With health care affordability under threat across the country, Gov. Kathy Hochul’s proposed budget sends an important and reassuring signal: New York intends to protect Medicaid. The governor’s plan to invest an additional $4 billion recognizes a basic truth — that Medicaid is not a line item to be trimmed, but essential infrastructure that millions of New Yorkers rely on every day.

This commitment deserves credit, especially in an election year, with fiscal pressures mounting and a hostile federal environment looming. The governor has chosen stability over austerity, a choice that matters for the low-income families, seniors, people with disabilities and people living with chronic conditions who depend on Medicaid.

But this proposal is only the first step in a long budget process, and many critical questions remain, with revisions and negotiations still ahead. While the plan largely maintains existing programs, it offers little clarity about whether long-term funding will be sufficient to truly support patients, providers and the health care workforce. New York’s leaders must stay focused on protecting Medicaid from erosion. Early commitments will mean little if funding is later scaled back or Medicaid rates are cut in ways that reduce access to care or strain the system people depend on.  

Federal Medicaid cuts stress New York

The damage already inflicted at the federal level has shifted enormous costs onto states, providers and patients — costs New York State cannot fully absorb on its own. Last year’s budget reconciliation bill, HR1, enacted sweeping Medicaid cuts while allowing enhanced Affordable Care Act subsidies to expire.HR1 will strip billions from New York’s health care system, eliminate coverage for more than a million residents and cost tens of thousands of health care jobs. Providers are already bracing for workforce shortages and service reductions. Communities are preparing for longer wait times and fewer options for care. These pressures will only intensify if Congress fails to act and fix the damage caused by this bill.

People living with — or at risk for — HIV will feel the impact first and hardest. Medicaid is the largest payer of HIV care in the United States, currently covering roughly 40% of people living with HIV; it will support the vast majority at some point in their lives. In New York, Medicaid has been central to our effort to end the HIV epidemic — making lifesaving treatment, prevention tools like PrEP and comprehensive support services accessible to those who need them most.After years of decline, new HIV infections are rising again. Weakening Medicaid at the federal or the state level would reverse decades of public health gains and put lives at risk at the very moment when effective treatment and prevention tools exist but remain out of reach for too many.

One of New York’s greatest strengths in serving people with complex health needs is its Medicaid Special Needs Plan, or SNP, model. SNPs deliver coordinated, person-centered care by integrating medical services with behavioral health, pharmacy and social supports.For people living with HIV, this model works because it recognizes the realities of their lives —addressing housing instability, mental health needs and other barriers that traditional health plans too often overlook. The SNP model improves outcomes while controlling costs. It reduces hospitalizations, supports medication adherence and keeps people engaged in care. It is exactly the kind of smart, evidence-based approach policymakers should be protecting and expanding—not undermining through cuts or uncertainty.

Hochul, Legislature and NY's congressional delegation have to get to work

The governor and the Legislature must work together to ensure Medicaid is protected throughout the entire budget process, with adequate funding to sustain providers, support the workforce and preserve proven models like SNPs.

And our state’s congressional representatives must take responsibility for and act to redress the harm caused by HR1. That means restoring Medicaid funding, extending ACA premium tax credits and recommitting to health care affordability as a national priority. State leadership can blunt some of the damage — but only Congress can fully repair it.

New York has long led the nation in advancing health equity, racial justice and public health. Hochul’s proposed Medicaid investment is a meaningful step in that tradition. Now, Albany and Washington must follow through. Protecting Medicaid isn’t just about defending a program — it’s about protecting people, strengthening communities and ensuring that a health care system that works continues to work for those who need it most.

Doug Wirth is the president and CEO of Amida Care, New York’s largest Medicaid special needs health plan.

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