Enrollment in New York’s Medicaid program could grow by hundreds of thousands of beneficiaries as workers lose their job—and their insurance coverage—because of the economic shock waves generated by COVID-19.

A new analysis from the United Hospital Fund found the state is better equipped to handle a spike in workers seeking Medicaid benefits than during the Great Recession of 2007–2009.

“The infrastructure that’s in place to connect people to coverage right now is significantly more robust than it was in the Great Recession,” said Nathan Myers, director of UHF’s Medicaid Institute.

The Urban Institute last month estimated changes in insurance status by state based on how many people are unemployed. It projected an increase of 641,000 Medicaid enrollees in New York if the state unemployment rate is 15% and a 1.2 million increase if state unemployment reaches 25%.

The state’s unemployment rate reached 15% in April, compared with 3.6% in the same month last year. More businesses are operating this week, as New York City entered phase one of the state’s reopening plan and Long Island and Westchester County prepared to move to phase two. The second phase allows for more office-based businesses to open, as well as real estate services. But the state’s hard-hit hospitality sector, which shed about two-thirds of its jobs in April, will remain closed for a while.

New York already covers about 6 million people under Medicaid, which is about 2 million more than enrollment in December 2007. That number is expected to grow.

During the Great Recession, Medicaid enrollment grew by more than 400,000.

Between February and April this year alone, New York’s Medicaid enrollment had a net gain of 136,000. That monthly growth rate would be four times as large as the monthly rate during the first 12 months of the Great Recession. Enrollment also tended to lag behind spikes in unemployment.

“That suggests we might see a long tail in Medicaid enrollment growth,” said Emily Arsen, a senior research analyst and the lead author of the report. “People will be more incentivized to seek health coverage because they’re concerned about their health in a way they weren’t in the Great Recession, and accessing Medicaid coverage is substantially easier than it was.”

Since the recession, New York created its State of Health marketplace to allow people to sign up for Medicaid, Child Health Plus, Essential Plan and commercial insurance coverage. In addition to Medicaid sign-ups, health plans are expecting more customers to look for coverage for themselves after losing their job. Some consumers who are thinking they might have to shell out more than $1,000 per month for a family plan might find they qualify for subsidized products.

The Essential Plan debuted in 2016 as an option for New Yorkers who aren’t eligible for Medicaid because of their income or immigration status. It’s an insurance product heavily subsidized by the federal government, and it could make coverage accessible to more people during the economic downturn.

The downturn comes as New York was already struggling to keep up with the costs of its $70 billion Medicaid program, in which it shares cost with the federal and local governments. It implemented a $2.2 billion savings program, reducing funding for hospitals and long-term-care providers, as part of the budget passed in April.

Gov. Andrew Cuomo has warned the that the state could need to reduce spending by an additional 20% if it doesn’t receive additional federal support.

The state is getting some federal support. One of Congress’ earliest coronavirus relief packages included a 6.2 percentage point increase in the federal government’s contribution to Medicaid costs.

But the timing of the Covid-19 pandemic, which arrived just as the Trump administration was implementing its new public-charge policy in February, could adversely affect immigrants. The rule could make it harder for immigrants to obtain a green card if they access certain public benefits, such as Medicaid.

“There’s an equity aspect in access to Medicaid,” Arsen said. “Particularly immigrant communities who might be concerned about public charge, and making sure they’re eligible to enroll in Medicaid.”

This article orginally appeared in Crain’s New York Business.

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Recession could add hundreds of thousands to New York’s Medicaid program – ModernHealthcare.com