Alliance Alert: We are encouraged to see New York State taking steps to protect Medicaid coverage for people who could otherwise lose access to healthcare because of the new federal work requirements established under H.R. 1. The state’s decision to pursue an exemption for approximately 200,000 Bronx residents, along with efforts to expand exemptions for people with disabilities, chronic health conditions and other qualifying circumstances, is an important step toward preventing unnecessary coverage losses.
While these exemptions will help protect people, particularly those who face significant barriers to finding employment, we must do more to ensure that New Yorkers understand the coming changes and have the support they need to maintain their health coverage. Many people could lose coverage simply because they are unaware of the new requirements or struggle to navigate the reporting and verification processes.
We should also view this moment as an opportunity to expand access to supported employment, education, benefits counseling and other voluntary programs that help people who want to work find and maintain meaningful employment. People with mental health and substance use challenges often face barriers to employment, but with the right individualized supports, we can successfully enter or return to the workforce. Our response should focus not simply on helping people meet new requirements, but on creating real opportunities for employment, financial stability and recovery.
The Alliance will continue closely monitoring New York’s implementation of H.R. 1, including how the state communicates these changes, identifies eligible exemptions and protects people from unnecessary losses of health coverage. We will also continue advocating for investments in employment supports that help more New Yorkers achieve their personal goals.
No one should lose access to essential healthcare because of administrative barriers or a lack of employment opportunities. New York must work to protect coverage while helping people access the services, supports and opportunities they need to thrive.
State Exempts 200,000 Bronx Residents from Federal Medicaid Work Rules
By Amanda D’Ambrosio | Crain’s Healthcare | October 7, 2026
Roughly 200,000 Bronx residents will be exempt from federal Medicaid work requirements set to take effect Jan. 1, due to the county’s elevated unemployment rate, State Medicaid Director Amir Bassiri said Wednesday.
New York is racing to implement federal Medicaid work requirements, which were passed in Congressional Republicans’ 2025 tax law, H.R. 1, before they take effect in less than three months. Starting Jan. 1, many Medicaid members will have to prove that they are working or participating in community engagement for at least 80 hours per month, or earning a household monthly income of $580, to keep their insurance.
Residents of the Bronx will not have to prove that they are working, in school or volunteering to stay enrolled in Medicaid, Bassiri said at a roundtable on H.R. 1 hosted by the United Hospital Fund.
The exemption offers relief to a county with the third-largest Medicaid population in the state, with roughly 837,000 enrollees as of August, state data shows. Roughly 200,000 of those enrollees were expected to have to comply with the rules prior to the exemption.
State health officials are pursuing exemptions for members who are eligible, including medical frailty exemptions for individuals with certain chronic conditions, and short-term hardship exemptions that apply to individuals and counties.
The federal government has allowed states to pursue these short-term hardship exemptions for counties with an unemployment rate that is more than 1.5 times the nationwide average or above 8% — a category that includes the Bronx, Bassiri said. The exemption will stay in place as long as the Bronx has an unemployment rate that meets the criteria.
New York notified the U.S. Centers for Medicare and Medicaid Services that it would pursue the short-term hardship exemption for the Bronx, but there is no formal approval process, said Cadence Acquaviva, a spokesperson for the Department of Health.
Approximately 2 million of the state’s 6.4 million Medicaid members will have to comply with federal work requirements, according to state data. Roughly 60% of impacted enrollees live in the city.
Initial national projections show that between 10% and 20% of people who have to comply with upcoming work rules will lose their insurance, Bassiri said. But state officials are optimistic that coverage losses will be less in New York, due to rules that allow members to self-attest their medical frailty designation and other flexibilities.
“We are not expecting — with self-attestation of medical frailty, the optional short-term hardship exemptions — that 20% of people will lose coverage,” Bassiri said. “In fact, they will not; I will say they will not.”
Still, Bassiri added, there is a risk that some consumers will either be unaware of the changes or unable to go through the verification process in a timely manner, which “we all collectively need to … be mindful of as we get closer to implementation.”
Oct. 8, 2026: A previous version of this story misstated the name of United Hospital Fund. The story has been corrected.