CSS Report Examines Proposals to Mitigate Heath Care Coverage Losses Under H.R. 1

Absent Albany Intervention, 480,000 citizens and lawfully present immigrants will be cut off from their coverage  

The enactment last year of the “One Big Beautiful Bill (H.R.1) set in motion a series of health care cuts that would have left approximately 1.5 million New Yorkers without coverage over the next 2 years. In anticipation of a loss in federal funding, Governor Kathy Hochul included contingency funds in her executive budget in the event the federal government cut or reduced funding for public health insurance programs that cover lawfully present immigrants and citizen New Yorkers. But the Governor and State Legislature must act in the next few weeks to ensure that 480,000 New Yorkers do not lose coverage.  

A new Community Service Society of New York (CSS) report examines four steps that New York State lawmakers can take to mitigate the imminent loss of federal financing which affects citizens and legal immigrants enrolled in Medicaid, the Essential Plan (EP), and Qualified Health Plans (QHPs) on the NY State of Health Marketplace. With the state budget due on April 1, policymakers have fewer than three weeks to agree on a course of action for the 480,000 residents who are set to lose coverage starting July 1, 2026.  

Taking Advantage of New York’s Basic Health Plan Trust Fund 

Unlike other states, New York has an important policy lever – in the form of the Basic Health Plan Trust Fund – that can be used to continue to provide coverage for many lawfully present immigrants residing in the state. It currently has $8.9 billion that can only be used to pay for health insurance and could be used to fill coverage gaps created by H.R.1. Earlier this month, New York received approval to phase out its 1332 Waiver program and return to operating a 1331 BHP, preserving coverage for approximately 1.3 million out of the currently enrolled 1.7 million “Essential Plan (EP)” enrollees.  

Although H.R.1 reduced eligibility for federally funded health coverage from more than a dozen immigration statuses to just three (Medicaid, EP and QHPs), it did not terminate the eligibility for lawful immigrants to participate in a BHP.  

Under the 1331 BHP, the state will be able to continue to cover lawfully present immigrants with incomes between 0-200 percent of FPL and citizens and H.R.1 qualified immigrants with incomes above the Medicaid income eligibility levels (138 percent of FPL).  

For $2.5 billion, health coverage can be preserved for 480,000 New Yorkers 

In short, the CSS report analyzes the available options to address the 480,000 citizens and lawful immigrants with incomes between 138 and 250 percent of FPL who will no longer be eligible for free EP coverage after July 2026 and moderate-income lawful immigrants who will no longer qualify for subsidies after January 1, 2027. Report co-authors Elisabeth Benjamin and Mia Wagner describe in detail four interlocking proposals state lawmakers can adopt to ensure no coverage losses for this population. 

The four proposals are:  

1. The BHP proposal, including modeling the number of people who will be enrolled in BHP, how much it will cost, and the sustainability of the BHP trust fund (this proposal already has been initiated by Governor Hochul); 
2.   A proposal to provide EP coverage for the 444,000 EP 5 enrollees scheduled to lose coverage on July 1, 2026; 
3.   A proposal to ensure that a small group (6,000) of non-BHP eligible legal immigrants (the “Dreamers”) stay covered; 
4.  A proposal to provide state-funded premium assistance that replicates the federal premium assistance that 30,000 lawful immigrants are set to lose on January 1, 2027, under H.R.1. 

The four proposals are estimated to cost the state as little as $2.3 billion. This cost can be absorbed by the $3 billion the Hochul Administration already allocated in its proposed budget to pay for Medicaid for those who will be enrolled in the now-approved BHP.   

“For states like New York with large urban centers and diverse populations, H.R.1 represented a cruel and punitive attempt to eviscerate our public health landscape. It is contrary to our values as a state and as a pioneer in innovative health policies that serve all residents,” said David R. Jones, CSS President and CEO. “We call on Albany lawmakers to show the rest of the nation that New York values its immigrant communities and will always protect access to health care for its residents, despite efforts by Washington to strip it away.”  

“New York has a long tradition of filling in insurance coverage gaps created by the federal government,” said Elisabeth Ryden Benjamin, CSS Vice President of Health Initiatives and report co-author. “Thankfully, Governor Hochul’s proposed budget initially allocated contingency funding in the event the federal government did not approve the resumption of our state Basic Health Program. Now that that has occurred, we are hopeful that in the next three weeks, the Governor, the Majority Leader, and the Speaker can come together to redeploy that contingency funding to save health insurance for the 480,000 New Yorkers set to lose coverage beginning this July.”  

"It is essential to the stability of our state’s health care system to ensure these 480,000 New Yorkers continue to be insured,” said Mia Wagner, CSS Director of Health Policy and report co-author. “Without access to health insurance, patients are forced to choose between going to the doctor and paying their bills. The state must act to protect the physical and fiscal health of New York in this year’s budget.” 

The Community Service Society of New York (CSS) has worked with and for New Yorkers since 1843 to promote economic opportunity and champion a more equitable city and state. We power change through a strategic combination of research, services, and advocacy to make New York more livable for people facing economic insecurity. www.cssny.org 

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