Agnes McCray — a Syracuse resident with pink glasses, chic style and kind brown eyes — hasn’t had to go to a hospital for 13 years. She attributes this to Medicaid, the public health insurance program that supports people with disabilities and covers long-term care for her cerebral palsy.
“The program supports me to live independently and live, dare I say, the American dream,” McCray said. “I am a person first. I am not labeled by my disability, my extraordinary differences.”
Her 27-year-old son, Charles Hudson, is her caregiver. He is paid through New York’s Consumer Directed Personal Assistance Program, the state’s Medicaid program that covers home care for about 200,000 New Yorkers who are older or disabled. With the independence the program provides her, McCray advocates for other people with disabilities in Central New York, spends time with friends and catches the occasional theater show or movie.
“I just saw that Tom Cruise movie because I wanted to see him acting instead of being a stunt person,” McCray said. “I mean, ‘Mission: Impossible’ is fine, I guess, but I wanted to see if he still knew how to act.”
With major federal cuts to Medicaid taking effect and a consequential election Nov. 3, McCray worries about the future of her ability to stay independent. As costs rise and federal support declines for Medicaid and other state-run health insurance, New York is looking for ways to save money. That includes cutting insurance enrollment and overhauling the home care program that supports people like McCray.
The outcome of the election will set the table for how New York manages federal Medicaid cuts in its next legislative session. The state stands to lose billions of federal funding for health care, which will result in 1.5 million people losing coverage, according to the nonpartisan Fiscal Policy Institute. Among New York’s state and federal candidates, proposals differ for how to respond to the cuts, ranging from deeper cuts to the program to a wealth tax.
“The whole community will be affected,” McCray said of Syracuse’s outsized disabled community. “For me, it's the possibility of being in a nursing home when the nursing homes are already crowded.”
Impacts of federal cuts
In July 2025, President Donald Trump signed into law House Resolution 1 (H.R. 1) — also called the One Big Beautiful Bill Act, also known as H.R. 1 — which contains the largest ever cuts to Medicaid. Among the cuts are new work requirements, shorter retroactive coverage and an end to federal funding for Medicaid enrollees who are asylum seekers and refugees.
The bill reduces federal Medicaid funding by roughly $900 billion between 2025 and 2034, according to research by the Commonwealth Fund. While Medicaid gets most of its money from the federal government, states run the program and will decide how to handle the cuts.
With many of the federal cuts kicking in on Jan. 1, states are scrambling to prepare for less funding and more paperwork, according to Nancy Nielsen, the senior associate dean for health policy at the University of Buffalo’s Jacobs School of Medicine. For changes like an increase in eligibility checks and the new work requirements, states will face a new burden of paperwork that will result in more people losing insurance, Nielsen said.
“The intent was to make sure people still need Medicaid, [and] that there's not fraud and abuse going on,” Nielsen said of the rationale for the cuts. “It all sounds really good, but … the amount of fraud and abuse that you think you're looking for is not nearly what is touted as the reason for doing this.”
One of the first results of H.R. 1 in New York was the end of more than $7.5 billion in federal funding for the Essential Plan, the state’s public insurance program for people who make too much to qualify for Medicaid but not enough to afford their own insurance. Some advocates pushed for raising taxes on the wealthy to generate the revenue needed to preserve the program. However, the state opted to reduce eligibility for the program from 250% of the federal poverty level (FPL) to 200%, which is about $31,920 a year for one person. Roughly 178,000 people went uninsured as a result.
The coming Medicaid cuts that will take effect in January will leave even more people uninsured as states lose federal funding, Nielsen said.
“More people are going to lose health insurance because of these Medicaid changes, a lot more people, so states have to figure out what to do,” Nielsen said. While states have the autonomy to decide how they’ll respond, “states are also not the pot of gold at the end of the rainbow.”
That’s why Nielsen said it is important that voters weigh how candidates would respond to the coverage losses.
“What I hope that people pay attention to when somebody is running for office is do they care about the people who are losing health insurance?” Nielsen said. “We’re not talking about fraud and abuse, nobody is advocating for people to do anything fraudulent, but there are legitimate people who are going to lose their health insurance.”
State candidates
Charles Hudson, McCray’s caregiver, views the election in New York as a critical test of how the state will manage the federal cuts to Medicaid. The state’s response to previous cuts has been to make cuts of its own, but Hudson wants to see the state’s legislators pursue new tax revenue first.
“I think the most intelligent thing would be to tax the rich,” Hudson said. “The only feasible thing to do is to stop taking the money away from the individuals who need it and take it from those who have it but are not willing to give it to all those other individuals.”
In New York’s fiscal 2025 budget, the state comptroller’s office recorded that the Medicaid program cost $115.6 billion, about 60% of which came from federal dollars. The program is expected to lose $8.4 billion a year from the federal cuts, according to Medicaid Matters, a statewide coalition that supports the program.
Mo Brown, the Democratic nominee for New York state Assembly District 129, is proposing a temporary wealth tax on the state’s highest earners to fund Medicaid. Brown said this could be a pied-à-terre tax targeting secondary luxury residences.
“Part of the reason I ran for state legislature as opposed to staying on the county legislature is because the state has the ability to do something,” Brown said of the cuts. “We have the ability to call on our top earners and say, ‘Hey, we're going through something tough, can you help us right now?’ ”
A democratic socialist, Brown argues that introducing a wealth tax is the necessary response to less federal funding, as opposed to the state introducing austerity measures to keep its Medicaid program intact.
“One of the tenets of democratic socialism is that we want health care to be treated like a right,” Brown said. “Everyone deserves health care just by being a person who's alive. When you look at it that way, you're gonna legislate differently.”
As the cost of delivering health care rises, Medicaid’s costs are expected to grow to $133.7 billion in 2029, according to the state comptroller’s office. Brown said a wealth tax would be temporary.
“If we do something to specifically address Medicaid, it should be tied to the federal administration, meaning it should be temporary,” Brown said. “The point would be to bridge us through until we can get better federal representation.”
His Republican opponent, Shawn Fiato, did not respond to multiple phone calls by press time.
Gov. Kathy Hochul’s plan for managing the impacts of the federal Medicaid cuts isn’t yet clear; Hochul’s reelection campaign did not respond to a request for comment.
While she opted to cut the Essential Plan instead of finding new revenues, she also supported New York City Mayor Zohran Mamdani’s pied-à-terre tax. At a Politico summit in March, Hochul said she was cautious about further raising taxes on the wealthy.
“I need people that are high net worth to support the generous social programs that we want to have in our state,” Hochul said.
Her opponent, Republican gubernatorial candidate Bruce Blakeman is Nassau County’s executive. On June 29 of this year, he told Fox Business host Larry Kudlow that the property tax burden that pays for Medicaid in New York is too high, and the solution is to “cut Medicaid in half.”
Four months later, during an Oct. 13 debate with Hochul, Blakeman contradicted himself, saying, “Let me be clear, I never said that I would cut Medicaid in half.”
To this date, Blakeman continues denying he suggested cutting Medicaid to reduce property taxes.
A spokesperson for Blakeman’s campaign did not respond to a request for comment.
Federal candidates
New York’s congressional Democrats have said that if they take back power in Congress, they will restore funding to Medicaid. At a press conference in July, Sen. Chuck Schumer told WAER that if Democrats take back power in Congress, they will reverse the cuts to both Medicaid and the Essential Plan. That would require the support of Trump, who signed H.R. 1 into law.
In an interview with WAER, Central New York’s Democratic Rep. John Mannion said the federal government’s reduction in Medicaid funding threatens states’ ability to provide reasonable reimbursement rates to providers.
“The states have to be good partners,” Mannion said. “But the federal government can’t come and be adversarial to that.”
He’s leaning on his experience in Albany where he was the chairman of the New York State Senate Committee on Disabilities.
“When I was in the state senate for four years, we advocated aggressively for reasonable reimbursement rates related to Medicaid for long term care and other programs,” Mannion said. “Some of those increases were long overdue. We got some of them accomplished.”
His Republican opponent, Kailee Buller, told WAER she supports the Trump administration’s efforts to crack down on Medicaid fraud.
“We have seen there is a significant amount of fraud in some of these processes, and I want to make sure that anyone that’s defrauding these programs is penalized to the highest extent of the current law,” Buller said. “No one should be without health care, no one should be without food, no one should be without housing, but we have to recalibrate the process.”
Buller did not describe what that would entail. She also said she supports work requirements for Medicaid, with exceptions for new mothers and people with disabilities.
Although people with disabilities are exempt from the work requirements contained in the federal Medicaid cuts, McCray worries about the effects the cuts will have throughout the health care system. One of her biggest fears is being in a nursing home.
Before making decisions on how to legislate health care, McCray wants to see elected officials do more research on how the cuts will affect access to care for people like herself.
“It will be a devastating time for all,” McCray said. “We need politicians and those who will now be voting to step up and be about the people first. People before politics.”
WAER’s Brycen Pace contributed reporting.
