Navigating Medicaid enrollment in New York
Understanding barriers for Medicaid recipients and navigators ahead of federal policy change
Year: 2025
Partner: Robin Hood Foundation, Blue Ridge Labs
Team: Blue Ridge Labs Founder Fellowship
Role: Service Designer, Research Lead
Sector: Nonprofit
Partner: Robin Hood Foundation, Blue Ridge Labs
Team: Blue Ridge Labs Founder Fellowship
Role: Service Designer, Research Lead
Sector: Nonprofit
Background
With sweeping federal Medicaid changes on the horizon, including new work requirements, eligibility restrictions, and increased administrative burdens, New York State’s navigator network faces a surge in demand at the same time their funding is under threat.
Navigators are community-based assistors who help low-income New Yorkers enroll and stay enrolled in Medicaid and Marketplace coverage through the New York State of Health (NYSOH) platform. How might we identify the friction points in the enrollment experience and surface technology and policy opportunities to better support navigators and the communities they serve?
Approach
Conducted as part of the Robin Hood Foundation’s Blue Ridge Labs Founder Fellowship, this research took place between September and November 2025. We conducted roughly 20 semi-structured conversations with recipients, navigators, and organizations across the U.S. Medicaid and Marketplace ecosystem, alongside observational research at community health tabling events. Two co-design workshops with 18 NYC-based navigator and CBO staff helped validate findings and generate actionable ideas grounded in lived experience.
Discovery
Early phase to understand the NYSOH platform, navigator roles, and policy landscape.
How I contributed:
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Conducted interviews with Medicaid and Marketplace recipients and navigators
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Performed desk research on HR1 and federal and state policies shaping NYSOH service delivery
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Developed recipient and navigator personas grounded in interview findings
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Created a recipient journey map spanning awareness, enrollment, renewal, and transitions off coverage
Design
Synthesized what we learned into workshop-tested opportunities and recommendations.
How I contributed:
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Facilitated two co-design workshops with 18 navigator and CBO staff to validate findings and generate platform and policy recommendations
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Organized insights across five challenge areas: the online application experience, official notices, NYSOH escalation paths, navigator visibility and tools, and recipient anxiety and trust
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Produced a research report with prioritized opportunities for New York State, nonprofits, and civic technology partners
Methods and Insights
Set out to identify general technology and policy opportunities in New York.
HR1 was about to add work requirements, funding cuts, and new checkpoints on top of an already-strained system. Navigators, not the platform or marketplace brokers, are the real shock absorber for policy change, so understanding their experience quickly became the actual center of the study.
Ran ~20 interviews with recipients and navigators, observed tabling in the field, and did parallel policy research on NY State policy and HR1.
We wanted findings grounded in lived experience and system context at the same time, not sequenced one after the other. The hardest problems didn’t live in any single method, they only showed up by triangulating what people said, what we saw in the field, and what the policy actually required.
Mapped the application and notice experience end to end, from identity verification to renewal, and validated it with navigators.
The renewal is where recipients and navigators spend the most hands-on time, is is most at risk from HR1, and where small friction compounds into lost coverage. Most breakdowns weren’t about the NYSOH interface being broken, they were about trust, timing, and language, as well as how the NY state policy and health organization supported Navigators.
Ran two workshops with 18 navigators and CBO staff to build personas, validate findings in the journey map, and generate opportunities together.
Navigators are the experts on their recipients and their own workflow, we didn’t want to hand them our interpretation of their work. The strongest opportunities came directly from navigators, in their own language, not from us translating their pain points after the fact.
Expanded the opportunities to include policy recommendations.
Navigators told us their biggest blockers weren’t UI friction but rules, account visibility, consent, and speaking authority. Some of the highest-leverage opportunities were policy and permissions changes, not screens, a reminder that service design in government often means redesigning policy, not just flows.
What we accomplished
Produced a research report surfacing five primary challenge areas, each accompanied by concrete, navigator-informed opportunities for improving the NYSOH platform, communication design, escalation processes, and navigator tools. The research also made a policy-level case for increased navigator funding and elevated status within the enrollment ecosystem ahead of anticipated HR1 impacts.
Impact
The findings positioned navigators not just as enrollment helpers but as essential connectors between policy, technology, and the lived experience of recipients, and made clear that investing in navigator capacity would have measurable returns in enrollment retention, reduced coverage gaps, and stronger equity outcomes for communities facing linguistic, digital, and economic barriers.
