ALBANY As the Medicaid cuts enacted by Congress and President Donald Trump take effect, New York is working to preserve its expanded low-income healthcare program by shifting it back to an older configuration.

The move could protect coverage for 1.3 million people currently on the New York Essential Plan, but would kick nearly a half-million New Yorkers off the plan.

On Wednesday, at the directive of Governor Kathy Hochul, state health officials started the rules-changing process to roll back the state’s Essential Plan to what is called a Basic Health Program.

“For months, I’ve warned that Washington Republicans’ devastating cuts would rip health care away from New Yorkers. Today, we have no choice but to confront that reality,” Hochul said in a statement midday Wednesday.

The Essential Plan was established by an innovation program in the Affordable Care Act, part of the wider Medicaid expansion program that law allows states to opt into. It provides medical insurance to people making up to 250% of the federal poverty line, about $39,000 per year, who don’t have access to employer-sponsored or family health coverage. Premiums typically came in at more than $6,000 cheaper per year compared to a marketplace coverage plan, and provided emergency, preventative and specialist coverage.

The Basic Health Program is another kind of Medicaid expansion program that follows a pre-established configuration. It provides coverage for people making up to 200% of the federal poverty line, and can be used to cover legally registered non-citizens.

The state only fully transitioned out of the Basic Health Plan last year, when the Centers for Medicare and Medicaid Services approved the state’s 2023 application to suspend their BHP program and open up the Essential Plan. The approval was meant to allow the program to run until 2028.

But federal actions, backed by Trump and congressional Republicans have yanked back the federal dollars meant to pay for the expanded New York program. The ‘One Big Beautiful Bill,’ which Republicans are trying to rebrand as a tax cuts bill, yanked back $7.5 billion in grants meant for the Essential Plan, making it impossible to fund.

Reverting to the Basic Health Program won’t preserve coverage for everyone; the Essential Plan covers about 450,000 people who sit between the BHP and Essential Plan income limits. Once the Essential Plan is eliminated, they will lose their healthcare coverage.

The process requires a public comment period and a state Health Department rule change; the 30-day comment period on the change opened on Wednesday.

“By reverting to a Basic Health Program, Governor Hochul is making sure that 1.3 million working people will be able to keep their affordable health insurance,” said state Health Commissioner James McDonald. “Even with these steps, too many New Yorkers — nearly half a million– will lose affordable health coverage and be forced to choose between keeping food on the table and paying their medical bills. I am grateful to Governor Hochul for standing up and doing what’s right while Washington Republicans rip health care away from their constituents.”

Hochul said the loss of coverage for nearly half a million New Yorkers is a tragedy, and she noted that 127,000 people who are likely to lose their Essential Plan coverage are in districts represented in Washington by Republicans who voted for this bill, including Representatives Claudia L. Tenney, R-Cleveland and Elise M. Stefanik, R-Schuylerville.

“It doesn’t have to be this way,” Hochul said. “If Republicans give a damn about protecting health care for their constituents, they can act right now to pass a three-year delay of HR1’s cuts to health care eligibility and keep every New Yorker on the Essential Plan covered. And in the meantime, the Center for Medicare and Medicaid Services needs to work with us to identify more low-cost health insurance options for New Yorkers.”

She also called on private employers who restrict employee hours to avoid having to offer health insurance to stop and provide health insurance, reducing the number of working people who have to rely on taxpayer-sponsored coverage.

“The message from across our state is clear: we can act together and stop these devastating impacts before it’s too late,” Hochul said.