New York Medicaid 2026: Eligibility, MLTC, Pooled Trust & Recovery

New York Medicaid runs on rules families arriving from other states will not recognize. For the non-MAGI (SSI-related) population the Medicaid Income Level is $1,836/month for a household of one, $2,489/month for a household of two, and New York applies it as a medically needy standard rather than a hard dollar cap: income above the level is spent down, not an automatic denial. The non-MAGI resource limit is $33,038 single, $44,796 couple.1 The Personal Needs Allowance for nursing facility residents is $50/month (18 NYCRR 360-4.6).1

New York is the rare state running two parallel Medicaid programs: MAGI Medicaid (adults under 65 not on Medicare) and Non-MAGI Medicaid (older adults, people with disabilities, and SSI-linked applicants). Long-term care flows through Managed Long-Term Care (MLTC) plans, Medicaid Advantage Plus (MAP) for dual eligibles, and PACE.2 The Consumer-Directed Personal Assistance Program (CDPAP) lets families hire and pay many adult relatives as personal assistants, though not a spouse, a person legally responsible for the consumer's care, the consumer's designated representative, or the parent of a consumer under 21.3

Two New York features stand out. Pooled Income Trusts let an applicant certified disabled deposit surplus income into a nonprofit trust and use it for living expenses while qualifying for Community Medicaid, though not if they are married and budgeted under spousal impoverishment post-eligibility rules.4 And Spousal Refusal under SSL § 366(3)(a) lets a community spouse refuse to make their income and resources available toward the applicant's care, with the State keeping a right of recovery against them.5

The 30-month Community Medicaid lookback authorized by Part MM of Chapter 56 of the Laws of 2020 was conditioned on federal approval, and as of July 30, 2026 CMS still listed New York's request as a pending application, so the only operative transfer lookback is the federal 60-month institutional one.2 That is a status, not a green light: confirm current community-based transfer rules with your district or a New York elder-law attorney before any gift.1 And estate recovery in NY reaches only the probate estate, which keeps exposure low for families who plan.

In This Guide

• The 60-Second Version
• How This Guide Is Organized
• Eligibility and Income Limits
• The Excess Income Program
• Pooled Income Trusts
• How to Apply
• MAGI vs Non-MAGI Medicaid
• Managed Long-Term Care (MLTC)
• CDPAP: Consumer-Directed Personal Assistance Program
• Spousal Refusal
• The 30-Month Community Medicaid Lookback
• Long-Term Care: Nursing Home Medicaid
• Estate Recovery (Probate-Only Since 2011)
• What Makes New York Medicaid Different
• What This Pillar Doesn't Yet Cover
• Where to Get Help
• The Bottom Line
• Quick Navigation

The 60-Second Version

• NY runs two parallel Medicaid systems: MAGI (for adults under 65, not on Medicare) and Non-MAGI (for older adults, people with disabilities, and SSI-linked applicants).1
• Medicaid Income Level: $1,836/month household of one, $2,489/month household of two. A medically needy standard, re-budgeted from the 2026 Federal Poverty Levels per GIS 26 MA/05, so income above it is spent down.1
• Resource limit: $33,038 single, $44,796 couple. The home is exempt up to $1,130,000 in equity, and that cap lifts entirely if a spouse, or a child under 21 or blind or disabled, lives there.1
• Personal Needs Allowance for nursing facility residents: $50/month.1 A separate $653/month allowance applies to certain waiver participants and MLTC enrollees budgeted under spousal impoverishment rules.1
• Excess Income Program, applicants over the income limit can spend down by submitting medical bills; OR1
• Pooled Income Trust, an applicant certified disabled (at any age) can deposit excess income into a nonprofit (d)(4)(C) trust and still qualify for Community Medicaid, though not if married and budgeted under spousal impoverishment post-eligibility rules, including a married MLTC enrollee.4 More than a dozen NY administrators accept monthly income for a spend-down.6
• Spousal protections (Non-MAGI): CSRA the greater of $74,820 or the spousal share up to $162,660; CSMIA $4,066.50/month.1
• Spousal Refusal under SSL § 366(3)(a) takes the well spouse's income and resources out of the determination. The applicant still has to meet the limits on their own.5
• 30-month Community Medicaid lookback: still a pending federal request as of July 30, 2026; the 60-month institutional lookback is the operative one. Confirm current transfer rules before any gift.2
• Regional transfer-penalty divisors per GIS 25 MA/14, effective 1/1/2026: NYC $15,282 / LI $15,193 / N. Metro $15,024 / Northeastern $14,783 / Central $14,146 / Rochester $15,675 / Western $13,765.1
• MLTC enrollment is mandatory, statewide, for Medicaid recipients 21 or older needing community-based long-term care for more than 120 continuous days, subject to statutory exclusions.2
• Appeal clocks: 60 days on the notice, but only 10 days after an MLTC plan's Final Adverse Determination if you want services to keep running.7
• CDPAP pays many adult relatives, subject to a plan-of-care and cost-comparison test, but never a spouse, a legally responsible person, the designated representative, or the parent of a consumer under 21.3 See How to Get Paid as a Family Caregiver in New York.
• Estate recovery reaches the probate estate only, so joint tenancy, life estates, living-trust assets, and beneficiary-designated accounts are not reached.8
• Application portal: ACCESS HRA (NYC) / NY State of Health (MAGI) / local Department of Social Services (Non-MAGI outside NYC).

How This Guide Is Organized

This pillar covers Medicaid for New York's older adults, adults with disabilities, and people who need long-term care, organized around the questions families ask first.

Eligibility and Income Limits

New York Medicaid for older adults and adults with disabilities runs through the Non-MAGI track. The 2026 limits:1

Medicaid Income Level: $1,836/month for a household of one, $2,489/month for a household of two on the state's non-MAGI standards chart, where household size is always one or two. New York runs a medically needy income standard rather than a fixed dollar cap: GIS 26 MA/05 directs districts to re-budget at every redetermination effective January 1, 2026 or later using the Medically Needy Income Level based on the 2026 Federal Poverty Levels, and an applicant whose income is above their category's level spends down to the Medicaid Income Level. So being over the number is the start of a conversation, not a denial.1

Resource limit: $33,038 single, $44,796 couple on that same chart line.1

Home equity exemption: $1,130,000, the federal maximum, which New York elects. The federal cap at 42 U.S.C. § 1396p(f) starts at a $500,000 base a state may raise to no more than $750,000, both indexed to CPI-U from 2011, producing a 2026 range of $752,000 to $1,130,000. Under § 1396p(f)(2) the cap does not apply at all if the applicant's spouse, or a child under 21 or blind or permanently and totally disabled, lawfully resides in the home.1

Spousal impoverishment protections (Non-MAGI):

• CSRA (Community Spouse Resource Allowance): on or after January 1, 2026 the community spouse may keep the greater of $74,820 (New York's state-elected minimum) or the spousal share (one-half of the couple's countable resources), up to the federal maximum of $162,660.1
• CSMIA (Community Spouse Monthly Income Allowance): New York uses the federal maximum, $4,066.50/month in 2026.1

Personal Needs Allowance for nursing facility residents: $50/month under 18 NYCRR 360-4.6.1 Do not carry that figure across to home-based care. GIS 26 MA/05 sets a separate personal needs allowance of $653/month, effective January 1, 2026, for certain waiver participants and Managed Long-Term Care enrollees who are budgeted under spousal impoverishment rules. Different population, different number.1

Two-track distinction (NY-specific):

• MAGI Medicaid, adults under 65 not on Medicare, processed through NY State of Health marketplace
• Non-MAGI Medicaid, older adults, people with disabilities, SSI-linked, processed through local DSS / NYC HRA

→ The full NY eligibility tables, by category and pathway: Eligibility & Income Limits.

The Excess Income Program

Applicants whose income exceeds $1,836/month single (or $2,489 couple) but who otherwise qualify for Non-MAGI Medicaid have two main paths to coverage:1

Path A, The Excess Income Program (NY's spend-down): Submit verifiable medical bills equal to or exceeding the excess income each month. Once bills meet the spend-down amount, NY Medicaid pays for the rest of the month's covered services. Operationally cumbersome, most families struggle to track and submit bills monthly.

Path B, A Pooled Income Trust (described below). For most NY families, this is the dramatically better option.

→ The Excess Income Program walkthrough: Excess Income Program (dedicated guide coming soon).

Pooled Income Trusts

This is the single most distinctive and high-leverage planning tool in NY Medicaid. Authorized by 42 USC § 1396p(d)(4)(C) and operationalized via NYS DOH GIS 19 MA/04 and GIS 20 MA/03.4

The mechanism: A New Yorker certified disabled can join a non-profit-administered pooled trust. There is no age limit, unlike the (d)(4)(A) self-settled special needs trust, which is capped at under 65. But certification of disability is the gate: being 65 or older does not by itself qualify you. An existing SSA disability determination (SSI or SSDI) establishes it; otherwise New York makes its own determination using MAP-3177 plus the DOH adult disability packet. Each month, the applicant deposits the excess income (income above the $1,836 level) into the trust, and the trust pays the applicant's living expenses (rent, utilities, food, transportation, insurance) out of the deposited funds. Income placed in the trust is excluded when determining income eligibility under community rules, so the applicant can qualify for Community Medicaid covering home care and personal care services. The exclusion applies only to income deposited in the same month it is received; deposits cannot be made retroactively for a prior month.4

Math example (illustrative): An applicant with $3,000/month in income and $2,000/month in living expenses can:1

• Deposit $1,164/month (the excess over $1,836) into the pooled trust
• Continue to use those funds for rent, utilities, food, etc. via trust disbursement
• Qualify for Community Medicaid that pays for home care that typically far exceeds the monthly trust deposit
• Net: NY Medicaid covers care worth far more than the deposited income

Active NY pooled trust administrators (2026): more than a dozen nonprofit administrators accept monthly income for a Medicaid spend-down in New York, per the NY Health Access roster of pooled Supplemental Needs Trusts (an unofficial, self-described non-exhaustive list, last updated April 9, 2026). They include NYSARC Trust Services, Center for Disability Rights (CDR) Pooled Trust, Life's WORC, LIFE Inc., KTS Pooled Trust, Everfund, SCS Pooled Trust, UCS Trust Services, LCG Community Trust, Protect Your Family, OHEL, The Theresa Foundation, Community Living Corporation, Future Care, and others. Appearing on that roster is not the same as accepting monthly income: several listed organizations run asset or third-party trusts only, and a few limit enrollment to specific counties. Where a county restriction is listed, call before assuming you are outside it. The registry gives two different and non-matching county lists for the Western New York Coalition trusts, so an upstate resident should ask rather than read themselves out. Enrollment and monthly fees vary widely by administrator and change mid-year, so confirm the current schedule directly before joining; the dedicated guide compares them.6

Who uses it most (all of whom must carry a disability certification):4

• Older adults with Social Security plus a small pension exceeding $1,836/month
• Working adults with disabilities receiving SSDI plus part-time wages
• Caregivers planning Community Medicaid for an unmarried aging parent

Important coordination points:4

• A Pooled Income Trust is a Community Medicaid tool. Assets used to fund it that are not counted under community rules will count in determining the income a recipient must contribute toward nursing-home care.
• It can create an institutional transfer penalty. A transfer of assets into such a trust by someone age 65 or older can trigger a transfer-penalty period for institutional Medicaid, because the transfer exception at 42 U.S.C. § 1396p(c)(2)(B)(iv) reaches only a trust established solely for the benefit of a disabled individual under 65. (A neighbouring exception at (c)(2)(B)(iii) reaches a trust for the individual's own disabled child of any age.) Get advice before funding one if nursing-home Medicaid is a possibility within five years.
• How the trust pays matters. Payments made directly to a third party for the beneficiary are not counted as the beneficiary's income; money paid directly to the beneficiary is counted. Since September 30, 2024, SSA counts only shelter expenses as In-Kind Support and Maintenance, so trust payments for groceries no longer reduce an SSI benefit (89 FR 21199, Mar. 27, 2024).
• To get the income rebudgeted, give your local social services district a copy of the trust and a written statement of the monthly amount you will deposit.
• On death, the trust must either retain the remainder for other disabled beneficiaries or pay the State up to the total Medicaid paid on the beneficiary's behalf.

The single biggest mistake families make: waiting too long to set it up. Because the exclusion reaches only income deposited in the month it is received, every month spent getting the account open is a month of surplus that cannot be sheltered retroactively.4

→ The full Pooled Income Trust deep-dive with administrator-by-administrator fee comparison, the 4-step enrollment process (Joinder + LDSS MAP-751W/MAP-3177 + DOH-5143/5139/5173 + rebudgeting), and the 10 critical pitfalls: Pooled Income Trust.

How to Apply for New York Medicaid

Intake channels differ by category, so the first step is knowing your track. Here is the sequence for an older-adult or disability (Non-MAGI) applicant.

New York's appeal deadline is usually 60 days, not 90. For a direct, fee-for-service Medicaid action you request the State Fair Hearing within 60 days from the date printed on the notice, so count from that date rather than the day the envelope arrived. OTDA tells people to read the notice itself, because the notice states whether the limit is 60 days or 90.7 The federal 90 days at 42 CFR 431.221(d) is only the ceiling on what a state may allow, and New York generally uses 60.9

Aid continuing is something you ask for, not something that happens. To keep your coverage running while the appeal is decided, request the hearing before the effective date on the notice, or, if the notice was not sent before that date, within 10 days of its postmark date. If you never received a notice at all and your help was stopped or reduced, you can still request a hearing, and you must ask at the same time that it be restored; restoration is not automatic. Federal law is stronger than that in one situation worth knowing: under 42 CFR 431.231(c) the agency must reinstate and continue services until a decision if the action was taken without the required advance notice, you request a hearing within 10 days of receiving the notice of action (receipt is treated as 5 days after the notice date unless you show otherwise), and the action did not result from applying federal or state law or policy.7,10 The trade-off: if you keep coverage this way and then lose the hearing, the agency may recover what it paid while you waited, so OTDA warns you may have to pay back Medical Assistance received during the appeal.7,10

A managed care or MLTC service denial runs on two clocks, and the shorter one is the one families miss. You appeal to the plan first, and after its Final Adverse Determination you have at least 120 days to request the fair hearing. But to keep services running you must request the fair hearing within 10 days of that Final Adverse Determination, not 120. Services authorized under aid continuing must be continued for at least 10 days from when the Final Adverse Determination is sent. You can also proceed as if you had exhausted the plan appeal if the plan never resolved it, resolved it late, or sent a notice that did not meet federal requirements.7 See New York Medicaid Appeals and Fair Hearings for how to file and what happens after a decision.

→ The complete application walkthrough with form-by-form line items and county-by-county LDSS contacts: How to Apply.

MAGI vs Non-MAGI Medicaid

NY runs two parallel Medicaid programs with different eligibility rules, application processes, and benefit packages:1

MAGI Medicaid: adults under 65 not on Medicare, parents and caretaker relatives, pregnant women, and children. Income test only, no asset test, using tax-based Modified Adjusted Gross Income, processed through the NY State of Health marketplace.

Non-MAGI Medicaid: adults 65 and over, people with disabilities, and SSI-linked applicants. Both income and asset tests, traditional Medicaid budgeting, processed through LDSS or NYC HRA. This is the track that carries MLTC, CDPAP, nursing home Medicaid, and most LTC benefits, and it is what most of this pillar is about.

Managed Long-Term Care (MLTC)

For Medicaid recipients age 21 or older who need community-based long-term care services for a continuous period of more than 120 days, MLTC enrollment is mandatory, and the demonstration it runs under is statewide. MLTC plans deliver personal care, CDPAP, home health aide services, adult day health, the Assisted Living Program, short-stay nursing facility care, durable medical equipment, non-emergency medical transportation, and supplemental services, through capitated plans authorized at NY Public Health Law § 4403-f.2

Not everyone is swept in. PHL § 4403-f(7)(b)(v) excludes from mandatory enrollment, among others, OPWDD waiver participants, Assisted Living Program participants, TBI- and NHTD-waiver participants, people receiving hospice at enrollment, Native Americans, people expected to be Medicaid-eligible for less than six months, and people permanently placed in a nursing home for three months or more.2

A functional floor applies to new enrollment. Since September 1, 2025, MLTC Policy 25.04 requires an applicant to need at least limited assistance with physical maneuvering with more than two activities of daily living, or, with a documented dementia or Alzheimer's diagnosis, at least supervision with more than one ADL. PACE is not subject to it. Anyone enrolled in an MLTC plan before September 1, 2025 keeps Legacy Status under the prior standard as long as enrollment stays continuous; a coverage gap forfeits it.2

Switching plans is limited. For MLTCP enrollments effective on or after December 1, 2020, a 90-day grace period to change plans is followed by a nine-month lock-in unless you can show Good Cause. Lock-in does not apply to MAP, PACE, or FIDA-IDD.2

Three MLTC product types:

1. Partial-cap MLTC, most common; covers Medicaid LTSS only (Medicare and acute care remain separate)
2. Medicaid Advantage Plus (MAP), fully integrated for dual eligibles (Medicare + Medicaid in one plan). Joining a MAP plan is not a Medicaid-only decision: New York Medicaid Choice states that when you join Medicaid Advantage Plus you must also enroll in that plan's Medicare product, so you give up Original Medicare or a different Medicare Advantage plan to do it.11
3. PACE (Program of All-Inclusive Care for the Elderly), fully integrated for participants 55+ in select NY areas

The NY Independent Assessor (NYIA), created through a contract with MAXIMUS Health Services, conducts the independent assessment for MLTC and CDPAP: a Community Health Assessment, an order from the Independent Practitioner Panel, and, where a proposed plan of care newly calls for more than 12 hours per day on average, a second medical review by the Independent Review Panel.2

→ The full MLTC deep-dive with plan-by-plan comparison and county availability: Managed Long-Term Care.

CDPAP: Consumer-Directed Personal Assistance Program

CDPAP is New York's Medicaid program, codified at NY Social Services Law § 365-f and implemented by 18 NYCRR § 505.28, that lets a consumer, or a designated representative, hire, train, and direct their own personal assistants, often a close family member or friend who is paid as an employee. As of March 31, 2025, roughly 255,000 CDPAP consumers had taken action ahead of the April 1 transition deadline, including about 195,000 who had started or completed registration with the new fiscal intermediary.3

Which relatives can be paid, and on what condition. Subject to the exclusions below, another adult relative may be paid, provided the district or managed care organization determines the services are consistent with the plan of care and cost no more in the aggregate than equivalent services from a non-relative. That cost test is not a formality; it is the condition on the whole permission.3

The 2025 fiscal-intermediary transition: Effective April 1, 2025, Public Partnerships LLC (PPL) became the single statewide fiscal intermediary for CDPAP, replacing what NYSDOH describes as a fragmented system of 600 fiscal intermediaries. The fiscal intermediary acts as the joint employer of the personal assistant and handles wages and benefits, income tax and other required withholdings, and employment records.3

A functional floor applies. Effective September 1, 2025, a Minimum Needs Requirement applies to CDPAP and personal care services: at least limited assistance with physical maneuvering with more than two ADLs, or, with a dementia or Alzheimer's diagnosis, at least supervision with more than one ADL. People assessed and authorized for these services before September 1, 2025, or continuously enrolled in MLTC, are granted Legacy Status and are not subject to it. Legacy Status reaches further than that sentence suggests, which matters to anyone who was mid-process when the rule changed. Someone with a valid assessment completed after August 31, 2024 and before September 1, 2025 who was not yet authorized gets Service Legacy status if they are authorized within one year of that assessment. Someone whose initial assessment was scheduled before September 1, 2025 and rescheduled through no fault of their own to a later date is assessed under the Legacy criteria anyway, provided the rescheduling happened before the original appointment date. And while PACE enrollment is not subject to the requirement, PACE participants are granted MLTC Plan Legacy and Service Legacy through the same process as other plans. The two DOH statements of the rule do not fully agree on the age cut-off for the plan-enrollment prong (21 and older in 25 OHIP/ADM-03, 18 and older on the CDPAP program page), so confirm it with your plan or district.3

If the dementia route applies, the diagnosis has to be documented, not asserted. Someone assessed under the lower dementia threshold must supply proof of an Alzheimer's or dementia diagnosis during the assessment, on form DOH-5821. Other licensed professionals may complete the form, but the diagnosis itself must be made by a physician (M.D. or D.O.), who does not need to be a New York Medicaid provider. And a Minimum Needs denial is appealable. When a NYIA assessment finds you do not meet the requirement, the outcome notice says so and carries conference and fair hearing rights.3

What CDPAP covers: assistance with ADLs (bathing, dressing, toileting, transfers, ambulation, eating) and IADLs (meal prep, medication management, light housekeeping, transportation).

2026 minimum wage for CDPAP personal assistants (NY Department of Labor home-care aide minimum, effective 1/1/2026): $19.65/hour in New York City, Long Island, and Westchester County, and $18.65/hour in the rest of the state.3

Who may never be paid. Under NY Social Services Law § 365-f and 18 NYCRR § 505.28, the consumer's spouse, a person legally responsible for the consumer's care and support, and the consumer's designated representative may not serve as the paid personal assistant. NYSDOH puts it to families this way: the personal assistant "can include a friend or family member, as long as they are not the Medicaid member's spouse, their designated representative or the parent of a CDPAP consumer under the age of 21." The designated-representative bar catches people by surprise: the relative who signs as your representative cannot also be your paid aide.3 For families needing to pay a spouse, the alternatives are VA Veteran-Directed Care, VA Aid and Attendance, and NY Partnership Long-Term Care Insurance (legacy policies).

→ The full caregiver-pay deep-dive with the PPL transition timeline, hiring and payroll mechanics, the IRS Notice 2014-7 difficulty-of-care exclusion, VA pathways, and worked family examples: How to Get Paid as a Family Caregiver in New York.

Spousal Refusal

Spousal Refusal under SSL § 366(3)(a), sometimes called "just say no," is the statutory right of a community (well) spouse to refuse to make their own income and resources available toward the applicant spouse's long-term-care costs. The provision is current: the NYS DOH Information Notice edition current for 2026 cites SSL § 366(3)(a) and instructs that Medicaid "must be provided to the institutionalized spouse if the community spouse fails or refuses to contribute their income towards the institutionalized spouse's cost of care."5

The mechanism: When one spouse needs Medicaid LTC and the other does not, the community spouse declines to contribute. Eligibility for the institutionalized spouse is then determined without counting the refusing spouse's income and resources. The resource half of that is conditional, not automatic. Per the NYS DOH notice, the institutionalized spouse escapes ineligibility over the community spouse's excess resources only if that spouse executes an assignment of support rights in favor of the social services district, or is unable to execute one because of physical or mental impairment. That mirrors the federal mechanism at 42 U.S.C. § 1396r-5(c)(3). The well spouse must still cooperate by disclosing resource information: "Refusal to provide the necessary information shall be reason for denying Medicaid for the institutionalized spouse as Medicaid eligibility cannot be determined." A narrow undue-hardship route exists past that denial, but it is cumulative rather than a general waiver, and it still requires the assignment.5

What it does not do. Spousal refusal removes only the refusing spouse's income and resources from the determination. The applicant spouse must still meet New York's own non-MAGI income and resource limits on their own separate countable assets. It is not a way around the $33,038.5

The catch: New York retains a right of recovery against the refusing spouse. SSL § 366(3)(a) provides that furnishing the assistance "shall create an implied contract with such relative, and the cost thereof may be recovered from such relative," and per the DOH notice the State or local district "at its option, may refer the matter to court" both to review the community spouse's actual ability to pay and to recover Medicaid expenditures. Before any court referral, Medicaid "will request a contribution from a community spouse of 25 percent of the amount [of] their otherwise available income that exceeds the minimum monthly maintenance needs allowance plus any family member allowance(s)," and the community spouse may schedule a conference with the local district to negotiate it. The State's right is real; exercising it is discretionary. Whether to use Spousal Refusal is a strategic question for an elder-law attorney.5

→ The full Spousal Refusal deep-dive: Spousal Refusal.

The 30-Month Community Medicaid Lookback

The most-asked-about NY Medicaid topic in 2026: Is the 30-month lookback in effect? The honest answer is that it is still a pending federal request, and you should not treat that as permission to give assets away.

Background: Part MM of Chapter 56 of the Laws of 2020 (specifically section 13, amending Social Services Law § 366(5)(e)) authorized a 30-month lookback for Community Medicaid (home care, MLTC, CDPAP, personal care) subject to federal approval. NYSDOH stated the earliest date the State would seek implementation was March 31, 2024. As of July 30, 2026, the CMS Section 1115 demonstration record for New York still listed the community-based long-term care amendment request, submitted March 25, 2021, as a "Pending Application." The only operative transfer lookback for New York Medicaid long-term services and supports is therefore the federal institutional one.2

What is unambiguously in effect: the federal 60-month lookback under 42 U.S.C. § 1396p(c)(1)(B)(i), which applies to disposals of assets made on or after February 8, 2006 and runs from the date the applicant is both institutionalized and has applied. Transfers in that window before a nursing home Medicaid application can trigger a transfer penalty.1

How penalties are calculated: New York divides the transferred amount by the regional transfer-penalty divisor, the average private-pay nursing-home rate for the region. Per GIS 25 MA/14, effective 1/1/2026: NYC $15,282; Long Island $15,193; Northern Metropolitan $15,024; Northeastern $14,783; Central $14,146; Rochester $15,675; Western $13,765.1

→ The full 30-month lookback deep-dive with implementation triggers and 4 strategic scenarios for families: 30-Month Lookback.

Long-Term Care: Nursing Home Medicaid

For residence in a Medicaid-certified nursing facility, NY requires:1

1. Income test, resolved through the Net Available Monthly Income (patient-pay amount): the resident's monthly income minus the $50 PNA, minus health insurance premiums, minus any MMMNA diverted to a community spouse, minus a dependent-family allowance, minus certain incurred medical costs1
2. Asset test, countable resources at or below $33,038 (household of one)1
3. Functional eligibility, Nursing Facility Level of Care
4. 60-month lookback, fully enforced for institutional applications1
5. Residence in a Medicaid-certified facility

One requirement families still get told about is gone. Per GIS 25 MA/15, issued December 23, 2025, New York eliminated the requirement to apply for or maximize other benefits as a condition of Medicaid eligibility, including RSDI, unemployment, VA cash benefits, retirement-account payouts, savings-bond waivers, and the spousal elective share. The requirement to apply for Medicare remains.1

NY nursing facility costs: New York nursing home care is among the most expensive in the country. Per the CareScout 2025 Cost of Care Survey (released March 2, 2026, the most recent state-level data, superseding the 2024 Genworth/CareScout survey), a semi-private room runs about $186,333/year (roughly $15,528/month), the 3rd-highest of any state, and a private room about $200,750/year (roughly $16,729/month), the 2nd-highest, against national medians of about $114,975 and $129,575. Both figures assume 365 days of care. These are industry-survey medians, not government figures, and costs vary widely across the state, with New York City and downstate generally higher than upstate.12

→ The full nursing home Medicaid playbook: LTC Nursing Home.

Estate Recovery (Probate-Only Since 2011)

New York recovers against the probate estate only. The revised regulation at 18 NYCRR 360-7.11 that had implemented an expanded definition of "estate" expired effective December 6, 2011, and districts must not include assets that pass outside the probate estate as part of the decedent's estate for recovery purposes.1 Recovery is administered by the New York State Office of the Medicaid Inspector General (OMIG), whose contract vendor performs asset research and supports the county attorneys who appear in Surrogate's Court, where the claim is filed.8

What gets recovered: Recovery applies only to recipients who were age 55 or older, or who were permanently institutionalized at a medical facility, upon their death. The two authorities word the age test differently, and the difference matters at the edge: OMIG's FAQ keys it to being 55 or older at death, while SSL § 369(2)(b)(i)(B) permits recovery from the estate of someone who was 55 or older when he or she received such assistance, so assistance received before the recipient turned 55 sits outside the statutory recovery scope. "Permanently institutionalized" likewise has a narrow meaning: an inpatient not reasonably expected to be discharged and return home, so a short rehabilitative stay someone is expected to come home from does not trigger it. OMIG's claim "is against the deceased recipient's estate assets only" and "pertains only to assets in the deceased recipient's name." Heirs, beneficiaries, and surviving spouses are not personally responsible for that claim; recovery comes out of estate assets only, up to the lesser of the Medicaid lien amount or the available estate assets. Read that protection for what it is, though: it is scoped to the estate claim. New York's regulation separately permits recovery from a legally responsible relative who has sufficient income and resources and fails or refuses to make them available, and the surviving-spouse and minor-child deferral below is not written to reach that separate route.8

What is not reached (the forms New York's own guidance names):8

• Jointly owned assets, including joint tenancy with right of survivorship
• Life estates
• Living-trust assets
• Beneficiary-designated accounts

New York's guidance states the probate-only rule at that level of generality and does not publish an exhaustive list of every asset form that passes outside probate, so treat any longer list you find elsewhere as a hypothesis to confirm with a New York elder-law attorney, not as settled coverage.

A lien is not the same as a sale. A Medicaid lien may be placed on a deceased recipient's real property, but no action is taken on it until the property is sold, and if a family member wishes to live there rather than sell, no recovery happens until the title or deed transfers and the recipient's name comes off.8

Deferrals and exemptions: Recovery is deferred, not waived, while there is a surviving spouse, a child under 21, or a child of any age certified blind and/or disabled. Medicaid recovers when those circumstances no longer apply, and OMIG reviews potential recovery from a surviving spouse's estate when that spouse dies, so a deferral is a delay, not a cancellation. Permanent exemptions bar recovery for a recipient who received 36 months of nursing home benefits (or the equivalent) under a New York State Partnership for Long Term Care approved policy, and for certain income, property, and resources of Native Americans or Alaskan Natives. Recovery may also be waived in whole or in part for undue hardship. See the dedicated guide for the hardship standards.8

The biggest mistake NY families make: worrying about exposure the probate-only rule does not create. For many families the estate claim is far smaller than they fear.8 An hour with a New York elder-law attorney is usually enough to find out which category your own assets fall into.

→ The full estate recovery deep-dive with the 6-step recovery process, 7 exemptions, and 6 NY-specific planning techniques: Estate Recovery. For federal context, the OBRA-93 mandate, 51-jurisdiction matrix, hardship-waiver standards, and cross-state planning toolkit, see Medicaid Estate Recovery Explained.

What Makes New York Medicaid Different

1. The non-MAGI resource limit is $33,038 single / $44,796 couple, far more room than long-term-care applicants get in most states.1

2. The income level is a medically needy standard, not a hard cap. At $1,836/$2,489, income above the level is spent down rather than disqualifying, which is why the whole architecture here is built around surplus income rather than a cliff.1

3. Pooled Income Trusts are unusually well-established in NY, with more than a dozen nonprofit administrators and published fee schedules.6

4. Spousal Refusal under SSL § 366(3)(a) is a live statutory right, with a real state right of recovery attached.5

5. The 30-month Community Medicaid lookback is still a pending federal request, a status to watch with counsel rather than a planning green light.2

6. Estate recovery reaches the probate estate only, since the expanded-estate regulation expired in December 2011.1

7. CDPAP lets many adult relatives be paid, subject to a plan-of-care and cost-comparison test, with spouses, legally responsible persons, and designated representatives excluded.3

8. The nursing-facility Personal Needs Allowance is $50/month, what a resident keeps after the patient-pay calculation.1

9. Two parallel Medicaid systems (MAGI vs Non-MAGI), with most elder-care content in the Non-MAGI track.

10. The home equity exemption is at the federal max of $1,130,000, and lifts entirely where a spouse or a minor, blind, or disabled child lives in the home.1

What This Pillar Doesn't Yet Cover

We are continuously expanding this pillar. Topics planned for 2026:

• MLTC plan-by-plan comparison, every MLTC plan by geography, performance, and switching mechanics
• CDPAP PPL transition, operational mechanics post-statewide-FI consolidation
• Excess Income Program, month-by-month bill-submission walkthrough
• NY Medicaid Asset Protection Trust, drafting, funding, and 5-year lookback timing
• Caregiver Child Exemption, documentation evidence package
• NYIA, preparing for the New York Independent Assessor evaluation
• Community Medicaid recertification (DOH-5173), annual renewal mechanics

If your situation isn't covered above, the resources below can help with your specific question.

Keeping New York Medicaid Coverage Once You Have It

Missing a renewal is one of the most common ways people lose coverage they still qualify for, and federal rules put most of the work on the agency. Before asking you for anything, New York Medicaid must first try to renew your coverage automatically from information it already holds, and may only request documents if it cannot. That first step is required for both tracks, though on different triggers: for MAGI coverage the agency must renew ex parte whenever reliable information in your account lets it, and for non-MAGI coverage it must do so if sufficient information is available.13 If it does need paperwork, it must send a renewal form and give you at least 30 days from the date on that form, not from the day it was mailed, to return it.13 That 30-day duty, and the 90-day reconsideration window below, are federal requirements only for eligibility based on modified adjusted gross income (MAGI). If you qualify through age, disability, long-term care, a Medicare Savings Program, or the medically needy pathway, New York may offer the same windows but is not required to, so ask your local Department of Social Services what applies to you.13

If coverage does close because a form went unreturned, that is not the end of it. Federal rules require the agency to reconsider your eligibility without a new application if you return the renewal form within 90 days of the termination (required for MAGI-based coverage; a state option otherwise).13 So a MAGI-based renewal missed by a few weeks is usually recoverable, provided you act.

Return a renewal form the week it arrives. See New York Medicaid Recertification and Renewal for the full cycle and how to recover coverage that has already closed.

Where to Get Help

The Bottom Line

1. New York gives applicants real room on resources ($33,038/$44,796) and on the home ($1,130,000 in equity). The $1,836 income level is the constraint, but it is a spend-down standard.1
2. The Pooled Income Trust is high-leverage, with a hard limit. A married applicant budgeted under spousal impoverishment post-eligibility rules, including a married MLTC enrollee, gets no income disregard from it at all. Check your budgeting before you enroll.4
3. The 30-month Community Medicaid lookback is a pending federal request, not a settled non-rule. Confirm current transfer rules before making a gift.
4. Estate recovery reaches the probate estate only. Non-probate assets are outside it.
5. Spousal Refusal is a live New York right, and the State keeps a right of recovery against the refusing spouse.
6. Watch the appeal clocks. Sixty days on the notice, but only 10 days to keep services running after an MLTC plan's Final Adverse Determination.7
7. Get help. Your local LDSS, NYC HRA, or New York Medicaid Choice can walk you through your own situation.

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Find personalized help navigating New York Medicaid at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.