When Jan. 1 rolls around, drastic changes are coming to the Medicaid system.
As part of H.R. 1, or the “Big, Beautiful Bill,” that became federal law in July 2025, those receiving Medicaid have to earn at least $580 per month or work 80 hours a month to retain their coverage starting Jan. 1, 2027. People can also show they are working by going to school, joining a job training program, or performing volunteer work.
In Niagara County, where around 15,300 residents on Medicaid could be impacted by the work requirement changes, healthcare professionals and those working for insurance companies have launched a new group to help mitigate the changes. The Niagara Medicaid Collaborative met for the first time Wednesday to help navigate this new reality and work on ways its patients on Medicaid can keep their coverage.
“The implications of (H.R. 1) with respect to healthcare, I feel like we’re in a rowboat going through a tsunami,” said Niagara Falls Memorial Medical Center CEO Joseph Ruffolo as the meeting started.
Of the 7.2 million New Yorkers that have Medicaid coverage, about 2 million are at risk of losing it because of the new work requirements. In Western New York, about 109,500 of the 380,000 Medicaid recipients are at risk. And Niagara County has 52,856 residents on Medicaid, with the number of at-risk recipients at 15,328. Nearly 450,000 New Yorkers already lost Medicaid coverage this year after being on the state’s Essential Plan, for those making too much money to qualify for Medicaid but not enough for private insurance.
Among the other changes Medicaid recipients have to abide by are renewing their coverage every six months instead of once a year, retroactive coverage can only cover the previous month, the open enrollment period is cut in half to two months, and some immigrant groups may lose coverage completely. Those with outdated paperwork are also at risk.
With volunteerism as one way for a Medicaid recipient to keep coverage, the collaborative is putting together a website of volunteer opportunities people can go to. Catherine Shick of FeedMore WNY, one of the region’s largest food banks, said they have a need for Meals on Wheels drivers. Kristina Daloia, the hospitality program manager of Heart, Love & Soul, said they can take in three Medicaid-eligible volunteers at a time, with their experience also helping develop soft skills for employment.
Gerald Cracknell, the executive director of the county’s Career Center Worksource One, said they pay for the majority of workforce development opportunities.
“Our goal is to keep all of them protected by doing volunteerism and the workforce,” said Shiela Kee, executive director of special initiatives for NFMMC. “If that doesn’t happen, thousands of people are going to lose their Medicaid benefits. How many, we don’t know yet.”
The Medicaid changes would also have a significant impact on providers and hospitals who rely on insurance payments for portions of their revenue. Niagara Falls Memorial Medical Center, which, according to 2024 tax filings, took in $146.7 million in revenue that year, relies on Medicaid for around 40% of that amount. The changes in the healthcare industry as a whole could see them losing as much as $8 billion per year in Medicaid payments, with greater ripple effects on the national economy costing about $14 billion per year.
While this organization is focused on initially serving Niagara County residents, Kee said they hope their efforts expand into Erie County, then the rest of Western New York. Eventually, they want to see every region of the state having some program like this.
“The worst thing that could happen is not having healthcare coverage,” Kee said. “If you need to see a doctor or if you have a mental health appointment, you need coverage.”
Those with further questions about these Medicaid changes can call the collaborative’s dedicated helpline at 716-278-4264.