New York State recently submitted a request to extend its Medicaid 1115 Waiver beyond March 2027. The proposal would continue funding for:

• Housing support services

• Nutrition services

• Transportation assistance

• Social Care Networks (SCNs)

• Care management programs for Medicaid members with health-related social needs.

For NYC residents, this means programs that help address issues outside of traditional medical care—such as food insecurity and housing instability—could continue if approved.

New York City Medicaid members should continue watching their mail, email, and NY State of Health accounts for:

• Renewal notices

• Requests for proof of income

• Immigration documentation requests

• Household information verification

Missing a renewal deadline can result in loss of coverage. Brokers and assistors are reporting increased numbers of Medicaid renewals and coverage transitions in 2026.

Federal legislation provides for Medicaid community engagement requirements beginning January 1, 2027, for certain populations. Many individuals are expected to qualify for exemptions, including some:

• People with disabilities

• Caregivers

• Pregnant individuals

• Other protected groups defined in federal and state guidance

New York is expected to issue additional implementation details before these requirements take effect. Important Information for NYC Medicaid Members

If you're enrolled in Medicaid in New York City, you should:

• Update your mailing address immediately if it changes.

• Report income changes promptly.

• Open and respond to all renewal notices.

• Review any NY State of Health correspondence carefully.

• Verify your Managed Care plan annually.

• Keep copies of all requested documentation.

New York's Medicaid home care programs remain under intense review by both state and federal officials as policymakers work to improve oversight, strengthen consumer protections, and ensure the responsible use of public funds. The discussions primarily focus on how home care services are administered, financed, and delivered to Medicaid beneficiaries across the state.

Key Areas Under Review Include:

1. Program Administration

State officials continue evaluating how Medicaid home care services are coordinated and delivered to ensure beneficiaries receive timely, appropriate, and high-quality care. The goal is to improve program efficiency while minimizing administrative barriers that may affect access to services.

Current reviews include:

• Authorization and approval processes for home care services.

• Coordination between Medicaid Managed Care plans and providers.

• Timeliness of service delivery for eligible members.

• Oversight of member complaints and appeals.

• Quality assurance and performance standards for providers.

2. Fiscal Intermediary Operations

New York's transition to a Single Fiscal Intermediary (SFI) model for the Consumer Directed Personal Assistance Program (CDPAP) has received significant attention. State and federal officials continue reviewing:

• Contract administration and procurement procedures.

• Consumer transitions to the new fiscal intermediary system.

• Payroll processing for personal assistants.

• Compliance with federal Medicaid requirements.

• Operational readiness and service continuity protections.

The transition has generated ongoing legal and policy discussions regarding implementation timelines and consumer impacts.

3. Medicaid Spending and Accountability

New York maintains one of the nation's largest Medicaid programs, making fiscal oversight an important priority. Reviews are focused on:

• Responsible management of Medicaid expenditures.

• Preventing fraud, waste, and abuse.

• Improving transparency in home care spending.

• Ensuring funds are directed toward medically necessary services.

• Strengthening financial accountability measures across the program.

Officials continue examining ways to balance program sustainability with maintaining access to essential services for beneficiaries.

4. Consumer Protections

Protecting Medicaid beneficiaries remains a central focus of ongoing discussions. Current efforts are intended to ensure:

• Members continue receiving authorized services without interruption.

• Consumers have access to clear information regarding their rights and benefits.

• Individuals can file complaints or request appeals when necessary.

• Vulnerable populations receive appropriate care coordination and support.

• Home care workers and consumers are supported throughout program changes.

What This Means for Medicaid Members

At this time, Medicaid beneficiaries who have been approved for home care services should continue receiving their authorized benefits. Policy discussions and administrative reviews do not automatically change an individual's eligibility or approved services.

Members should:

• Continue attending scheduled assessments and appointments.

• Respond promptly to Medicaid renewal notices.

• Maintain current contact information with Medicaid and their Managed Care plan.

• Report any interruptions in authorized services immediately.

• Keep copies of all notices and documentation received from Medicaid or their health plan.

Looking Ahead

New York is expected to continue refining its Medicaid home care programs throughout 2026 and beyond. Policymakers have emphasized three primary objectives:

• Maintaining access to medically necessary home care services.

• Strengthening program oversight and fiscal accountability.

• Improving consumer protections for Medicaid beneficiaries.

While discussions regarding administration and funding continue, eligible Medicaid members should not assume that currently authorized services will automatically end. State officials have repeatedly emphasized the importance of preserving access to care while implementing improvements to the program.

Important Reminder: If you currently receive Medicaid home care services, continue using your benefits as authorized and respond promptly to any communications from your Medicaid Managed Care plan or New York State regarding renewals, assessments, or program updates

Home Care Programs Continue Receiving Scrutiny

New York's Medicaid home care programs continue to receive significant attention from both state and federal officials regarding:

• Program administration

• Fiscal intermediary operations

• Medicaid spending

• Consumer protections

Who Is Affected?

This change applies to individuals enrolled in the Essential Plan 200–250% FPL category (sometimes referred to as Essential Plan 5).

If your household income is above 200% of the Federal Poverty Level, your Essential Plan coverage ended on June 30, 2026 unless you qualify for another exception or coverage category.

What Are Your Options?

If you lost Essential Plan coverage, you may qualify for:

• A Qualified Health Plan (QHP) through NY State of Health, with financial assistance depending on your income.

• Medicaid, if your eligibility has changed.

• Continued Essential Plan coverage if you qualify under certain pregnancy or postpartum rules.

• Employer-sponsored health insurance, if available.

Important Deadlines

Losing Essential Plan coverage qualifies you for a Special Enrollment Period, allowing you to enroll in new health insurance without waiting for the annual Open Enrollment period. Acting promptly helps prevent a gap in coverage.

No Changes for Most Essential Plan Members

If you are enrolled in Essential Plan 1 through Essential Plan 4 (generally for individuals and families with income up to 200% FPL) and continue to meet eligibility requirements, your coverage is not affected by this change.

We're Here to Help

Health Unity Foundation is an officially designated NY State of Health Assistor Organization. Our certified enrollment staff can help you:

• Review your eligibility

• Compare available health plans

• Apply for a Qualified Health Plan

• Renew your health insurance

• Determine whether you qualify for Medicaid or other programs

• Understand your financial assistance options

Our enrollment assistance is free, confidential, and available in multiple languages.

Need assistance? Contact Health Unity Foundation today to review your coverage options and maintain your health insurance without interruption.