New York is one of three states to have a “basic health plan,” as authorized by the Affordable Care Act; in New York, this is known as the Essential Plan (EP). The EP provides health insurance to lawfully present individuals with incomes up to 200 percent of the federal poverty level (approximately $31,920 for an individual in 2026) who are not eligible for Medicaid, Child Health Plus, or employer-provided health plans.
Previously, the EP operated under a federal waiver that allowed for expanded benefits and authorized coverage for New Yorkers with incomes up to 250 percent of the federal poverty level. This version of the EP was available from April 1, 2024, through June 30, 2026. Changes made by Public Law 119-21 limited the availability of premium tax credits for many immigrants; these tax credits were a key funding source for the EP. As a result, the State requested and received federal approval to terminate the waiver and to the current plan.
As a result of these changes, EP enrollment dropped by 320,000 between March 1, 2026, and August 30, 2026, with enrollment changes fairly evenly split between New York City and the rest of the state. More than 1.3 million individuals were enrolled statewide as of August. On a county basis, the share ranged from 2.5 percent in Tomkins County to 13.5 percent in Queens County.
| Location | March 1, 2026 Enrollment | August 30, 2026 Enrollment | Enrollment Change (amount) | Enrollment Change (percent) |
|---|---|---|---|---|
| New York City | 1,005,165 | 845,275 | -159,890 | -15.9% |
| Rest of State | 686,425 | 525,998 | -160,427 | -23.4% |
The Division of the Budget (DOB) is projecting a decrease in EP costs in State Fiscal Year (SFY) 2027, to $11.4 billion, reflecting the decreased funding available as well as an expected decline in enrollment. The State's most recent financial plan projects a decline in EP projected spending, with SFY 2030 projected as “TBD”.
Essential Plan Spending, SFY 2017 – SFY 2027
- Data Table – Essential Plan Spending, SFY 2017 – SFY 2027
State Fiscal Year
2017State Fiscal Year
2018State Fiscal Year
2019State Fiscal Year
2020State Fiscal Year
2021State Fiscal Year
2022State Fiscal Year
2023State Fiscal Year
2024State Fiscal Year
2025State Fiscal Year
2026State Fiscal Year
2027All Funds $3.6 $4.0 $4.1 $3.9 $4.6 $5.6 $6.3 $9.8 $12.9 $14.1 $11.4
Note: Totals combine State and federal funding. Data for SFY 2027 are estimates; all other years are actual.
Source: NYS Division of the Budget
Essential Plan Enrollment, CY 2017 – August 2026
- Data Table – Essential Plan Enrollment, CY 2017 – August 2026
2017 2018 2019 2020 2021 2022 2023 2024 2025 March 2026 August 2026 Total Enrolled 665,324 738,851 790,152 796,998 883,450 959,832 1,179,977 1,198,392 1,658,174 1691590 1371273
Source: New York State of Health
Essential Plan Enrollment by County, August 2026
Source: New York State of Health, U.S. Census Bureau, Office of the State Comptroller analysis
- Data Table – Essential Plan Enrollment by County, August 2026
County
Enrollment
Percent Enrolled
Albany 12,263 3.8% Allegany 1,435 3.1% Bronx 148,433 10.6% Broome 8,224 4.2% Cattaraugus 2,636 3.5% Cayuga 2,600 3.5% Chautauqua 4,456 3.6% Chemung 2,924 3.6% Chenango 1,766 3.9% Clinton 2,539 3.2% Columbia 2,424 4.0% Cortland 1,937 4.2% Delaware 1,551 3.5% Dutchess 10,996 3.7% Erie 37,214 3.9% Essex 1,220 3.3% Franklin 1,588 3.4% Fulton 2,337 4.5% Genesee 1,987 3.4% Greene 1,724 3.6% Hamilton 171 3.4% Herkimer 2,292 3.9% Jefferson 4,054 3.6% Kings (Brooklyn) 267,398 10.1% Lewis 938 3.5% Livingston 1,809 2.9% Madison 2,006 3.0% Monroe 31,445 4.2% Montgomery 2,214 4.4% Nassau 87,362 6.2% New York (Manhattan) 74,080 4.4% Niagara 7,803 3.7% Oneida 9,197 4.1% Onondaga 17,551 3.8% Ontario 3,436 3.0% Orange 20,283 4.9% Orleans 2,011 5.0% Oswego 4,189 3.5% Otsego 1,805 3.0% Putnam 3,474 3.5% Queens 319,024 13.5% Rensselaer 5,163 3.2% Richmond (Staten Island) 36,340 7.2% Rockland 21,967 6.1% Saint Lawrence 3,403 3.2% Saratoga 6,429 2.7% Schenectady 8,071 5.0% Schoharie 925 3.1% Schuyler 612 3.6% Seneca 1,058 3.2% Steuben 3,498 3.8% Suffolk 97,837 6.3% Sullivan 3,575 4.4% Tioga 1,745 3.7% Tompkins 2,626 2.5% Ulster 7,477 4.1% Warren 2,502 3.8% Washington 2,384 4.0% Wayne 3,661 4.0% Westchester 47,195 4.6% Wyoming 1,234 3.1% Yates 775 3.2%