BY JIMMY LAWTONNorth Country This Week

Some St. Lawrence County residents who rely on Medicaid will have to take additional steps to keep their health coverage next year as new federal requirements begin taking effect.

But state officials say Medicaid recipients should keep their information current, watch for a notice from the state and not assume the new work requirements apply until they receive a notification from NY State of Health.

Changes coming

Starting Jan. 1, 2027, some Medicaid recipients between the ages of 19 and 64 will have to show they are working, attending school, participating in job training or volunteering for at least 80 hours a month or earn at least $580 a month, officials say..

The changes are part of a new federal rule. NY State of Health, which published information about the changes Monday, Aug. 10, said some details could change as the federal government finalizes the rules.

For people who could be affected, the first step is to make sure the state has current contact information.

NY State of Health says people who may be subject to the new requirements by Sept. 30 will be notified. The notices will explain whether the requirements apply and what recipients will need to do. Until then, Medicaid coverage remains unchanged.

Local debate

Candidates in New York State’s 21st Congressional District have very different views on the changes which impact a massive number of people across more than a dozen counties in the district.

Across the district 215,000 of the 770,000 residents are enrolled in Medicaid.

The Healthcare Coalition for the North Country estimates that 50,000 enrollees could be impacted by the changes, while Health Care for All New York Coalition estimates more than 38,000 enrollees could lose their insurance completely.

Democrat Blake Gendebien supports rolling back federal Medicaid spending cuts and advocates for restoring Affordable Care Act premium subsidies for low-income families who have been hit by rising healthcare costs.

Republican Anthony Constantino on the other hand says introducing stricter eligibility parameters preserves Medicaid resources for the most vulnerable populations that need them most.

Exemptions

The new requirements are not expected to apply to everyone on Medicaid. There are a number of exceptions, including for people 65 and older, people 18 and younger, pregnant women and those who were pregnant within the previous 12 months as well as people with certain disabilities or health conditions that make it difficult to work, according to officials.

Some parents and caregivers will also be exempt. This includes parents, guardians and caretakers of children under 14 and people caring for a disabled individual. 

Other exceptions cover certain people enrolled in Medicare, TANF or substance-use treatment programs, as well as some American Indian and Alaska Native people, current and former foster youth and veterans with a total disability.

Some people may qualify for temporary exceptions as well. Those can include people who have been hospitalized or stayed in a nursing facility, people who have had to travel for serious medical care that was not available in their community, and people living in areas affected by a federally declared emergency or disaster. High-unemployment areas may also qualify for a temporary exception, officials say..

New rules

Health officials say for those subject to the work requirements, the state will allow several types of activities to count toward the monthly total.

A person can work at a job, attend school at least half time, participate in a job training or work program, or volunteer in the community.

The requirement can also be met by combining income and hours. Someone earning $380 a month, for example, would receive credit for about 52 hours based on the federal minimum wage of $7.25 an hour. That person would then need another 28 hours of an approved activity to reach 80 hours, officials say.

Some adults ages 19 to 64 will have to renew their Medicaid coverage every six months instead of once a year, as part of another change set to take effect.

People who apply for Medicaid before Jan. 1, 2027, or renew before March 1, 2027, will receive 12 months of coverage if they remain eligible. After that transition period, people affected by the new rule who apply or renew will generally have six-month renewal periods.

People enrolled through NY State of Health can update their address, phone number and email through their online account, with help by calling 1-855-329-8850.

St. Lawrence County residents who receive Medicaid through the Department of Social Services should call  315-379-2111.

The state said it will continue updating its information as the federal government finalizes the rules.

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