Medicaid in NYC Before the 2027 Work Requirement: Enrollment by Borough, 2024 to 2026

Every month the New York State Department of Health publishes a one-page count of Medicaid enrollees by county of residence, its Medicaid Enrollment Databook. New York City’s five boroughs are five of those counties. We collected all 32 monthly pages from January 2024 to August 2026, the latest the state has posted, and compared them with two other public counts: the Medicaid cases the city’s Human Resources Administration (HRA) handles, and the state’s monthly report on Medicaid managed care plans.

The result is a picture of the city’s Medicaid rolls before the biggest federal change to the program in years. The work requirement has not started. Coverage is already shrinking.

A year of decline, before the rule

The city’s count fell in eleven of the twelve months to August 2026. The exception, May, rose by 297.

The year started with losses of 20,502 and 19,632 in September and October. The pace picked up in winter, broke in March, and then slowed: from April to August the city lost an average of 10,527 enrollees a month, against 23,963 a month from September to February.

New York City holds 56.0% of the state’s Medicaid enrollees, but it accounted for 69.3% of the statewide decline over the year. Outside the city, enrollment fell 5.1%; statewide, 7.2%, from 6,862,152 to 6,368,977.

Borough by borough

Queens had 27.0% of the city’s Medicaid enrollees in August 2026 but 36.5% of the year’s decline. It fell from 1,086,579 to 961,841. Brooklyn, the largest borough by enrollment with 33.1% of the city’s total, lost 87,424 people, 25.6% of the decline. The Bronx lost 74,206 and Manhattan 45,903. Staten Island changed least.

Over two years, the steepest fall was in Manhattan, 15.8%, followed by Queens at 13.7%. The data here count people, not rates per resident, so the table compares each borough with itself.

Counts are by county of residence: Kings County is Brooklyn, New York County is Manhattan, Richmond County is Staten Island. In the August 2026 report the five boroughs add up to one person fewer than the published city total.

The March 2026 drop

Between February and March 2026, the city’s count fell from 3,764,861 to 3,619,379, a one-month drop of 3.9%. Every borough fell; Queens fell most, 5.8%, and accounted for 41.1% of the city’s March decline. The rest of the state fell too, by 61,203, so this was not a New York City event alone: statewide, enrollment dropped by 206,685 in that month.

The state’s databook does not explain the drop, and we found no Department of Health notice that does. We did not find a federal or state coverage change dated March 2026 on the timeline of federal changes reaching New Yorkers. So we can describe where it shows and where it does not, but not why it happened:

Two things stand out. The cases HRA handles, which include people on cash assistance, on SSI and on Medicaid alone through the city’s offices, fell by 26,623, less than a fifth of the total. And mainstream Medicaid managed care, the health plans most enrollees use, lost only 11,700 members in NYC that month. The bulk of the March decline fell among enrollees outside HRA’s caseload and outside those plans. The published data stop there.

The three sources are separate reports with their own counting dates and definitions. The comparison shows where the decline is visible, not an exact accounting of who left.

Who handles the cases

The HRA count also shows how the decline splits. Between August 2025 and August 2026, HRA’s Medicaid caseload fell from 1,564,655 to 1,401,037, 10.5%. Almost all of that came from one category, Medicaid only, people who get Medicaid through HRA without cash assistance or SSI: it fell by 132,352, 20.7%. Cases tied to cash assistance fell 3.9%, and SSI cases 2.5%.

Everyone else on Medicaid in the city, the difference between the state’s count and HRA’s, fell 7.6%, from 2,343,987 to 2,165,704. That group includes the people who enroll through NY State of Health, the route the work requirement is aimed at. In the managed care report, NYC members enrolled through NY State of Health fell from 1,870,904 in August 2025 to 1,766,389 in August 2026, 5.6%.

What the data cannot say about the work rule

The requirement is written for adults 19 to 64 in Medicaid’s expansion group, mostly people who apply through NY State of Health. It does not reach people 65 and older, children, or people on Medicaid through a disability determination, and it has long lists of exemptions.

None of the counts here separates that group. The closest is the managed care report: in September 2026, 1,769,537 NYC managed care members came through NY State of Health, 73.8% of the city’s 2,398,066 mainstream managed care members. But that figure includes children, parents and pregnant people as well as the working-age adults the rule is written for, and it leaves out people outside managed care. It is not a count of New Yorkers the rule will reach, and we have not turned it into one.

The largest plan, Healthfirst, had 934,187 NYC members in September 2026, 39.0% of mainstream managed care in the city. A plan’s member services line is one more place to confirm that your contact details are current.

What this means for you

If you are 19 to 64 and on Medicaid, the first test is your renewal. People already enrolled meet the rule at renewal, starting with renewals from March 1, 2027. You meet it in a month with 80 hours of work, job training, community service or school, or monthly income of at least $580, or by showing an exemption: pregnancy, caring for a child under 14 or a disabled person, a disability, a serious medical condition, treatment for drug or alcohol use, and others. Who is exempt and what to show.

The letter matters more than the rule. NY State of Health was due to notify everyone the rule applies to by September 30, 2026. Some adults will also renew every six months instead of once a year. Each renewal is a letter that has to reach you and be answered; an out-of-date address is the most common way to lose coverage you still qualify for.

If coverage ends anyway, keep getting care. NYC Care at the city’s public hospitals and community health centers treat patients regardless of coverage, and New York’s hospital financial assistance law caps what an uninsured patient can be charged up to 400% of the poverty level. What to do when coverage ends.

Methodology

Data. New York State Department of Health, NYS Medicaid Enrollment Databook, one PDF a month with enrollment by county of residence, January 2024 to August 2026, downloaded on October 16, 2026. The pages carry the note “Data Last Updated: 08/07/2026”; the September and October 2026 pages were not yet posted. NYC Human Resources Administration, Citywide HRA-Administered Medicaid Enrollees, NYC Open Data, same period. New York State Department of Health, Medicaid Managed Care Enrollment Reports, Table IIa, New York City totals for August 2025, February, March, August and September 2026.

Measures. Changes are the difference between monthly counts; percentages are that difference divided by the earlier month. “All other NYC enrollees” is the state’s NYC count minus HRA’s caseload in the same month, two reports with their own counting rules, so it is an approximation. Managed care figures cover mainstream Medicaid managed care only, not long-term care or HARP plans.

What we did not do. We did not estimate how many New Yorkers the work requirement will reach, because no published NYC table separates expansion adults 19 to 64 from other enrollees. We did not attribute the March 2026 drop to any cause, because no primary source we found states one.

Download: nyc-medicaid-enrollment-by-borough.csv, one row per month, with every borough, the city, the rest of the state and HRA’s caseload by category, plus the headline figures. Free to reuse under CC BY 4.0. Credit: NYC Med News, “Medicaid in NYC Before the 2027 Work Requirement,” October 16, 2026, from NYS DOH and NYC HRA data.