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As new Medicaid work requirements are set to take effect in January, approximately 200,000 Bronx residents could get a reprieve.

Because of the borough’s high unemployment rate, Bronx residents qualify for a federal hardship exemption from the new requirements, state officials said. New York plans to implement the exemption, which would apply automatically to eligible Medicaid recipients without requiring them to take additional steps.

Amir Bassiri, Medicaid director for the New York State Department of Health, confirmed at a meeting with health officials earlier this month that The Bronx is eligible for the exemption .

Under federal guidelines, counties qualify for a short-term hardship exemption if their unemployment rate is at least 8% or 1.5 times the national average, whichever is lower. The Bronx has an unemployment rate of 7.1%, according to the most recent available state Labor Department data .

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Without an exemption, many Bronx residents would have to show they are working at least 80 hours a month, attending school at least part time, or volunteering to maintain their health coverage. Health advocates have warned that the additional paperwork and reporting requirements could cause eligible people to lose their coverage.

The Bronx also has the city’s highest share of Medicaid recipients. New York’s 15th Congressional District, which includes parts of The Bronx, has 510,000 Medicaid enrollees, the most of any congressional district in the country.

Urban Health Plan, a community health center in New York, described The Bronx as “ground zero for what H.R. 1 means in practice,” referring to President Donald Trump’s sweeping budget package passed last year. The law made significant changes to Medicaid, including the new work requirements.

Almost 66 million Americans rely on Medicaid , the government health insurance program for low-income Americans that is jointly funded by the federal government and states. Some 3.5 million enrollees live in New York City . But H.R. 1 threatens to shrink that population by cutting nearly $1 trillion in federal Medicaid spending over the next decade . The New York City Department of Health and Mental Hygiene estimates that up to 900,000 New Yorkers are at risk of losing Medicaid coverage because of the new work requirements.

New York has drafted a letter seeking the exemption but has not formally submitted it to the federal government, Bassiri said. He said the exemption does not require federal approval and would take effect once the state submits the letter.

A spokesperson for the U.S. Centers for Medicare & Medicaid Services confirmed Friday that the agency had not received New York’s letter. Asked whether the agency expected to grant the exemption, the spokesperson said CMS “does not speculate on potential future actions.”

Bassiri spoke with Healthbeat last week about how the exemption would work, how long it could last and the challenges facing the state as it prepares to implement the new requirements. He described the exemption as a “slight relief.”