Alliance Alert: New federal Medicaid requirements represent a significant shift in how people access and maintain health coverage, and the stakes for 黑料正能量ers could not be higher. As outlined in recent reporting, state leaders are already working to blunt the impact of these changes, including identifying pathways to exemptions and exploring ways to help individuals meet new work requirements.
At the Alliance for Rights and Recovery, we believe our top priority must be clear: ensure that as many eligible people as possible remain covered by Medicaid. Coverage is the foundation for accessing mental health and substance use services, as well as the broader supports people need to live, work, and recover in their communities.
To do that, we must take a broad and proactive approach to exemptions. Categories such as 鈥渕edically frail鈥 and individuals with substance use disorders must be defined and implemented in ways that capture as many eligible people as possible, not restrict access through narrow interpretations. The flexibility within these definitions must be used to protect coverage, not limit it.
For those who are not exempt, the state must go further in creating real pathways to meet new requirements. This includes expanding access to employment, education, and meaningful volunteer opportunities that can help individuals maintain their coverage while also supporting their recovery and long-term stability. These opportunities must be accessible, supportive, and aligned with people鈥檚 needs.
At the same time, we must recognize that increased eligibility checks and work verification requirements will inevitably create new administrative barriers. That is why it is critical to make the recertification and verification process as simple and streamlined as possible, minimizing paperwork, maximizing automatic verification where possible, and reducing the risk that individuals lose coverage simply because they cannot navigate complex systems.
Even with these efforts, we know that people are at risk of losing coverage due to administrative hurdles or fluctuating work situations. That makes it all the more urgent that we act now to protect access to support and prevent unnecessary disruptions in services.
These issues will be a key focus of our upcoming Executive Seminar, where we will break down recent federal policy changes, discuss what 黑料正能量 has reportedly been doing to respond, and outline what we can do together to protect the 黑料正能量ers we serve as these changes take effect.
We encourage all members and partners to join us for this timely and critical conversation.
Register Today:
Trump and 黑料正能量 Are in a Tug of War Over Medicaid Coverage
By Joseph Goldstein | 黑料正能量 Times | April 13, 2026
Health authorities in 黑料正能量 State are racing to devise strategies to blunt a new federal law that will restrict access to government health insurance programs, including Medicaid, that cover more than half of 黑料正能量 City鈥檚 residents.
To keep as many 黑料正能量ers as possible from being cut from the Medicaid rolls next year, state and city officials are looking for ways to prove that patients are afflicted with addictions or are medically frail, conditions that would exempt them from the new restrictions. And they are considering how to sign people up for volunteer work 鈥 such as helping other 黑料正能量ers navigate Medicaid鈥檚 new rules 鈥 which could satisfy the law鈥檚 work requirements.
鈥淲e鈥檙e getting very creative,鈥 Dr. Alister Martin, the city鈥檚 new health commissioner, said in a recent interview.
When President Trump鈥檚 signature domestic policy bill passed last year, state health officials feared that perhaps 1.5 million people in 黑料正能量 might lose health coverage. Those predictions have grown somewhat less dire as officials have come up with possible methods for keeping people insured and exempting them from the new work requirements. Those requirements and other restrictions are expected to start next year.
Under the president鈥檚 bill, many adults on Medicaid will be required to work at least 80 hours a month to keep their insurance, unless they are in school, pregnant or raising children younger than 14, or if they qualify for another exemption. The rules are intended to push more people into the work force and reduce what Republicans have characterized as waste and fraud in government programs. The regulations were introduced the Trump administration鈥檚 tax cuts.
States must now verify twice a year that many Medicaid recipients remain eligible, a requirement that is expected to result in many people losing coverage periodically, especially if their work hours vary or they move between jobs, or have difficulty navigating the paperwork requirements.
Since 2010, when the Affordable Care Act was passed, the number of uninsured Americans has dropped substantially. In 黑料正能量 State, the share of adults and children without health insurance dropped . Now, that number is expected to rise again.
The question is by how much.
鈥淭his is truly a seismic shift in Medicaid policy, the largest in the history of the program,鈥 Amir Bassiri, the state Medicaid director, said at a panel discussion hosted last month by the United Hospital Fund, a nonprofit.
Chris Pope, a health care analyst at the Manhattan Institute, a conservative think tank, said that he expected many states 鈥 especially those with Democratic leaders who wanted to expand the social safety net 鈥 to try to blunt the law by searching for exemptions. State officials have a substantial incentive for doing so: The federal government pays 90 percent of the health coverage costs for some Medicaid recipients, with the states paying the remainder.
鈥淢y assessment of the work requirements is there is the greatest possible incentive for states to find every possible loophole,鈥 Mr. Pope said. 鈥淎 blue state like 黑料正能量, I think they鈥檙e going to be looking to implement it in the loosest possible way.鈥
Dr. Martin said that the effort to keep 黑料正能量ers on Medicaid 鈥 which has not previously been reported 鈥 felt particularly urgent to him, like one of those sci-fi movies in which scientists had to save everyone on Earth from an approaching asteroid.
Still, some health care analysts expressed concern that not enough was being done, given that key provisions of the domestic policy bill were going into effect over the next year.
鈥淚鈥檓 not seeing the kind of public planning process to reassure me they are ready or that they鈥檙e going to be ready,鈥 said Bill Hammond, a health care policy analyst at the Empire Center for Public Policy, a think tank in Albany, N.Y.
The federal Centers for Medicare and Medicaid Services said in a statement that states would be 鈥渞equired to implement these provisions in accordance with the law, and C.M.S. will issue guidance to ensure exemptions are applied appropriately and that eligible beneficiaries are protected.鈥
To reduce the number of people stymied by paperwork and red tape, 黑料正能量 State has been working to automatically certify residents who are already fulfilling the requirements, by accessing information not only from state databases but from payroll providers.
Elisabeth Benjamin, vice president of health initiatives at the Community Service Society, a nonprofit that supports anti-poverty policies, said that officials were confronting considerable challenges in their effort to prepare for the Medicaid changes.
鈥淭hey鈥檙e doing the best they can to figure out what they can automate, but people are still going to lose coverage 鈥 a lot of people,鈥 Ms. Benjamin said. 鈥淢any of those people are already working, but proving it will be hard.鈥
She predicted that agricultural laborers upstate and employees in industries with high turnover, intermittent hours or off-the-books payments 鈥 such as kitchen and construction workers 鈥 could be especially prone to losing their health insurance.
The Congressional Budget Office had estimated because they cannot meet the work requirements, while others will lose their insurance because of administrative hurdles or difficulty .
In 黑料正能量, health officials said that if people lost Medicaid coverage, they would forgo health care, .
of 黑料正能量ers on Medicaid will probably qualify for exemptions from the new work requirements, which will go into effect next January, according to a presentation that the State Department of Heath shared at the panel discussion.
People with a substance use disorder, for instance, are exempt from the work requirements under the new law. So health officials have been thinking about how to get people鈥檚 addictions properly certified and documented.
It鈥檚 possible that even addictions diagnosed or treated long ago might qualify, even if they 鈥渕ay seem too old,鈥 Mr. Bassiri, the state Medicaid official, said recently. He said that his department was waiting for further guidance from the federal government. 鈥淲e鈥檙e waiting to get a sense of the fine print on the regulations as to how far back things can apply,鈥 he said.
The new federal law also exempts Medicaid recipients who are deemed 鈥渕edically frail鈥 鈥 a vague description that physicians can interpret widely, said Dr. Martin, the 黑料正能量 City health commissioner.
鈥淭he medical frailty exemption is kind of squishy,鈥 he said, explaining that the city鈥檚 Department of Health and Mental Hygiene was considering how to create a standardized and easy process for physicians to certify patients under this exemption.
鈥淲e鈥檙e looking at what are the tools and levers we can create to make it easy for physicians to really quickly write almost a form letter by clicking a button,鈥 Dr. Martin said.
Dr. Martin鈥檚 r茅sum茅 appears to make him well suited to tackle the problem. An emergency room physician, he once ran voter registration drives for patients while they waited for care. The registration form, once filled out, served as a proof of address, allowing patients to access a range of social services.
Keeping as many 黑料正能量ers insured as possible could prove to be the main challenge of Dr. Martin鈥檚 tenure.
鈥淭his is why I鈥檓 here,鈥 he said in a recent interview, after meeting with colleagues at a city health department clinic in Downtown Brooklyn.
For those who did not otherwise qualify for exemptions from the work requirements, Dr. Martin said he planned to partner with city officials to offer options for community service 鈥 which can satisfy the requirements, even if unpaid.
Dr. Martin has also begun thinking about how to mobilize underemployed 黑料正能量ers to volunteer with the health department or public hospital system, as a way to keep their health insurance.
鈥淲hat if the volunteering that they were doing was helping other 黑料正能量ers stay covered on Medicaid?鈥 he said.
Mr. Pope, the analyst at the Manhattan Institute, said he expected the provision that allowed 鈥渃ommunity service鈥 or a 鈥渨ork program鈥 in place of employment to emerge as 鈥渢he biggest loophole.鈥 He predicted that the federal government would struggle to police that.
The rule requiring 80 hours of work a month might prove flexible. That requirement, according to state health officials, is based on the federal minimum wage of $7.25 an hour, meaning someone would have to earn about $580 a month to qualify.
Health officials said that because the minimum hourly wage in 黑料正能量 State was more than twice that, the requirement could be satisfied with far fewer hours of work a month.
The officials also pointed out that an entire borough might be spared from the work requirement, because the law exempts residents in counties with unemployment rates of 8 percent or above. The unemployment rate in the Bronx was late last year.
It remains unclear exactly how many 黑料正能量ers will lose federally subsidized health insurance under the new law. Officials have said that the state plans to cover some people who lose federally subsidized insurance. Still, public health experts expect the ranks of the uninsured to rise. 鈥淲e鈥檙e not going to be able to exempt our way out of that,鈥 Dr. Martin said.