Health policy experts and local providers warn that Upper Manhattan could be among the hardest-hit areas in New York State if sweeping federal Medicaid cuts move forward — seriously straining the city’s ability to respond to public health crises like the recent Legionnaires’ disease outbreak in Harlem.

Congressional District 13, which includes Harlem and East Harlem, has one of the highest concentrations of Medicaid recipients in the city and state. Under the “One Big Beautiful Bill Act,” which President Donald Trump signed last month, thousands of residents would face increased administrative burdens, including twice-yearly recertification and new work requirements starting in 2026.

About 10 million Americans could lose health insurance under President Donald Trump’s tax cut and spendin

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