By David Olson

Updated June 29, 2026 7:04 am

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More than 63,000 Long Islanders will lose their state Essential Plan healthcare coverage on July 1. State officials blame federal funding cuts for their decision to significantly scale back a program that provides zero-premium insurance to residents who earn too much to qualify for Medicaid but have low or lower-middle-class incomes.

Healthcare experts warn that many people kicked off the program will not be able to afford insurance and will avoid seeking care, allowing health conditions to get worse until patients end up in hospital emergency rooms.

Here's what to know about the cutbacks and what experts predict will be their effects.

The state is ending coverage for those earning 200% to 250% of the federal poverty level, which is $66,000 to $82,500 a year for a family of four, and $31,920 to $39,900 for an individual. There are exceptions, including pregnant women. As of early May, 34,477 Suffolk residents and 28,940 Nassau residents in that income range were enrolled in the Essential Plan, according to state Health Department numbers.

Essential Plan policyholders with incomes below those minimums will, with a few exceptions, not lose coverage.

Last year’s Big Beautiful Bill, as President Donald Trump named it, cut about $7.5 billion in federal funding for the Essential Plan, according to the state. The White House and congressional Republicans argued that the cuts and other changes to health programs in the bill were designed to focus spending on those who most need federal assistance and to reduce federal spending, while Democrats said they were instituted to help pay for tax cuts for the wealthy.

An estimated 1.3 million New Yorkers who make 138% to 200% of the poverty level — the annual income ceiling for Medicaid is 138%, or $22,025 for an individual — will remain on the Essential Plan, with mostly federal and some temporary state funding.

Many will become uninsured, said Vanessa Baird-Streeter, president and CEO of the Health & Welfare Council of Long Island, which helps enroll people in programs like the Essential Plan.

"People are living paycheck to paycheck already, and this is going to force people to make choices between the priorities in their life," such as healthcare, food and housing, she said.

Buying insurance through the Affordable Care Act marketplace is an option.

Most people losing Essential Plan coverage can receive federal subsidies to help them buy insurance.

"But they’re much less generous than they were before," said Wendy Darwell, president and CEO of the Suburban Hospital Alliance of New York State, which represents hospitals on Long Island and in the Hudson Valley.

The same law that slashed Essential Plan funding greatly reduced ACA subsidies.

For example, a family of four on Long Island with an income of $74,250 would pay $453 a month for a premium with the ACA’s benchmark silver plan, which offers moderate deductibles and co-pays, according to a cost calculator from the San Francisco-based health policy nonprofit KFF.

An ACA bronze plan has no premium for families of that income, and a $4 monthly premium for an individual earning $35,910. But the average deductible for a bronze plan in 2026 is nearly $7,500, KFF found.

"It’s an illusion of coverage, because people can’t really use that coverage," said Elisabeth Benjamin, vice president of health initiatives at Manhattan-based Community Service Society of New York, which works to increase access to healthcare. "You’re asking people to spend huge portions of their income on coverage, which is not tenable."

And people earning incomes low enough for Essential Plan eligibility typically don’t have access to employer-based insurance, she said.

There are some free and low-cost health options. Federally qualified health centers, which are located in what are considered "medically underserved" communities, provide primary care for a cost based on the patient’s income. You can find a center here: findahealthcenter.hrsa.gov. At Harmony Healthcare, the largest network of FQHCs in Nassau, costs typically are about $25 per visit, said president and CEO David Nemiroff.

Many people’s health will deteriorate, Nemiroff said.

"Folks aren't going to stop being sick, they're not going to stop having cancer, they're not going to stop having diabetes, they're not going to stop having heart disease," he said. "They're just not going to seek care for what we could help much earlier on in the process, for much less cost and much better quality of life."

Wrong, Darwell said.

"This has a domino effect on the entire healthcare system," she said.

Older, sicker people losing Essential Plan coverage will do everything they can to find a way to pay for insurance, she said. Many younger, healthier people will take a chance of not obtaining coverage. When insurance plans have a larger percentage of people with serious health conditions, their costs go up, and that increases premiums for everyone, Darwell said.

Many uninsured people use hospital emergency departments for care, she said. State law requires that hospitals not charge uninsured and underinsured people of certain incomes or else provide heavy discounts to them. An increase in the number of those patients increases costs for hospitals, which ultimately increases costs for everyone, she said.

It's much cheaper to prevent or control disease than to treat it, so with more people avoiding care until they get very sick, "it will probably in the long term cost all of us, New Yorkers and throughout the United States, much more money," Nemiroff said.

Yes. On Jan. 1, many people on Medicaid will have to show they are working at least 80 hours per month, or spending that much time volunteering or in a job training program — or a combination. Attending school at least half time also meets the new requirement. There are exceptions to the rule, including for some people with disabilities and parents or caregivers of children under 14.

There are other changes as well starting Jan. 1, including a requirement for some Medicaid recipients to apply to renew coverage every six months instead of every year.

Nemiroff said those "paperwork challenges" will push many people eligible for Medicaid off the program "because they won’t understand the bureaucracy that is being put in place."

The Robert Wood Johnson Foundation, a healthcare nonprofit, estimates 4.9 million to 10.1 million people will lose Medicaid coverage by 2028 because of the work and certification changes.