New York Moves to Exempt Bronx Residents From Medicaid Work Rules as Borough Unemployment Tops Federal Threshold

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Joe Raedle | Getty Images Share on Twitter Share on Facebook Share on Pocket New York is moving to exempt Bronx residents from the federal Medicaid work requirements set to begin Jan. 1, 2027, because the borough’s unemployment rate is high enough to qualify for a temporary hardship exception. The state Department of Health told Becker’s Payer Issues that the Bronx is currently the only county in New York that meets the federal standard.

About 200,000 Bronx residents who would otherwise have to show work or other qualifying activities could be spared, state health officials said at an Oct. 7 United Hospital Fund briefing, according to Becker’s.

The exemption would lift a new reporting requirement in a borough where about 60% of residents rely on Medicaid, according to Gothamist. It does not end other coverage requirements, and details of how long it would last are still being worked out.

The work requirements come from the federal budget law enacted in 2025. Most Medicaid expansion adults ages 19 to 64 will need to show at least 80 hours a month of work, school, job training, or volunteering, or monthly earnings of about $580, to keep coverage.

Under a federal rule from the Centers for Medicare and Medicaid Services, states may offer a short-term hardship exception in counties where unemployment is at or above 8% or 1.5 times the national average. The exception is optional, so each state decides whether to use it.

The Bronx unemployment rate was 7.1% in August, compared with a national rate of 4.3%, both not seasonally adjusted. That clears the 1.5-times test, which works out to about 6.45%, though not the 8% mark. Data compiled by USAFacts also show the August rate at 7.1%.

The Bronx rate has moved around the threshold in recent months. State labor data show it at 7.1% in June, 6.1% in July and 7.1% in August, which makes the exemption’s length and how often it is recalculated important. State Medicaid Director Amir Bassiri said the exemption would continue as long as the borough’s rate stays above the federal threshold, according to a statement from the Bronx Safety-Net Alliance, a coalition of local health providers and community groups.

State Health Department spokesperson Cadence Acquaviva told Gothamist the state is pursuing a county-wide, short-term hardship exception because of the borough’s high unemployment. She said the state has notified CMS and that “there is no formal approval process.”

CMS has not publicly confirmed the arrangement. According to Gothamist, CMS said New York had not submitted a formal request to use the exemption. The Bronx Safety-Net Alliance said the Health Department is working with CMS to finalize how the exemption will be applied, with details expected in November.

Several points remain unclear, including the exact data window the state will use, how often eligibility will be reviewed, and what happens if the Bronx rate drops below the threshold. Those answers will determine whether residents can count on the exemption for all of 2027.

The New York City Health Department welcomed the plan. Spokesperson Chantal Gomez told Gothamist that a borough-wide exemption “would mean that thousands of New Yorkers will face less of a burden.”

MedicalDaily previously reported that up to 900,000 New York City Medicaid enrollees could face coverage risks when the work rules start, largely because of documentation hurdles.

The Bronx Safety-Net Alliance, which pressed for the exemption, estimates that about 600,000 Bronx adults ages 19 to 64 are enrolled in Medicaid, roughly two-thirds of that age group.

The exemption does not cover the other four boroughs. Enrollees in Brooklyn, Queens, Manhattan and Staten Island who are subject to the rules will still need to report qualifying activities or qualify for another exemption.

Bronx residents also face other changes. Starting Jan. 1, 2027, some adults ages 19 to 64 will need to renew their Medicaid every six months instead of once a year, according to the state’s Stay Covered guidance. Missing a renewal could still lead to a loss of coverage, even with the work-rule exemption.

The people with the most at stake are working-age adults with irregular hours, gig work or seasonal jobs, whose monthly hours can rise and fall. Caregivers and people with health problems that have not been formally documented may also find reporting difficult.

Medicaid members should not assume they are exempt until the state tells them. The Stay Covered page says New York State will let enrollees know if a temporary exception applies to them. It also lists other exemptions, including for people who are pregnant or were pregnant in the past 12 months, parents or caregivers of a child under 14, people with disabilities, people in a drug or alcohol treatment program, and veterans with a total disability.

Enrollees can make sure NY State of Health has their current address, phone number, and email. Keeping pay stubs, school enrollment records, or volunteer logs is still wise in case the Bronx exemption ends or does not apply to a particular person.

Questions can go to the NY State of Health Customer Service Center at 1-855-329-8850. People who lose Medicaid only because of the work requirement are not eligible for premium tax credits on the state’s marketplace, which makes keeping Medicaid especially important.

The Bronx exemption could protect a large share of the borough’s working-age Medicaid enrollees from new reporting rules in 2027. It is not yet final; it depends on unemployment staying high, and it does not replace the need to watch for state notices and renew coverage on time.

What is New York planning for the Bronx? The state Health Department is moving to exempt the Bronx from federal Medicaid work requirements under a short-term hardship exception for high-unemployment counties.

Why does only the Bronx qualify? Federal rules allow the exception where unemployment is at least 8% or 1.5 times the national average. The Bronx rate was 7.1% in August against a national rate of 4.3%, and state officials say no other county meets the standard.

How many people could be affected? About 200,000 Bronx residents who would otherwise be subject to the work rules, according to state health officials.

When do the work requirements start? The requirements begin Jan. 1, 2027, for most Medicaid expansion adults ages 19 to 64.

Is the exemption final? Not fully. The state says no formal federal approval is needed, but CMS has not publicly confirmed the plan, and Bronx providers say details are expected in November.

Will Bronx residents still need to renew Medicaid? Yes. Starting in 2027, some adults ages 19 to 64 will renew every six months, and missing a renewal can still end coverage.

What should Bronx Medicaid members do now? Keep contact information up to date, watch for state notices, save records of work or school activities and call NY State of Health at 1-855-329-8850 with questions.