New York State Essential Plan 200-250 Coverage to End Effective 7/1/2026

There is an important change to the New York State Essential Plan that will impact members enrolled in the 200–250% Federal Poverty Level (FPL) eligibility category.

Due to recent federal policy changes affecting the Essential Plan program, the Essential Plan 200–250 coverage category will be discontinued effective July 1, 2026. As a result, members currently enrolled will no longer maintain coverage under this product after June 30, 2026.

New York State of Health (NYSOH) will issue notices to impacted members enrolled in EP 200-250 on April 1, 2026. In addition, members will learn their eligibility status from NYSOH by May 15, 2026, which will indicate members' available coverage options. There is no change in benefits right now. Members will remain covered through June 30, 2026.

There will be no changes at this time for members enrolled in Essential Plan 1-4 (income up to 200% FPL) who are citizens or lawfully present.

What Does This Mean for Healthfirst Members?

Members currently enrolled in EP 200-250 will:

• Lose eligibility for EP 200-250 coverage as of July 1, 2026.
• Be able to enroll in other coverage. Many EP 200-250 members are expected to be determined eligible for a Qualified Health Plan (QHP) to maintain continuous coverage.
• Experience changes in premiums and out-of-pocket costs if they enroll into QHP, as QHPs’ cost-sharing designs and amounts differ from those in EP 200-250.

Impacted members can access Healthfirst Customer Service and Marketplace Enrollment Support for assistance comparing plans and completing enrollment.

A Member’s Coverage Post July 1 depends on their Pregnancy/Postpartum and Immigration Status

Pregnant and Post-Partum EP 200-250 Members will be transitioned into a different Essential Plan or Medicaid Managed Care (MMC) plan, depending on their due date.

Members will stay covered but will move to a different plan based on their pregnancy status and timing.

For additional information around specific coverage after July 1 for pregnant and expecting members, please see the guidance on NYSOH for 1332 waiver, with detailed FAQs.

How You Can Prepare and Support Your Patients

• Advise impacted patients to carefully review all state notices and take timely action to avoid gaps in coverage.
• Encourage your patients to update their information on file and sign up for text alerts from NYSOH by visiting nystateofhealth.ny.gov or calling 1-855-355-5777, Monday to Friday, 8am-8pm, and Saturday, 9am-1pm.
• Direct patients to respond promptly to eligibility and enrollment notices from NY State and Healthfirst.
• Verify eligibility at each visit, particularly for patients who are historically enrolled in EP 200-250.
• Ensure claims for covered services reflect dates of service on or before June 30, 2026, under this product.

Thank you for your continued partnership and for supporting our members during this transition.

More Information

Stay Connected with NY State of Health

Questions?

For questions about the EP 200-250 changes, contact NY State of Health at 1-855-355-5777, or visit info.nystateofhealth.ny.gov

For all other questions, please contact your Network Account Manager, or call Provider Services at 1-888-801-1660, Monday to Friday, 8:30am-5:30pm.

Coverage is provided by Healthfirst Health Plan, Inc., Healthfirst PHSP, Inc., and/or Healthfirst Insurance Company, Inc. (together, “Healthfirst”).
April 2026