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.
Table of contents:
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.
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:
- 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
- Child Health Plus
- The Essential Plan
- Qualified Health Plan (QHP) and Premium Tax Credits to reduce costs
- 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:
- Non-MAGI Medicaid (for age 65+, blind, or disabled), including:
- 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.
- Institutional Medicaid for nursing home care
- Medicaid for residents of Adult Homes, OMH Community Residences and Residential Care Centers
- Medicaid Buy-In for Working People with Disabilities
- Medicaid Cancer Treatment Program (if not income-eligible for MAGI or non-MAGI Medicaid)
- 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.
- Programs that pay private health insurance premiums if eligible:
- COBRA Continuation coverage
- AIDS Health Insurance Program
- Children in Foster Care or those who are under age 26 and were in foster care on their 18th birthday
- Family Planning Benefit Program (FPBP)
- Presumptive Eligibility for Pregnant Individuals
- 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:
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.
Below is a big picture timeline of a few of the major changes taking place.
MECM is taking a phase-in approach, in which online applications for non-MAGI Medicaid are permitted in limited cases 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 allow online applications for the simplest cases, also known as cases in “Wave 1."
The “Wave 1” MECM group of applicants is limited to the following:
- Non-MAGI Medicaid applications for people age 65+, disabled or blind, who meet both of these criteria:
- Their income is under the Medicaid limit so that they have no spend-down and do not need any special budgeting strategies (such as using a Pooled Trust, spousal refusal, spousal impoverishment, etc.), and
- 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.
- Medicare Savings Program applications for people who meet either of these criteria:
- People who are only seeking to enroll in an MSP-only and not Medicaid.
- 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:
- September 30, 2025 (“soft launch”) through November 2025:
- *New* applications: NYSOH call center and MECM Assistors began using MECM to submit applications for the group in Wave 1 described above: non-MAGI Medicaid without a spend down or long term care needs, and for MSP (alone or with non-MAGI Medicaid). Any other applications are referred to the local DSS. Note that from September through November 2025, the general public may not yet file applications on the MECM website themselves. Instead, applications are limited to the following sources:
- People calling the NYSOH Call Center (1-855-355-5777) – They will be screened as to whether they meet the Wave 1 criteria above. Those who do will be guided through the application with the help of the NYSOH Call Center staff. Those who do not will be referred to the LDSS.
- People assisted by a MECM Assistor – “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 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.”
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- Transfer of first batch of Non-MAGI Medicaid Cases that were in NYSOH from before COVID: On September 30, 2025, DOH transferred roughly 14,000 non-MAGI Medicaid cases from NYSOH to MECM. These consumers are a fraction of the 140,000 larger group of consumers in the same situation: consumers who were originally in the MAGI group when they applied for Medicaid on NYSOH, and later became enrolled in Medicare (thus becoming “dual eligibles”), so they should have been transitioned to “non-MAGI” Medicaid. Before COVID, Medicaid for these new Medicare beneficiaries would have been transferred to the LDSS to be re-budgeted as non-MAGI Medicaid. However, because of policies during the COVID Public Health Emergency, these 140,000 Medicaid cases remained on NYSOH as MAGI cases, even though the Medicaid enrollees now qualified for non-MAGI Medicaid. Moving forward, due to MECM, MAGI recipients who become newly enrolled in Medicare, and thus become “dual eligibles,” will be transferred from NYSOH to MECM. However, in the initial roll-out of MECM, only those dual eligibles who meet the criteria for Wave 1 (no spend down, no long term care needs, etc.) will be transferred from NYSOH to MECM, while the others will be transferred to the LDSS.
- November 2025:
- DOH will assess the functionality of the MECM system, and onboard additional FE-ABDs as MECM Assistors.
- December 1, 2025: Public Launch for Wave 1 Only
- *New* applications: The MECM website and application portal will become publicly available online, so that anyone who meets the Wave 1 criteria above can use MECM to apply for: non-MAGI Medicaid without a spend down or long term care needs, and MSP (alone or with Medicaid).
- December 5, 2025:
- Renewals for cases that were originally in NYSOH as MAGI Medicaid and then transferred to MECM because consumer got Medicare coverage: These ~14,000 cases were transferred from NYSOH to MECM on September 30, 2025 without verifying current eligibility, so beginning on December 5, 2025, MECM will conduct a renewal for these cases. MECM will conduct renewals very differently than the way the LDSS did. Instead of sending the consumer a paper renewal form to manually fill out and mail back, MECM will reach out on the back end to existing state and federal data sources to find information needed to renew Medicaid and MSP.
- So long as the necessary information is available, the individual will be “administratively renewed” (also called “ex parte renewed”), which means the individual will not need to do anything and the MECM system will renew the individual. Hopefully, Medicaid benefits and MSP for most consumers will be administratively renewed. These Medicaid recipients will receive a notice (branded as NYSOH), telling them that their Medicaid has been renewed.
- For anyone for whom MECM was not able to find all of the information needed for renewal using existing state and federal data sources, they will receive a notice (branded as NYSOH) instructing them to log-in to MECM, contact a MECM Assistor, or call the NYSOH Call Center to manually renew their Medicaid by no later than January 15, 2026. Consumers in this group who have not completed their renewal by January 15, 2026 will receive a notice that their Medicaid will be terminated at the end of January 2026.
- Most people in MECM will receive notices (branded as NYSOH) in the mail, as paper notices is the default communication preference in MECM. However, if their communication preference is set to paperless notices, they will receive their notices via email instead. MECM will also send out text reminders for renewals.
- If MECM identifies that any of these “wave 1” consumers have a spend-down, NYLAG understands that MECM will transfer the case to the LDSS with Medicaid coverage and the LDSS will initiate a paper renewal process with the consumer.
- February 1, 2026: Begin Monthly Transfers of non-MAGI Cases from LDSS and NYSOH to MECM
- DOH will begin the process of monthly transferring additional groups of the 140,000 non-MAGI cases from NYSOH (that had remained on NYSOH due to the COVID Public Health Emergency, mentioned above) to MECM in alignment with their original renewal date. In addition, NYLAG understands that certain non-MAGI cases from the LDSS’s will be transitioned to MECM on a monthly basis as well.
- April 2026:
- DOH will start bringing the following cases onto MECM: Presumptive Eligibility for Pregnant Individuals, and MSPs initiated by a Low-Income Subsidy (also known as “LIS” or “Extra Help”) application.
- DOH will also start automatically putting up MSP benefits for eligible individuals who do not currently have MSP.
- August 2026:
- DOH will start bringing the following cases onto MECM: Medicaid Buy-In for Working People with disabilities (MBI-WPD), Family Planning Benefit Program (FPBP), and Presumptive Eligibility for FPBP.
- Future work (dates TBD):
- DOH will bring all other non-MAGI Medicaid recipients (including Mainstream enrollees, HARP enrollees, and nursing home residents) onto 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:
- Unlike MAGI Medicaid, Non-MAGI Medicaid has a strict limit on resources. Since MAGI Medicaid has no limit on resources, the existing system used on NYSOH for MAGI Medicaid needed extensive changes to process non-MAGI applications.
- Non-MAGI Medicaid has many special budgeting rules that do not exist in MAGI Medicaid. For example: people with excess income may use medical bills to “spend down” their income to the Medicaid limit or may use a pooled trust to eliminate the spend-down, spousal impoverishment budgeting and “spousal refusal” are unique to non-MAGI Medicaid, and nursing home Medicaid has an entirely different type of budgeting. Programming the MECM system to correctly apply these special budgeting rules is a challenge. This is why the MECM roll-out is starting with the simplest cases – people whose income is under the Medicaid income limits so they do not need to use a “spend down” or other special budgeting rules.
- Phased-in approach leaves multiple “doors” and complicated transitions between systems. Medicaid applicants and enrollees in New York State will now need to navigate between NYSOH, MECM, and the LDSS. People may be confused as to which “door” to use for their application or their renewal, and they may attempt to use the wrong “door.” Although these three systems should speak with one another, and people should receive transfers/referrals between them, some consumers’ Medicaid applications or cases may fall through the cracks during the transition.
- Fair Hearings for some non-MAGI Medicaid eligibility issues will change. Historically, all non-MAGI Medicaid eligibility Fair Hearings and service-related Fair Hearings were heard by Administrative Law Judges through OTDA (the New York State Office of Temporary and Disability Assistance). However, with the changes brought on by MECM, non-MAGI Medicaid cases on MECM will now have their eligibility Fair Hearings heard by Hearing Officers through NYSOH, not Administrative Law Judges through OTDA. Meanwhile, non-MAGI Medicaid cases at the LDSS/HRA will continue to have their eligibility Fair Hearings heard by Administrative Law Judges through OTDA. (Note that the process will remain the same for MAGI Medicaid cases on NYSOH: NYSOH Hearing Officers will hear their eligibility Fair Hearings as well as their service Fair Hearings.) This change will inevitably confuse some consumers, who will contact the wrong agency to request a fair hearing and Aid To Continue. It is unclear what the transfer/referral process will be between the Fair Hearing divisions at OTDA and NYSOH, and a smooth process is necessary to protect appellants’ due process rights.
Benefits of MECM:
- The MECM system, like NYSOH, can verify application-related income and assets instantly, using electronic state and federal data sources that could not be connected to the old LDSS system (WMS). This data connection will allow real time eligibility determinations and will reduce the paperwork burden on applicants. Users will be prompted to provide more information when the system can’t fully verify from existing data sources.
- Renewals will also check back-end state and federal data sources, and thus be automated. MECM will also automate the process of verifying ongoing eligibility for Medicaid, reducing the need for manual renewal paperwork and mailing delays. Online renewals with income and asset verification done on the back end holds the promise of minimizing interruptions in coverage. Automatic renewal (without the need for the Medicaid recipient to complete any paperwork) is called an “administrative renewal” or “ex parte renewal.”
- There should be “no wrong door.” Applications on MECM will be screened and should receive a transfer/referral to wherever their Medicaid/MSP case should exist, be it in MECM, NYSOH, or the LDSS/HRA.
- MECM is all-device friendly. Users can apply for and renew their Medicaid/MSP benefits using a phone, tablet, computer, via text message, over the phone, in person, or via paper application. The website is also responsive to different devices and screen sizes, facilitating better ease of use no matter what device someone uses to apply/renew.
- Higher MSP enrollment is expected. Nationwide, only 60% of MSP-eligible people are enrolled in MSP. The ability to apply online for MSP, and receive a same-day determination, will make applying for MSP easier, which should increase enrollment among eligible people.
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.
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” 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 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.”
When DOH makes big policy changes, it must announce those changes through a policy directive, such as an Administrative Directive (“ADM”). You can find this year’s ADMs on the DOH 2025 Administrative Directives website. Although the MECM ADM has not yet been released, we continue to monitor the ADM website for its release. We will update this article with the ADM when it is available.
In the meantime, the DOH website on MECM is at https://www.health.ny.gov/health_care/medicaid/program/medicaid_modernization/. This website has some history of the modernization effort and the timeline, as well as other information.
