Significant Changes to Essential Plan
Recent changes in federal law (H.R. 1, Public Law 119-21) will eliminate premium tax credit eligibility for roughly half of New York’s 1.7 million Essential Plan enrollees, and cut $7.5 billion of annual funding for the program under the 1332 Waiver. Governor Hochul and the Department of Health announced today that the state will not backfill this funding, which is what supported truly significant expansions in Essential Plan eligibility in recent years.. Instead, the state plans to terminate the 1332 waiver and re-activate the Basic Health Program (BHP) in order to mitigate the impact and maintain coverage for 1.3 million individuals. 450,000 individuals with incomes under $39,125 per year will lose their access to comprehensive and low-cost health insurance. These changes are expected to take effect by July 1, 2026. Enrollees who remain eligible under the BHP will continue their coverage without disruption. Others will transition to Qualified Health Plans, either with or without financial assistance, depending on their income at the time. New York State of Health has opened a 30-day public comment period until October 10, 2025, to gather input on the proposed transition. Written comments may be submitted directly to NYSOH.Team@health.ny.gov. Find more information on the waiver here, and Governor Hochul’s statement here .