MedicaidCoverageMedium impact
Impact of Federal Budget Legislation H.R.1 on Essential Plan and Medicaid
EmblemHealth·NY·Provider News
Effective date
Jul 1, 2026
We identified it
Jul 28, 2026
Summary
Federal budget legislation H.R.1 will reduce funding for New York's Essential Plan and Medicaid programs, resulting in benefit changes for affected members. Essential Plan changes take effect July 1, 2026, and Medicaid changes take effect January 1, 2027. Billing teams must review the provided resources to understand member eligibility and coverage impacts.
Action Required
By June 1, 2026: Billing team must review the three provided resources from NY State Department of Health to understand Essential Plan changes by congressional district and member impact. By December 1, 2026: Billing team must review Medicaid changes scheduled for January 1, 2027, and update billing system rules and claim submission processes accordingly. Front desk and patient communication staff should be prepared to direct members with questions to the NY State of Health resources and contact information. Failure to understand coverage changes may result in claim denials or billing to patients for services affected by the funding cuts.