2025 Medicaid Modernization in New York State: Medicaid Eligibility and Client Management System (MECM)

For a background document comparing MAGI Medicaid, Non-MAGI Medicaid, and the Medicare Savings Program, click here. For an example MECM notice showing Medicaid and MSP eligibility, click here. For an example MECM notice showing Medicaid and MSP ineligibility, click here. For a copy of the slides from NYLAG's December 17, 2025 webinar on MECM, click here. For the YouTube recording of NYLAG's December 17, 2025 webinar on MECM, click here.

Table of contents:

Introduction

The New York State Department of Health (“DOH”) has launched a new program to modernize how certain Medicaid applicants/recipients will apply for and renew their Medicaid benefits. This modernization project is called the Medicaid Eligibility and Client Management system (“MECM”). MECM will impact how people apply for, and renew, a variety of Medicaid benefits including non-MAGI Medicaid and Medicare Savings Program benefits (MSP).

Medicaid Modernization is a multiyear project for which planning began in 2023, and that is being phased in on a gradual basis from 2025 to 2032. The DOH’s Medicaid Eligibility Modernization website can be found here.

A soft launch of MECM began on September 30, 2025. Certain community-based organizations and the NYSOH call center can help individuals apply for certain types of non-MAGI Medicaid and MSP on MECM, discussed below. The public will be able to access MECM to apply for certain non-MAGI Medicaid and MSP benefits on December 1, 2025.

To help the public gain familiarity with MECM, this article will provide a brief overview of the ongoing changes. We will update this article periodically as the Medicaid Modernization process continues.

Overview of Health Insurance Programs in New York State

There are a variety of public health insurance programs in New York State. Some programs are housed on the New York State online health insurance marketplace called the New York State of Health (“NYSOH”). Weblink is at https://nystateofhealth.ny.gov/. Other types of coverage have long been and continue to be administered by the Local Departments of Social Services (“LDSS”), such as the Human Resources Administration (“HRA”) in NYC. Below is a list of which health insurance programs are currently administered by NYSOH and which by the LDSS.

The process for applying and renewing Medicaid and other insurance programs is very different depending on where the program is administered. NYSOH-administered public health programs are typically online, and individuals may seek assistance through a NYSOH Navigator or Certified Application Counselor. LDSS-administered Medicaid programs are administered through a system called the Welfare Management System (“WMS”) and applications and renewals are typically on paper.

NY Health insurance programs that are administered on the NYSOH marketplace include: 

  1. MAGI Medicaid - coverage under the Affordable Care Act for individuals under age 65 who do not have Medicare, plus individuals who do have Medicare – who may be age 65 or more – who live with and are “caretaker relatives” of a minor child, grandchild, or other relative
  2. Child Health Plus
  3. The Essential Plan
  4. Qualified Health Plan (QHP) and Premium Tax Credits to reduce costs
  5. Small Business Options called SHOP (on NYSOH)

NY health insurance programs that are administered exclusively by the Local Departments of Social Services (“LDSS”)until the MECM changes begin:

  1. Non-MAGI Medicaid (for age 65+, blind, or disabled), including:
    1. Community Medicaid for home care, the Assisted Living Program, 1915(c) HCBS waiver programs (OPWDD Waiver, TBI Waiver, NHTD Waiver, and the Children’s Waiver), and other community-based long term care services, primary and acute care. See this fact sheet about non-MAGI Medicaid in NYS.
    2. Institutional Medicaid for nursing home care
  2. Medicaid for residents of Adult Homes, OMH Community Residences and Residential Care Centers
  3. Medicaid Buy-In for Working People with Disabilities
  4. Medicaid Cancer Treatment Program (if not income-eligible for MAGI or non-MAGI Medicaid)
  5. Medicare Savings Program (MSP) pays the monthly Medicare Part B premium for low-income Medicare beneficiaries and qualifies enrollees for the “Extra Help” subsidy for Medicare Part D prescription drugs. See New York Health Access Medicare Savings Program tab and DOH webpage on MSP.
  6. Programs that pay private health insurance premiums if eligible:
    1. COBRA Continuation coverage
    2. AIDS Health Insurance Program
  7. Children in Foster Care or those who are under age 26 and were in foster care on their 18th birthday
  8. Family Planning Benefit Program (FPBP)
  9. Presumptive Eligibility for Pregnant Individuals
  10. Individuals in receipt of cash assistance (also called Public Assistance or “PA”) and individuals in receipt of Supplemental Security Insurance (SSI) are automatically eligible for Medicaid and their cases are currently housed at the LDSS.

See also DOH  2013-ADM-04  Attachment: MAGI and Non-MAGI Eligibility Groups.

For a background document comparing MAGI Medicaid, Non-MAGI Medicaid, and the Medicare Savings Program, click here.

For more about MAGI Medicaid vs. non-MAGI Medicaid, see the following resources:

MECM: Medicaid Modernization in 2025

Since the Affordable Care Act (“ACA”), MAGI Medicaid and other public health insurance programs have been administered by NYSOH, using the NYSOH online eligibility system which was developed in the 2010’s. Meanwhile, non-MAGI Medicaid cases have been administered by the Local Departments of Social Services (“LDSS”), using an older (legacy) eligibility system called Welfare Management System (“WMS”). As WMS was developed in the 1970’s, it is extremely outdated.

With MECM, eventually (over the course of multiple years) all non-MAGI Medicaid cases will be moved over to MECM, housed within NYSOH. This will be a big change. Prior to MECM, the only way to complete most non-MAGI Medicaid applications and renewals filed with the LDSS was to completed them on paper and then submit them by mail or in person at a LDSS office. LDSS staff had to make manual data entries into WMS using information in the paper applications. By contrast, MAGI applications are filed online on NYSOH, which is a faster and more efficient process that allows for back-end data matching to state and federal data sources.

Phase-in Schedule - Wave 1 Starting September 30, 2025

Below is a big picture timeline of a few of the major changes taking place.

MECM is taking a phase-in approach, in which certain non-MAGI Medicaid cases are permitted on MECM starting on September 1, 2025. Some refer to these initial types of cases as “Wave 1” of MECM. Additional types of cases will be permitted in MECM over time.

Because non-MAGI Medicaid is so complex, the first phase of MECM will only handle Medicaid and MSP for the simplest cases, also known as cases in “Wave 1." 

The “Wave 1” MECM group of cases is limited to the following:

  1. Non-MAGI Medicaid cases for people age 65+, disabled or blind, who meet both of these criteria:
    1. Their income is under the Medicaid limit so that they have no spend-down and no Pooled Income Trust (however, we have learned that MECM can handle cases with spousal refusal budgeting), and
    2. They are not seeking long term care. This means they are not seeking to enroll in a Managed Long Term Care, MAP or PACE plan, or a 1915(c) home-and community-based service waiver program. Nor are they applying for personal care or CDPAP, whether through Immediate Need or otherwise, and they are not seeking Medicaid to cover a nursing home, an adult home, or the Assisted Living Program.
  2. Medicare Savings Program cases for people who meet either of these criteria:
    1. People who are only seeking to enroll in an MSP-only and not Medicaid.
    2. Non-MAGI Medicaid applicants who meet the Wave 1 criteria above (people with no spend-down who are not seeking long term care) and are applying for MSP as well as non-MAGI Medicaid.

Here is the phase-in schedule for MECM:

Updates from First Few Months of MECM

Data on Applications:

As of January 23, 2026, MECM had received 13,235 applications. Below is a slide from DOH describing those applications. 

Data on Renewals:

As of December 5, 2025, MECM had processed 13,427 renewals. Below is a slide from DOH describing those renewals. (The “Wave 1 update 1/2” slide below shows outdated metrics related to applications as of December 5, 2025. It also shows data for referrals to WMS at the LDSS and referrals to NYSOH, as of December 5, 2025.) Note that “admin renewed” describes the cases that the MECM system could fully renew using access to state and federal data sources, without any additional actions undertaken by the Medicaid recipient. The cases that were “moved to manual renewal” are those that the MECM system could not admin renew, and thus those consumers received a notice telling them they must manually renew by January 15, 2026. 

MECM Identifiers on Notices:

Although MECM notices will be branded as NYSOH, there are distinct identifiers for MECM cases that are different from NYSOH cases. Each MECM case number begins with the letters “MC” and has a Member ID beginning with the letters “PX.” See below for two examples of notices for MECM cases.

Meanwhile, each NYSOH case number begins with the letters “AC” and has a Marketplace ID beginning in the letters “HX.” See below for two examples of notices for NYSOH cases.

"Late" and "Late Late" Renewal Option in MECM:

Since 2016 (the early days of the ACA), DOH has permitted "late" and "late late" renewals for MAGI Medicaid cases on NYSOH. DOH has confirmed that it will also permit "late" and "late late" renewals for non-MAGI Medicaid cases on MECM, and DOH encourages people with cases on MECM to go into the system and try to renew their Medicaid even if the renewal date has passed.

Slide 16 of this DOH slide deck on the Public Health Emergency Unwinding describes how late renewals work: “Generally, renewals must be completed within a 30-day window as specified in the consumer's notice. [Medicaid] enrollees who do not renew timely, may still renew after their renewal window and through the end of the following month, after their coverage has ended. If they remain eligible for the same program and they enroll in the same plan that they had the previous year, then NY State of Health will provide coverage in the plan without any gaps. As always, [Medicaid] enrollees changing plans will have Fee-For-Service coverage while awaiting plan enrollment and will not have gaps in coverage.”

Here is the above information applied to a hypothetical Medicaid recipient in MECM named Bob. Bob has a 30-day renewal window in MECM (meaning his renewal will be considered “timely” in MECM) of February 15, 2026 to March 17, 2026. If MECM cannot admin renew Bob’s Medicaid on February 15, 2026, Bob will receive a notice (branded as NYSOH but with the MECM identifiers shown above) telling him that he must manually renew his Medicaid by March 17, 2026, otherwise his coverage end date will be March 31, 2026.

NYSOH Appeals FAQ:

On January 26, 2026, NYSOH updated its appeals and fair hearing FAQ page titled Questions about Appeals. The page now includes information about MECM and speaks to important Medicaid protections such as “Aid to Continue.” We encourage you to share this website widely with communities whose cases are, or may be, in NYSOH or MECM.

Limits on where to Apply for MSP:

NYLAG recently learned about a Medicaid recipient whose Medicaid case was at the LDSS, and when they went to apply for MSP on MECM, they were unable to do so. We’ve since learned that Medicaid recipients must apply for MSP wherever their Medicaid case currently is. This means if your Medicaid case is at the LDSS, and you want to apply for MSP, you must do so at the LDSS using the paper application. The only people who can apply for MSP on MECM are: (1) individuals who do not already have Medicaid and so are applying for Medicaid and MSP at the same time, and (2) individuals whose Medicaid case is already in MECM and now are wanting to apply for MSP.

Bypassing the Identity Proofing and Email Address Requirement:

Individuals who wish to apply for Medicaid or MSP in MECM directly on the New York State of Health must first create (or use an existing) My NY.Gov ID, which requires that they go through Experian Identity Proofing and also requires that they have an email address. (For more about the My NY.Gov ID, see the New York State government page, Get a My NY.Gov ID.)

However, any individual who works with a MECM Assistor (see more on them below) or works with the NYSOH Call Center to apply for Medicaid or MSP in MECM, does not need a My NY.Gov ID nor do they need an email address. For older adults, people with disabilities, and anyone else who may have difficulty navigating identity proofing and/or an email address, we recommend that they work with a MECM Assistor to apply for benefits in MECM.

Challenges and Benefits of MECM

The transition of non-MAGI applications and renewals to a new online system poses several challenges as well as benefits.

Challenges of Designing and Implementing MECM: 

Benefits of MECM:

On the Horizon:

As the new MECM system starts to accept and process new applications for non-MAGI Medicaid and MSP, the next challenges will be phasing in more complex Medicaid applications, such as those with special budgeting. Also, all 140,000 non-MAGI cases on NYSOH will be transferred onto MECM, and all non-MAGI Medicaid cases that now exist on the decades-old WMS system administered by the LDSS will be eventually transferred onto MECM as well.

Deloitte Retained as Consultant to Develop MECM

DOH hired Deloitte Consulting LLP (“Deloitte”) to design MECM. The Deloitte MECM contract (contract number C038860) is for nearly $300 million, and extends from 8/1/23 to 9/8/26.

Note that Deloitte has gained national press in recent years for issues with its Medicaid modernization systems, and three national advocacy groups (the National Health Law Program, Electronic Privacy Information Center, and Upturn) filed a formal complaint on January 31, 2024 urging the Federal Trade Commission to investigate Deloitte related to its Medicaid eligibility system errors. While we hope that similar issues will not occur in New York, it is important that the public is informed.

MECM Assistors

“MECM Assistors” are individuals who have been trained to help people apply for Medicaid and MSP on MECM. Staff at three organizations were chosen to be the initial MECM Assistors: Healthy Capital District Initiative, Public Health Solutions, and Community Services Society. Each of these organizations is already designated as a Facilitated Enroller for the Aged, Blind, Disabled (“FE-ABD”), meaning they already help individuals enroll into non-MAGI Medicaid across New York State. Staff at additional FE-ABD organizations, as well as other organizations, will become MECM Assistors over time.

Current MECM Assistors can be found by going to the NYSOH Find Local Help page, under “Types of Assistance” unchecking “Families and Individuals under 65” and instead checking “Individuals 65 or older, or those who are blind or disabled,” and then clicking “Show Results.”

NYS Guidance and Information on MECM 

When DOH makes big policy changes, it must announce those changes through a policy directive, such as an Administrative Directive (“ADM”) or a General Information System ("GIS") message. You can find a list of ADMs and GISs, organized by per, on the DOH Library of Official Documents - Search by Year website. Although the MECM directive has not yet been released, we continue to monitor the DOH website for its release. We will update this article with the directive when it is available.

In the meantime, the DOH website on MECM is available here: Continuing The Medicaid Eligibility Modernization. The DOH website has some history of the modernization effort and the timeline, as well as other information.



Article ID: 257
Last updated: 03 Feb, 2026
Revision: 1
Medicaid -> 2025 Medicaid Modernization in New York State: Medicaid Eligibility and Client Management System (MECM)
http://health.wnylc.com/health/entry/257/