What Medicaid covers
More than any other program in the state. Doctor visits, hospital care, prescriptions, labs, imaging, mental health and substance use treatment, dental, vision, transportation to appointments in many cases, and long-term care — the last of which no other program here covers.
If the application puts you in Medicaid rather than the Essential Plan, that is the better outcome, not a consolation prize.
Who qualifies
Eligibility runs on household income against the federal poverty level, and the threshold depends on which category you’re in.
Adults 19–64 without dependent children: generally up to 138% of the federal poverty level.
| Household size | 100% FPL | 138% FPL |
|---|---|---|
| 1 | $15,960 | $22,024 |
| 2 | $21,640 | $29,863 |
| 3 | $27,320 | $37,701 |
| 4 | $33,000 | $45,540 |
| 5 | $38,680 | $53,378 |
| 6 | $44,360 | $61,216 |
Each additional person adds $5,680 to 100% FPL. Annual figures.
Pregnant women: substantially higher — pregnancy is one of the strongest expansions in New York’s rules, and coverage continues after the birth for a defined postpartum period.
Children under 19: higher again, and Child Health Plus picks up where Medicaid stops, covering children regardless of immigration status.
Adults 65+ and people with disabilities: a different set of rules applies, including asset tests that don’t apply to the working-age categories. This is the part of Medicaid where professional help genuinely matters — the rules around long-term care, spousal assets and look-back periods are their own field.
Immigration status: full-scope Medicaid has requirements, but New York covers some immigrants through state-funded arrangements that federal rules would exclude. Assuming you don’t qualify is the most expensive assumption in this whole subject. If status is the barrier, Emergency Medicaid and NYC Care are the doors that stay open.
How to apply
Most working-age people apply through NY State of Health — nystateofhealth.ny.gov or 1-855-355-5777. People 65+, and those applying based on disability or for long-term care, generally apply through their local department of social services instead. This split confuses people constantly; if you’re told you’re in the wrong place, that’s usually why.
Have ready: proof of identity, proof of New York residence, proof of income, and — for the 65+ and disability categories — information about assets.
Certified navigators help for free and do not earn commission. In New York City, community organizations across the boroughs employ them, often in the languages the neighborhood actually speaks.
Once the application tells you which program you’re in, the remaining decision is the carrier — and that is a network decision, not a brand one. How to pick it in an hour.
Keeping it: the renewal problem
Medicaid renews. The notice goes to the address and email NY State of Health has on file. If you moved, the notice goes to the old apartment, you never see it, and coverage ends while you still qualify — and you find out at a pharmacy counter.
Three minutes of prevention:
- Update your address and phone with NY State of Health whenever you move.
- Open mail from the state, including things that look like junk.
- Renew on time rather than reapplying later. Reapplying works, but you’ll have a gap, and a gap is where an unexpected bill lands.
Medicaid vs the Essential Plan
| Medicaid | Essential Plan | |
|---|---|---|
| Income | Lower band (about 138% FPL for most adults) | Up to 200% FPL |
| Monthly premium | $0 | $0 |
| Deductible | None | None |
| Long-term care | Covered | Not covered |
| Age | All ages | 19–64 |
| Enrollment window | Year-round | Year-round |
You don’t choose between them. The application places you.
What changes in 2027: work rules and six-month renewals
From January 2027, many Medicaid enrollees aged 19 to 64 in the expansion group must show 80 hours a month of work, school, training or community service, or monthly income of at least $580, or an exemption. NY State of Health was due to notify everyone the rule applies to by September 30, 2026. People already enrolled meet it at renewal, starting with renewals from March 1, 2027, and some adults in this group will renew every six months instead of once a year. The exemptions are broad, from caring for a child under 14 to pregnancy and serious medical conditions. What to do now, who is exempt and what to keep as proof: Medicaid work requirements in 2027.
Questions people ask
Can I have Medicaid and a job?
Yes. Most adult Medicaid enrollees in this country work. Income is what matters, not employment status.
Does Medicaid cover dental?
Yes, though the network of dentists who accept it is thinner than the medical network — expect to make more calls.
What if my income goes up mid-year?
Report it. You may move to the Essential Plan or to a marketplace plan with tax credits. Reporting changes is routine and doesn’t put you at risk; not reporting them can create an overpayment problem later.
Is Medicaid the same as Medicare?
No. Medicare is federal coverage tied to age 65+ or disability. Medicaid is income-based. Some people have both, which is called being dual-eligible and comes with additional help.
Does using Medicaid affect immigration status?
Health coverage other than long-term institutional care isn’t part of the public charge analysis. For a pending case, ask an immigration attorney about your specific facts.
In this section
Medicaid Work Requirements in New York, 2027: Who Must Report 80 Hours and Who Is Exempt
From 2027, many Medicaid adults 19 to 64 must show 80 hours a month or an exemption. Letters by September 30, checks from March renewals. What to do now.
Where to Apply for Medicaid in New York City: Two Doors, and Which One Is Yours
New York runs Medicaid applications through two separate systems. Which one handles your case depends on your age and why you are applying, and going to the wrong one costs weeks.
Medicaid Renewal in New York: The Mail Problem, and What Changes in 2027
More New Yorkers lose Medicaid to a renewal notice sent to an old address than to any change in income. How renewal works, what to do if coverage already lapsed, and why 2027 doubles the risk.
Medicaid Spend-Down in New York: How the Excess Income Program Works
Over the Medicaid income limit? Under New York's Excess Income program, once a month's medical bills meet your spend-down, Medicaid pays the rest of that month.
Pooled Income Trusts in New York: Keeping Medicaid Without Spending Down
A pooled income trust lets a New Yorker over the Medicaid income limit keep coverage, and the money still pays rent and food. How it works, and what it costs.
Medicaid Home Care in New York: The Four Routes and Which One You Are In
Personal care, CDPAP, home health and Managed Long Term Care are four different things New Yorkers call home care. What each one covers, how hours are decided, and where the money question is settled.
CDPAP in New York: Paying a Family Member to Provide Care, and What the PPL Switch Changed
The Consumer Directed Personal Assistance Program lets Medicaid recipients hire, train and supervise their own aides, including relatives. PPL now runs payroll.
Free Rides to Medical Appointments on Medicaid in New York
Medicaid covers rides to covered medical appointments in New York at no cost to you. Who arranges them, the phone number, how far ahead to book, and what to have ready when you call.
Medicaid and Long-Term Care in New York: Nursing Home, Assisted Living, or Home
Medicaid, not Medicare, pays for long-term care in New York: at home, in assisted living or in a nursing home. The look-back, and why advice comes first.
Sources
- NY State of Health (checked 2026-08-12)
- New York State Department of Health — Medicaid (checked 2026-08-12)
- NY Health Access (checked 2026-08-12)
More in Medicaid in New York: Who Qualifies, How to Apply, How to Keep It
- Medicaid Home Care in New York: The Four Routes and Which One You Are In — Personal care, CDPAP, home health and Managed Long Term Care are four different things New Yorkers call home care. What each one covers, how hours are decided, and where the money question is settled.
- CDPAP in New York: Paying a Family Member to Provide Care, and What the PPL Switch Changed — The Consumer Directed Personal Assistance Program lets Medicaid recipients hire, train and supervise their own aides, including relatives. PPL now runs payroll.
- Free Rides to Medical Appointments on Medicaid in New York — Medicaid covers rides to covered medical appointments in New York at no cost to you. Who arranges them, the phone number, how far ahead to book, and what to have ready when you call.
This page explains how the system works. It is not medical advice. More.