New Yorkers have a lot on the line as the Republican-controlled Congress considers cuts to Medicaid that potentially total $880 billion over the course of the next decade, according to health care officials, lawmakers and policy experts.

“Even if Republicans pass a fraction of the cuts they’re pushing, it would devastate these communities,” Sen. Chuck Schumer, a New York Democrat, said after visiting nursing homes on Staten Island and Long Island earlier this month.

About half of the 8 million residents in the five boroughs are covered through the publicly funded insurance program, which pays for their doctor’s visits, hospital stays, and addiction and mental health treatment. It also pays for most long-term care for elderly and disabled residents, which is generally not covered by other forms of insurance.

The number of New Yorkers insured through the program is even higher when factoring in the state’s Medicaid expansion, which covers people with slightly higher incomes through an insurance option known as the Essential Plan. Statewide, traditional Medicaid covers about 7 million New Yorkers, while the Essential Plan covers another 1.6 million.

Rep. Nicole Malliotakis, a Republican who represents Staten Island and parts of Brooklyn, said last month that it was necessary to eliminate waste and fraud in Medicaid in order to “preserve this very important program that our seniors, our disabled, our children with developmental disabilities and vulnerable Americans rely on.”

But New York Democrats and health care advocates say the cuts would hit the most vulnerable residents the hardest, and reduce overall access to care in low-income neighborhoods. Dr. Douglas York, president and CEO of the nonprofit Union Community Health Center in the Bronx, described the potential ripple effects if some New Yorkers lose coverage.

“ If patients don't come in for care, they will wind up in an emergency room,” York said. “There’s also an immediate loss of revenue for the health center, and if that revenue can't be recovered, you start the process of workforce reduction — hours being cut back and other decisions you wouldn't want to make.”

It’s still unclear exactly what Medicaid reforms federal lawmakers will seek to put in place to reduce spending. That’s largely stopped New York lawmakers from taking the cuts into consideration during this state budget session.

But it will ultimately be up to states to decide how to manage the cuts.

No matter what, they will “leave states with some tough choices,” said Elizabeth Williams, senior policy manager for Medicaid at KFF, a health policy nonprofit.

Here’s what to know now about the Medicaid debate and the cuts' potential effects on New York patients, providers and the state budget.

What do we know so far about Congress’ plans for Medicaid?

Republicans in the House and Senate reached an agreement on a budget framework Thursday for cutting taxes and spending, and will now have to work out the details.

In February, the House released a budget plan that provided for up to $4.5 trillion in tax cuts, along with $2 trillion in spending reductions over a decade. The Energy and Commerce Committee was instructed to cut $880 billion in that timeframe, and policy experts determined that a sum that large could only come from Medicaid.

The new version of the budget blueprint does not include such steep overall spending cuts, but doesn’t rule them out, either. Senate Majority Leader John Thune of South Dakota said Thursday that he still wanted to target at least $1.5 trillion in government spending over a decade to “get the country on a more sustainable fiscal path,” the New York Times reported.

Possible Medicaid reforms could include limiting eligibility by establishing work requirements, which some Republicans in Congress have championed.

Changing how the federal government contributes to state Medicaid budgets could be another option, Williams said. Currently, the federal government provides matching funds that grow along with state spending. But Congress could opt to cap the amount the federal government will spend for each Medicaid enrollee.

The federal government could also reduce its contribution to Medicaid expansion programs, which would put New York’s Essential Plan at risk, Williams said. Currently, the federal government pays for 90% of coverage for the expansion population.

Project 2025 lays out a menu of Medicaid changes Congress could implement to reduce spending. The Trump administration has already implemented many of the proposals laid out in the policy blueprint, which was created by the Heritage Foundation, a conservative think tank.

How much does New York stand to lose?

While many details are still up in the air, KFF has modeled several possible scenarios and how they would affect each state.

If $880 billion in cuts were implemented evenly over a decade and applied proportionally to each state, New York would lose about $10 billion a year, or $400 per resident, according to one KFF analysis.

If New York wanted to preserve Medicaid coverage, KFF determined, the state could offset the losses by raising taxes 7%. Or it could opt to cut education spending by $14,200 per student.

Of course, those are just hypotheticals.

“ Raising taxes or cutting education would be very difficult for states to do and unpopular,” Williams said. “ We wanted to illustrate the choices that states could potentially have.”

Any policy that caps the amount the federal government spends per Medicaid enrollee would also likely limit how much federal spending can increase each year, which means the losses would compound over time, Williams added.

What could happen to health care services?

Hospitals, clinics and other health programs that serve Medicaid patients in New York are perennially asking state lawmakers to raise their rates, saying the program already falls short of covering their costs.

Gov. Kathy Hochul, in turn, is tasked with trying to keep state spending on the massive program in check — which is a challenge. Her executive budget for fiscal year 2026 included $35.4 billion in state Medicaid spending, an increase of $4.3 billion over the previous year.

Some New York hospitals serving large numbers of Medicaid patients already struggle to keep their doors open, even with additional subsidies from the state.

Any cuts to Medicaid — either through fewer insured patients or reductions in payment rates — would affect access to care overall, health care providers say.

For nonprofit community health centers, one of the biggest challenges is retaining specialists such as cardiologists or gastroenterologists, since they demand a lot more than Medicaid pays, said York of Union Community Health Center. Already, the health center is only able to have some specialists available during limited hours, and additional cuts could mean further reductions and longer wait times for patients, he added.

Long-term care for elderly and disabled New Yorkers, either in their homes or in nursing homes, is particularly vulnerable to Medicaid cuts. This care is often paid for by Medicaid because Medicare and other insurers generally do not cover it. That means nursing homes in the state overwhelmingly rely on Medicaid to keep their doors open.

New York is particularly generous in this area. The state makes it possible for elderly New Yorkers who were once too wealthy to qualify for Medicaid to take advantage of long-term care coverage — for instance by not penalizing people for transferring assets to loved ones.

What will happen to New Yorkers who no longer qualify for Medicaid?

If New Yorkers lose coverage through Medicaid or the Essential Plan and don’t have coverage through employers, they could end up shopping for health plans on the state’s Affordable Care Act marketplace. But they may struggle to find affordable options.

Federal tax credits designed to offset the cost of premiums for private marketplace plans, which were extended under President Joe Biden, are due to expire at the end of 2025.