New York Medicaid 2026: Income Limits, the Essential Plan & How to Apply

Quick answer: New York expanded Medicaid, so most adults ages 19–64 qualify with income up to 138% of the Federal Poverty Level — about $1,836 per month for one person (approximately $3,795 per month for a family of four) — with no asset test for working-age adults. If you earn a little too much for Medicaid, New York’s Essential Plan offers $0-premium coverage. New York Medicaid is run by the Department of Health, and you apply through NY State of Health at nystateofhealth.ny.gov.

Who This Is For

This guide is for New Yorkers trying to understand their Medicaid and health coverage options in 2026. New York Medicaid covers more than 7 million residents — approximately 36% of the state’s population — making it one of the largest and most comprehensive state Medicaid programs in the country. New York has long been among the most generous states in terms of income thresholds, covered benefits, and program design.

Unlike the non-expansion states covered in other guides on this site, New York adopted full Medicaid expansion under the ACA and went even further with its own state-funded programs. If you are a working-age adult and your income is below 138% of the Federal Poverty Level, you will almost certainly qualify for Medicaid in New York. If your income is somewhat higher, the state’s unique Essential Plan may provide coverage at zero premium cost.

This guide explains the income limits for each group, covers the important Essential Plan change that took effect July 1, 2026, explains how the application process works, and walks through what’s changing in late 2026 and into 2027 that could affect your coverage. For a comparison of all 50 states, see our guide on Medicaid income limits by state. For a national overview, see our Medicaid overview.

New York Expanded Medicaid — Adults 19–64

New York adopted ACA Medicaid expansion, which means most adults between 19 and 64 qualify for full Medicaid coverage if their income is at or below 138% of the Federal Poverty Level. For a single adult in 2026, that threshold is approximately $1,836 per month (about $22,025 per year), which already includes the standard 5% FPL income disregard. For a family of four, the threshold is approximately $3,795 per month.

Critically, there is no asset test for working-age adults applying under MAGI (Modified Adjusted Gross Income) rules. You do not need to spend down savings or sell property to qualify. Eligibility is based solely on your current monthly income, not on what you own. This is a major difference from the asset-based rules that apply to long-term care and disability-based Medicaid in New York and many other states.

New York Medicaid for working-age adults covers a comprehensive benefit package: doctor and specialist visits, hospital care (inpatient and outpatient), prescriptions, mental health and substance use treatment, dental care, vision, lab work, and preventive services. Benefits are delivered through Medicaid managed care plans in most of the state, meaning you’ll choose a health plan after enrollment. New York City and other urban areas have multiple plan options; rural areas may have fewer.

Self-employed individuals qualify on the basis of their net self-employment income, not gross revenue. If you work part-time or have irregular income, eligibility is determined based on current monthly income — if your income varies, you report what you expect to earn each month, and eligibility is reassessed at renewal. The program uses current income rather than annual projections in most cases.

The Essential Plan (Above Medicaid) — Important 2026 Change

New York’s Essential Plan is one of the most distinctive features of the state’s health coverage landscape. It is a state-specific program — authorized under the federal Basic Health Program (BHP) framework — that provides comprehensive coverage at $0 monthly premium for adults who earn too much for Medicaid but still cannot afford standard marketplace insurance.

The Essential Plan has no deductible, low copayments, comprehensive benefits including dental and vision care, and continuous enrollment — meaning you can sign up at any time of year, not just during an open enrollment window. For the past several years, it covered adults earning between roughly 138% and 250% FPL.

As of July 1, 2026, the Essential Plan’s upper income limit dropped from 250% to 200% FPL. This change was driven by federal funding adjustments under the One Big Beautiful Budget Act (HR1/OBBBA), which modified the federal funding mechanism for Basic Health Programs. New York has reverted to the standard BHP structure, so the Essential Plan now covers the band from approximately 138% to 200% FPL.

The practical impact is significant: approximately 450,000 New Yorkers who were enrolled in the Essential Plan at income levels between 200% and 250% FPL are now transitioning to subsidized Qualified Health Plans (QHPs) on the NY State of Health marketplace. These are standard marketplace plans with ACA premium tax credits applied. For most affected members, the plans will be more expensive than the Essential Plan — marketplace premiums are already expected to rise approximately 40% in New York in 2026, and the loss of the $0-premium option is a meaningful financial change for this population.

If you received a notice about a change to your Essential Plan coverage in mid-2026, this is why. Affected members should log into NY State of Health to compare available QHPs and select a new plan. Subsidies are available for income up to 400% FPL (and in some cases higher under enhanced subsidy rules). You can enroll through a special enrollment period triggered by the loss of Essential Plan coverage.

Income Limits by Group (2026)

New York’s income thresholds vary by the population being served. All figures below are gross monthly income unless noted, based on MAGI rules for non-elderly adults; the 2026 Federal Poverty Level for one person is approximately $1,330 per month (about $15,960 per year):

• Adults 19–64 (full Medicaid expansion): Up to 138% FPL — approximately $1,836 per month for one person, $3,795 per month for a family of four. No asset test. No spend-down required.
• Essential Plan: Approximately 138%–200% FPL as of July 1, 2026. $0 monthly premium. Open enrollment year-round. Benefits include dental and vision.
• Children (Child Health Plus): Children under 19 qualify for Child Health Plus at income levels higher than standard Medicaid — the exact threshold varies by age and family size, but the program is designed to provide near-universal coverage for children in New York regardless of immigration status.
• Pregnant women: Up to approximately 223% FPL, with 12 months of full postpartum coverage following the birth. Pregnant women have access to a broad range of OB, prenatal, and postpartum services.
• Aged, Blind and Disabled (Non-MAGI Medicaid): Income limit is approximately the same as the expansion limit (~$1,836 per month for one person), but an asset test applies. However, New York’s asset limits for this group are unusually high compared to other states: approximately $33,038 for a single individual and approximately $44,796 for a couple — roughly 17 times the national standard of $2,000. SSI recipients automatically qualify for Medicaid.
• Long-term care (nursing home and HCBS): Income cap of approximately $2,982 per month. A Pooled Trust or Miller Trust (Qualified Income Trust) is available for those whose income exceeds this cap. The community spouse resource allowance (CSRA) ranges from approximately $74,820 to $162,660, depending on total countable assets. New York’s home equity limit for Medicaid LTC is approximately $1,130,000 — one of the highest in the country.

Who Qualifies — Residency and Immigration Status

To qualify for New York Medicaid, you must be a New York State resident and either a U.S. citizen or a “qualified immigrant” as defined under federal and state law. Qualified immigrants include lawful permanent residents (green card holders), refugees, asylees, and several other immigration categories — each with specific rules about waiting periods and coverage types.

New York has gone further than the federal minimum in covering immigrants. Due to a state-funded program established following the Aliessa v. Novello court ruling, New York covers some lawfully-present immigrants who are not federally eligible for Medicaid. This is funded entirely with state dollars rather than federal matching funds. As a result, certain legal immigrants who would be turned away in other states can qualify for Medicaid here.

Undocumented adults are generally not eligible for full Medicaid in New York. However, emergency Medicaid covers life-threatening conditions for otherwise-ineligible individuals, and New York does provide some additional coverage for undocumented older adults (65+) through state-funded programs. Pregnant undocumented women may qualify for limited prenatal care coverage under separate state rules.

SSI recipients automatically qualify for New York Medicaid without a separate application.

How to Apply for New York Medicaid (Step by Step)

Applying for New York Medicaid is free and can be done in several ways. The most efficient approach for most working-age adults is the NY State of Health marketplace, which screens for all available coverage options simultaneously:

1. Apply online at NY State of Health — Go to nystateofhealth.ny.gov. This portal screens applicants for Medicaid, the Essential Plan, Child Health Plus, and subsidized marketplace plans in a single application. It’s available 24/7 and is the recommended starting point for most New Yorkers. Create an account, complete the application, and submit. You can also save progress and return.
2. Call 1-855-355-5777 — NY State of Health’s customer service line can assist with applications by phone and answer questions about plan options. Assistance is available in multiple languages.
3. Aged, blind, disabled, and long-term care applicants: If you are applying for Medicaid based on age or disability — or for long-term care Medicaid — you apply through your local Department of Social Services (DSS) rather than through NY State of Health. You can also call the NY State DOH Medicaid line at 1-800-541-2831 for guidance on this process.
4. In-person enrollment assistance: NY State of Health has a network of certified enrollers — Navigators and Assistors — who can help you apply in person or by phone at no cost. Find one at nystateofhealth.ny.gov/navigator.
5. Decision timeline: Eligibility determinations for most MAGI-based Medicaid categories are made within 45 days. Disability-related applications (for Non-MAGI Medicaid) may take up to 90 days. If you have not received a decision within the required timeframe, contact your local DSS or NY State of Health for a status update.
6. If denied: You have 90 days from the notice of denial to request a fair hearing. The notice must explain the reason for the denial and include instructions for appealing.

After enrollment, report changes in income, household size, or address within 30 days through NY State of Health or your local DSS. Changes that affect your eligibility category (for example, income rising above the Medicaid threshold) will trigger a transition — in most cases, to the Essential Plan or a subsidized marketplace plan. For detailed application guidance, see our page on how to apply for Medicaid.

New York-Specific Features

New York has several Medicaid provisions that are unique in the country or unusually generous compared to other states:

Spousal refusal: New York (and New Jersey) allows a community spouse — the partner of an institutionalized Medicaid applicant who remains at home — to legally refuse to make their income and assets available for the institutionalized spouse’s care. This can dramatically expand eligibility for long-term care Medicaid in cases where the community spouse has significant income or assets. This is a complex legal strategy that should be discussed with an elder law attorney familiar with New York Medicaid rules.

Exceptionally high non-MAGI asset limits: While most states set Medicaid asset limits at $2,000 for a single individual, New York’s asset limits for aged, blind, and disabled individuals are approximately $33,038 (single) and $44,796 (couple). This means many New Yorkers with modest savings who would be disqualified elsewhere can still qualify in New York.

Community Medicaid look-back: A 30-month look-back period for Community (home care) Medicaid is phasing in under recent changes. Previously, there was no look-back for home care Medicaid in New York. This change affects applicants seeking home and community-based services — asset transfers within the 30-month window may result in penalty periods. The look-back for nursing facility Medicaid in New York remains 60 months (5 years), consistent with the federal standard.

High home equity limit: New York’s home equity exemption for long-term care Medicaid is approximately $1,130,000 — among the highest in the nation. This means homeowners with significant equity in their primary residence can still qualify for nursing home Medicaid in many cases.

Immigrant coverage using state funds: As noted above, New York extends Medicaid-like coverage to some legal immigrants who are not federally eligible, using entirely state dollars. This makes New York’s coverage more inclusive than federally mandated minimums.

Important 2026–2027 Changes to Know

Several significant changes are affecting New York Medicaid in 2026 and 2027 that currently enrolled members and prospective applicants need to understand:

Essential Plan upper limit dropped to 200% FPL (effective July 1, 2026): As described in detail above, approximately 450,000 New Yorkers enrolled at 200–250% FPL are transitioning from the Essential Plan to subsidized marketplace plans. These members have received or will receive notices from NY State of Health. If this applies to you, take action promptly — review your QHP options and select a plan during your special enrollment period to avoid a gap in coverage.

Medicaid work requirements phasing in late 2026: Under rules enacted at the federal level and being phased into New York’s Medicaid program, adults aged 19–64 who are able-bodied and not pregnant, disabled, or caregiving may be required to complete 80 hours per month of qualifying activities (work, job training, volunteering, etc.) to maintain Medicaid eligibility. An estimated 725,000 New York City Medicaid enrollees could be affected. Exemptions apply for a range of circumstances — people who are disabled, caring for children or dependents, or meeting other criteria are exempt. New York is still working through the implementation details; watch for official notices from NY State of Health and local DSS offices about when this requirement will apply to your case.

Six-month renewals phasing in late 2026: Like many other states, New York is moving some Medicaid categories to 6-month renewal cycles. This means enrollees will need to verify continued eligibility more frequently. Keep your contact information, income, and household details current in NY State of Health to ensure renewal notices reach you and you have time to respond before coverage lapses.

Marketplace premium increases: Marketplace (QHP) premiums in New York are expected to rise approximately 40% in 2026 for many plan types. This makes the Essential Plan even more valuable for those who still qualify under the new 200% FPL limit, and underscores the importance of the July 2026 change for those transitioning out of it.

See also our guide on New York assistance programs for other benefits available to residents during this period of change.

Common Mistakes to Avoid

These are the most frequent errors New Yorkers make when navigating Medicaid and the Essential Plan:

• Confusing Medicaid with the Essential Plan: These are two separate programs with different income bands, enrollment mechanisms, and benefit details. Medicaid covers up to 138% FPL with no premiums and no deductibles. The Essential Plan covers 138–200% FPL (as of July 2026) at $0 premium. Both are administered through NY State of Health, but they are not the same program.
• Assuming you don’t qualify because your income seems too high: New York’s thresholds are among the most generous in the country. At 138% FPL (~$1,836/month for one person), many working and part-time employed adults qualify. Use the NY State of Health eligibility screener before concluding you’re ineligible.
• Missing renewal notices, especially under 6-month cycles: Starting late 2026, more frequent renewals mean more chances for coverage to lapse if notices go to outdated addresses or phone numbers. Update your contact information in NY State of Health immediately.
• Not reporting income changes within 30 days: Changes in income that move you out of the Medicaid income band should be reported promptly. Failing to report can result in overpayments that the state may seek to recover, and delays in transitioning you to the correct coverage type (Essential Plan or marketplace).
• Not responding to Essential Plan transition notices: If you received a notice that your Essential Plan coverage is changing due to the July 2026 income limit change, you must actively select a new marketplace plan during your special enrollment period. Failing to act will result in auto-enrollment in a default plan, which may not be the best option for your situation.
• Assuming the asset test rules from other states apply here: New York’s non-MAGI asset limits (~$33,038 single) are far higher than the $2,000 standard used in most other states. Don’t assume you’re disqualified by assets without checking New York’s specific rules.

Frequently Asked Questions

What is the income limit for New York Medicaid in 2026?

Adults aged 19–64 qualify up to 138% FPL — approximately $1,836 per month for one person or $3,795 per month for a family of four — with no asset test. Pregnant women qualify up to approximately 223% FPL. The Essential Plan covers 138–200% FPL at $0 premium (as of July 1, 2026).

What is the New York Essential Plan?

The Essential Plan is a New York state-specific program authorized under the federal Basic Health Program framework. It offers $0-premium comprehensive coverage — including dental and vision — for adults who earn too much for Medicaid. As of July 1, 2026, it covers income from approximately 138% to 200% FPL. You can enroll year-round through NY State of Health.

Did the Essential Plan change in 2026?

Yes. On July 1, 2026, the Essential Plan’s upper income limit dropped from 250% to 200% FPL due to federal funding changes (the One Big Beautiful Budget Act/HR1). Approximately 450,000 New Yorkers who were enrolled at 200–250% FPL are transitioning to subsidized Qualified Health Plans through the NY State of Health marketplace.

How do I apply for New York Medicaid?

Apply through NY State of Health at nystateofhealth.ny.gov or call 1-855-355-5777. The portal screens for Medicaid, the Essential Plan, Child Health Plus, and marketplace plans in one application. Aged, blind, disabled, and long-term care applicants apply through their local Department of Social Services or call 1-800-541-2831.

Does New York Medicaid have an asset test?

Not for working-age adults applying under MAGI rules (the standard for most adults 19–64). Aged, blind, and disabled applicants do have an asset test, but New York’s limits are approximately $33,038 for a single individual — far higher than the $2,000 limit in most other states. Long-term care Medicaid has its own asset rules.

What are New York Medicaid work requirements?

Work requirements for able-bodied adults ages 19–64 (80 hours per month of qualifying activities) are phasing into New York’s Medicaid program in late 2026. Exemptions apply for disability, caregiving, and other circumstances. An estimated 725,000 NYC enrollees could be affected. Watch for official notices from NY State of Health for specifics on implementation timing and exemptions.

What is the look-back period for New York long-term care Medicaid?

For nursing facility Medicaid, the look-back period is 60 months (5 years) — the federal standard. For Community (home care) Medicaid, a new 30-month look-back is phasing in. Asset transfers within these windows may result in penalty periods. Consult an elder law attorney before making any asset transfers if LTC Medicaid may be needed.

What other assistance programs are available in New York?

SNAP food benefits have separate eligibility rules from Medicaid. See our guide on New York food stamps for 2026 income limits. For the full range of New York state assistance programs, see our New York assistance programs guide.

Official Sources

• NY State of Health — apply online, screen for all programs
• NY State Department of Health — Medicaid: health.ny.gov
• NY State of Health customer service: 1-855-355-5777
• NY State DOH Medicaid line (aged/disabled/LTC): 1-800-541-2831
• Medicaid.gov — New York

Last reviewed: July 2026. Not affiliated with any government agency. Medicaid rules and figures change — confirm your situation with NY State of Health at nystateofhealth.ny.gov or call 1-855-355-5777.