New York Medicaid

Last verified: June 2026

What is New York Medicaid and how large is it?

New York Medicaid is simply called "New York Medicaid" — the state uses no separate brand name for its program. The New York State Department of Health (DOH) administers it jointly with the federal Centers for Medicare & Medicaid Services (CMS). As of December 2023, per the NY DOH, over 7.5 million New Yorkers were enrolled — roughly one in three state residents and one of the largest Medicaid programs in the country by enrollment.

New York expanded Medicaid under the Affordable Care Act. Most adults ages 19–64 with household income at or below 138% of the Federal Poverty Level qualify. That threshold was $20,783 per year for a single person as of January 2025 (per the NY DOH income standards table, revised November 2024). No asset test applies to standard MAGI-based coverage — savings accounts, a home, or a car do not disqualify an applicant.

Coverage is financed jointly by New York State and the federal government. New York generally spends more per enrollee than most states, reflecting a high cost of living and a broad set of covered services.

Two distinct application systems: NYC vs. the rest of New York

New York has a split administrative structure that affects where and how you apply. New York City residents apply through the Human Resources Administration (HRA), the city agency that handles social services. Outside New York City, applications go through your county's Local Department of Social Services (LDSS) — there are 57 counties outside NYC, each with its own DSS office.

The online portal for both pathways is NY State of Health (nystateofhealth.ny.gov) — the state's official health insurance marketplace. NY State of Health handles Medicaid applications, as well as enrollment in the Essential Plan and qualified health plans. The phone number is 1-855-355-5777 (TTY: 1-800-662-1220), available Monday–Friday.

Managed care is standard for most New York Medicaid enrollees. The state contracts with Medicaid managed care plans that coordinate medical, behavioral health, and pharmacy benefits. Long-term care has its own separate plan type — the Managed Long-Term Care (MLTC) plan — described below.

New York's Essential Plan: the coverage bridge most other states don't have

New York operates a program called the Essential Plan that fills the gap between Medicaid and commercial insurance. Adults ages 19–64 with income between 139% and 250% FPL — just above Medicaid's limit — can enroll in the Essential Plan for $0 or very low monthly premiums. This is distinct from Medicaid but is sold through the same NY State of Health portal.

The Essential Plan is unique nationally. Most states have a cliff at 138% FPL where Medicaid ends and marketplace subsidies begin, leaving some people with significant premium costs. New York's Essential Plan eliminates most of that gap for adults up to 250% FPL. Per NY DOH, approximately 1.2 million New Yorkers were enrolled in the Essential Plan as of recent years — a population that would face much higher costs in states without a comparable program.

The Essential Plan is not Medicaid. It does not provide the same level of benefits for long-term care and is not a pathway to MLTC or CDPAP. But for routine medical, behavioral health, and pharmacy coverage, it functions similarly to Medicaid for the income band it serves.

Managed Long-Term Care (MLTC): how New York delivers home and community-based care

For New Yorkers who need long-term services and supports — personal care, home attendant services, adult day care, nursing home care — the primary delivery mechanism is the Managed Long-Term Care (MLTC) plan. MLTC plans are private managed care plans under contract with NY DOH. Dual eligibles (people enrolled in both Medicare and Medicaid) are typically required to enroll in an MLTC plan to receive Medicaid-funded home care.

New York has one of the largest dual-eligible populations in the country, per KFF data. These approximately 700,000+ enrollees receive Medicare for acute care services and Medicaid through MLTC plans for long-term services, nursing home copays, and other costs Medicare does not cover.

Consumer Directed Personal Assistance Program (CDPAP) is available through MLTC plans and allows enrollees to hire and direct their own home care workers — including most family members (excluding spouses and parents of minor children). CDPAP is a significant feature of New York's long-term care landscape and is described in detail on the seniors and long-term care page.

New York Medicaid topics

New York Medicaid and Essential Plan eligibility at a glance

Source: NY DOH GIS 25 MA/01 (effective January 1, 2025). See the income limits page for full figures by household size.