New York Medicaid
Last updated August 2026
New York expanded Medicaid, so adults qualify on income alone: up to $22,025 a year for one person, $45,540 for a family of four, with no monthly premium. Enrollment runs year-round. Apply at nystateofhealth.ny.gov or 855-355-5777 if you are under 65; people 65+ or applying through disability generally go through their county DSS with form DOH-4220, though many 65+ cases are now moving to NY State of Health. Either door redirects you if needed.
Earn a little too much for Medicaid? New York has something most states do not: the Essential Plan. $0 premium, $0 deductible, dental and vision included, for adults up to $31,920 a year single, $66,000 for a family of four. One caution about old articles: the plan's 250 percent tier ended in July 2026 under federal cuts. The ceiling now is 200 percent of poverty.
Pregnancy opens wider doors: and each expected baby counts in your household size, so most single pregnant women use the two-person line of $4,022 a month. Coverage runs a full 12 months postpartum regardless of immigration status. Emergency Medicaid also covers urgent care regardless of status.
Kids rarely fall through: Children's Medicaid covers ages 1 to 18 up to $4,235 a month for a family of four, and above that the same application routes them to Child Health Plus instead of a denial.
Decisions come within 45 days, 30 for pregnant applicants and children. Free enrollment help exists statewide: certified Enrollment Assistors, and the Medicaid Helpline at 800-541-2831. One date to know: federal work requirements reach some NY enrollees January 1, 2027. If a decision seems wrong, request a fair hearing at 800-342-3334.
Phone 1-800-541-2831
Help available in English and Spanish.
Updated August 2026 Program details can change — confirm with the program directly.
Who qualifies
- Adults 19-64 up to 138 percent of the federal poverty level; children, pregnant people, seniors, and people with disabilities have their own rules
- One NY State of Health application checks Medicaid, Child Health Plus, and the Essential Plan together
You may qualify. The program makes the final decision.
How to apply
- 1
Under 65? Apply at nystateofhealth.ny.gov or call 855-355-5777, any day of the year.
- 2
65+ or applying through a disability? Apply at your county DSS with form DOH-4220.
- 3
Pregnant? Say so; the income line is higher, each expected baby counts in household size, and decisions come within 30 days.
- 4
Slightly over the Medicaid line? Complete the same application anyway; it also checks you for the $0-premium Essential Plan.
- 5
Want a human? Free certified Enrollment Assistors work statewide; the Find Local Help tool on NY State of Health lists them.
- 6
Watch for the decision: 45 days standard, 30 for pregnancy and kids.
- 7
Denied or dropped? Request a fair hearing: 800-342-3334 for county decisions, 855-355-5777 for marketplace ones.
What the application looks like
Common questions
What is the income limit for Medicaid in New York?
For adults under 65: $22,025 a year for one person, $29,864 for two, $45,540 for a family of four. Over that, check the Essential Plan, which is free up to $31,920 for one person.
What is the Essential Plan?
New York's $0-premium, $0-deductible health plan for adults who earn a bit too much for Medicaid, up to 200 percent of poverty: $31,920 single, $66,000 for a family of four. Dental and vision included, enrollment year-round. The old 250 percent tier ended in July 2026.
When can I apply for NY Medicaid?
Any day. Medicaid and the Essential Plan have no open-enrollment window. Decisions come within 45 days, or 30 for pregnant applicants and children.
I'm pregnant. What am I eligible for?
Coverage up to $2,966 a month for a household of one, counting each expected baby in your household size, through pregnancy plus 12 months postpartum, regardless of immigration status.
Does NY Medicaid cost anything?
No monthly premium. Some services carry small copays, and the state says they can be waived if you cannot afford them.
Will I have to work to keep Medicaid?
Starting January 1, 2027, federal work and community-engagement requirements reach some NY enrollees. Details are still landing; watch your renewal notices and ask your enroller.
Not sure this is the right program for your situation?
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