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 individuals ages 19 to 64 with incomes up to 250 percent of the poverty level (approximately $37,650 for an individual in 2024) that are not eligible for Medicaid, Child Health Plus, or employer-provided health plans.
First offered with coverage beginning January 1, 2016, the EP now covers over 1.6 million individuals. As the State began to redetermine Medicaid eligibility following the conclusion of the COVID-19 public health emergency, many New Yorkers shifted health insurance coverage from Medicaid to the EP, which resulted in a significant increase in coverage in 2025. As of March 2025, the EP covered 8.5 percent of New York’s residents, with the share as high as 16.4 percent in Queens.
As of April 1, 2024, the EP expanded eligibility pursuant to a Section 1332 State Innovation Waiver by raising the maximum income threshold to qualify for the EP from 200 percent of the Federal Poverty Level (FPL) to 250 percent. Additional benefits that are provided through the Section 1332 waiver include programs to address the social determinants of health, such as providing medically tailored meals, providing enrollees with persistent asthma with an air conditioner, as well as grants to help communities prepare for extreme weather.
The Division of the Budget (DOB) is projecting EP costs in State Fiscal Year (SFY) 2026 will total $13.2 billion, with outyear projections steadily increasing to a projected $15.0 billion in SFY 2029. The EP is now completely federally funded because of the waiver; previously, New York’s costs for the EP averaged $71.1 million from the SFY 2020 through SFY 2024 period.
Essential Plan Spending, SFY 2016 - SFY 2025 (billions of dollars)
Note: Totals combine State and federal funding. Data for SFY 2025 are estimates; all other years are actual.
Source: NYS Division of the Budget
Essential Plan Enrollment, CY 2016 – CY 2025
Source: New York State of Health
| County | As of March 1, 2025 | Mar-2025 |
|---|---|---|
| Enrollment | % Enrolled | |
| Albany | 14,624 | 4.6% |
| Allegany | 2,057 | 4.4% |
| Bronx | 172,021 | 12.7% |
| Broome | 9,873 | 5.0% |
| Cattaraugus | 3,678 | 4.9% |
| Cayuga | 3,603 | 4.8% |
| Chautauqua | 5,998 | 4.8% |
| Chemung | 3,936 | 4.8% |
| Chenango | 2,477 | 5.4% |
| Clinton | 3,261 | 4.2% |
| Columbia | 3,094 | 5.1% |
| Cortland | 2,525 | 5.5% |
| Delaware | 2,117 | 4.8% |
| Dutchess | 14,066 | 4.7% |
| Erie | 46,442 | 4.9% |
| Essex | 1,754 | 4.8% |
| Franklin | 2,154 | 4.6% |
| Fulton | 3,144 | 6.0% |
| Genesee | 2,641 | 4.6% |
| Greene | 2,302 | 4.9% |
| Hamilton | 224 | 4.4% |
| Herkimer | 3,189 | 5.4% |
| Jefferson | 5,198 | 4.5% |
| Kings (Brooklyn) | 329,293 | 12.9% |
| Lewis | 1,357 | 5.1% |
| Livingston | 2,537 | 4.1% |
| Madison | 2,817 | 4.2% |
| Monroe | 40,714 | 5.4% |
| Montgomery | 2,852 | 5.8% |
| Nassau | 102,623 | 7.4% |
| New York (Manhattan) | 95,563 | 6.0% |
| Niagara | 10,511 | 5.0% |
| Oneida | 12,165 | 5.3% |
| Onondaga | 22,648 | 4.8% |
| Ontario | 4,887 | 4.3% |
| Orange | 23,463 | 5.8% |
| Orleans | 2,897 | 7.4% |
| Oswego | 5,736 | 4.9% |
| Otsego | 2,594 | 4.3% |
| Putnam | 4,279 | 4.4% |
| Queens | 369,951 | 16.4% |
| Rensselaer | 6,641 | 4.2% |
| Richmond (Staten Island) | 40,972 | 8.3% |
| Rockland | 25,028 | 7.3% |
| Saint Lawrence | 4,531 | 4.2% |
| Saratoga | 8,391 | 3.5% |
| Schenectady | 9,899 | 6.2% |
| Schoharie | 1,376 | 4.6% |
| Schuyler | 883 | 5.0% |
| Seneca | 1,432 | 4.4% |
| Steuben | 4,749 | 5.2% |
| Suffolk | 116,828 | 7.7% |
| Sullivan | 4,669 | 5.8% |
| Tioga | 2,321 | 4.9% |
| Tompkins | 3,570 | 3.4% |
| Ulster | 9,703 | 5.3% |
| Warren | 3,368 | 5.2% |
| Washington | 3,145 | 5.2% |
| Wayne | 4,853 | 5.3% |
| Westchester | 55,711 | 5.6% |
| Wyoming | 1,666 | 4.2% |
| Yates | 1,173 | 4.8% |
| Total | 1,658,174 | 8.5% |
Source: New York State of Health, U.S. Census Bureau, Office of the State Comptroller analysis