changes to New York Medicaid, Child Health Plus and the Essential Plan.
NY State of Health. (n.d.). Reporting Changes.
NY State of Health. (2023). Health insurance coverage update - April 2023.
NY State of Health. (2023). Keep your health, keep your coverage (60s) [video]. YouTube.
Robinson, D. (2023). Phone scam targets New Yorkers enrolled in Medicaid amid renewal push. What to know. Lohud.
Tolbert, J., et al. (2023). 10 Things to know about the unwinding of the Medicaid continuous enrollment provision. Kaiser Family Foundation.
Tribal Health Reform Resource Center. (2023). Medicaid unwinding. National Indian Health Board.
U.S. Department of Veterans Affairs. (2022). VA & TRICARE information.
