New York Medicaid Pooled Income Trust (2026): Protect Your Income

A Medicaid New York Pooled Income Trust is how a New Yorker with too much income for Community Medicaid keeps that income and still gets home care. The 2026 income level is $1,836 a month for a household of one. Income you place into your own exception trust, run by a nonprofit, in the month you receive it is excluded when the district determines your income eligibility under community rules.1,2

One exception comes first. New York's consumer notice (OHIP-0119, issued with GIS 20 MA/03) says that if you are married and your eligibility is determined under spousal impoverishment budgeting with post-eligibility rules, for example because you are in a Managed Long Term Care plan, income you place in a trust will count in determining your eligibility. If that is you, check with your local district or a New York elder-law attorney before enrolling or depositing anything.1

For everyone else, the trust pays rent, food, telephone, and similar bills directly to vendors, so your income goes to living costs instead of a medical spend-down under the Excess Income (Spend-Down) Program.

What Is a Pooled Income Trust, Exactly?

A Pooled Income Trust (also called a Pooled Supplemental Needs Trust, Pooled SNT, or Surplus Income Trust) is authorized by federal Medicaid law at 42 U.S.C. § 1396p(d)(4)(C), so it is often just called a "(d)(4)(C) trust."

The trust must be established and managed by a nonprofit association and must keep a separate account for each disabled beneficiary, even though the accounts are pooled for investment and management. Accounts are established solely for disabled individuals, by the individual, a parent, a grandparent, a legal guardian, or a court. On the beneficiary's death, the remainder is either retained by the trust for other disabled beneficiaries or paid to the state Medicaid program up to the total medical assistance paid.1

There is a related but different vehicle, the (d)(4)(A) Self-Settled Special Needs Trust, which holds the assets of an individual under age 65. The pooled-trust exception, by contrast, carries no age restriction. There is also an unrelated vehicle called a Pooled Income Fund under IRC § 642(c)(5), a charitable-remainder vehicle used in estate planning. Same name, different concept. This guide is about the (d)(4)(C) Pooled Income Trust.1

Why a Medicaid New York Pooled Income Trust Matters

New York runs a medically-needy income standard: an applicant above the Medicaid income level is told to spend down to it. The pooled trust is the alternative to spending that money on medical bills.

Consider an unmarried New York senior with $3,000 a month in Social Security plus pension, applying for Community Medicaid in 2026. The 2026 Medicaid income level for a household of one is $1,836 a month, so the senior has $1,164 a month of excess income.2

• Without a pooled trust: the senior spends that $1,164 a month on medical expenses, or pays it to the local social services district as a "pay-in," to get coverage. It goes to medical bills every month.2
• With a pooled trust: the senior deposits the $1,164, the trust pays rent, utilities, and groceries, and the district excludes that income in determining eligibility under community rules.2

Over a year that is roughly $13,968 of household income going to living costs instead of medical bills; over five years, about $69,840.2

Eligibility: Who Can Use a New York Pooled Income Trust?

Two things must be true, and one situation disqualifies the income disregard:

1. You must be a certified disabled individual, at any age, including 65 and over. An existing Social Security Administration (SSA) disability determination establishes it: a Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) award. NYC HRA's Form MAP-3177 says that if you already have one, you should not submit the form. Without one, New York runs its own determination using MAP-3177 plus the state's adult disability packet: DOH-5143, DOH-5139, and DOH-5173 (HIPAA release), with medical records. Reaching 65 does not by itself substitute for that determination.1
2. You must have monthly income above the 2026 Medicaid income level: $1,836 a month for a household of one, $2,489 for a household of two. Below it, you do not need a pooled trust.2

And the disqualifier: if you are married and your eligibility is determined under spousal impoverishment budgeting with post-eligibility rules, income you place in a trust counts in determining your eligibility. OHIP-0119 gives enrollment in a Managed Long Term Care plan as its example. It is the most expensive thing on this page to learn late.1

The exclusion is a community-rules exclusion, and it does not carry over to Institutional/Nursing Home Medicaid. GIS 19 MA/04 states that assets used to fund an exception trust that may not count under community rules will count in determining the income the recipient must contribute toward the cost of long-term nursing home care. SSA policy separately excepts from the transfer penalty only a trust established for the sole benefit of someone under 65 who is blind or disabled, so funding a trust at 65 or older can trigger a transfer-penalty period if institutional care is sought (42 U.S.C. § 1396p(c)(2)(B)(iv); SSA POMS SI 01150.121).1

The Major Medicaid New York Pooled Income Trust Administrators

New York's pooled-trust landscape is documented by the NY Health Access "List of Pooled SNTs in New York State," an unofficial, non-exhaustive roster of nonprofits offering pooled Supplemental Needs Trusts or similar services (last updated April 9, 2026). Appearing on that roster does not mean an organization accepts monthly income to reduce a Medicaid spend-down; several listed trusts are asset or third-party vehicles only. The table below lists the ones the registry marks as accepting monthly income, and fee schedules change, so confirm figures directly before enrolling.3

NYSARC, Inc. Trust Services runs Community Trust II for spending down monthly income above the Medicaid limits. Its schedule effective June 1, 2026 sets a $300 minimum to establish ($200 of it a one-time enrollment fee), a flat monthly administrative fee from $35 on deposits of $1 to $350 up to a $420 cap at $6,501 and above (or 0.900% annually, whichever is greater), a 0.68% annual fiduciary-management fee, and a $75 annual audit and tax charge, with no renewal or per-disbursement fee. CDR is the flat-fee option: $240 startup per the registry, $20 a month covering up to 4 disbursements ($10 each after), and a $50 annual accounting fee. Life's WORC requires a double deposit before it pays expenses.3

Two entries carry conditions. Disabled and Alone / Life Services for the Handicapped ((212) 532-6740) takes monthly income only where a first-party trust already exists at the minimum deposit. Catholic Family Center in Rochester ((585) 232-1840) will act as trustee for monthly excess income, but per the registry it does not operate a pooled trust at all.3

Do not call these for a spend-down. The registry marks these as not accepting monthly income for a Medicaid spend-down, because their listed trusts are asset or third-party vehicles: ACLD (Bethpage), AHRC NYC Foundation, Camphill Resident's Trust, UJA-Federation Community Trusts, Westchester ARC Foundation, and YAI / National Institute for People with Disabilities. They may still be right for a third-party or asset trust, which is a different problem than surplus income.3

How to Enroll: The 4-Step Process

The enrollment sequence is roughly the same across administrators:

Fees: What You'll Pay

Fees fall into three categories. The figures here come from the NY Health Access registry (April 2026) and administrator schedules current as of mid-2026, and they do not all roll over on January 1, so confirm before enrolling.3

1. Enrollment / setup fee: one-time, commonly $100–$350. Some administrators waive it (for example, for current consumers or transfers from another pooled trust).3
2. Monthly administrative fee: this is where administrators differ most, in three common structures:
   • Percentage of the monthly deposit (most common): about 8.5% to 10%, with a floor around $25 to $42.50 and a cap around $200 to $420.3
   • Flat dollar fee: CDR's $20 a month covering up to 4 disbursements, or Community Living Corporation's flat $125.3
   • Sliding scale: a dollar fee that rises with the deposit. NYSARC, LIFE, Inc., and Protect Your Family all work this way.3
3. Annual fee, audit/accounting fee, or renewal fee: about $50–$200 annually. NYSARC charges a $75 annual audit and tax amount but no annual renewal fee.3

Per-bill processing fees are common above a base allotment of 3 or 4 disbursements a month, then roughly $5 to $10 each.3

Practical tip: the larger your surplus, the more a percentage-based fee costs you, so a flat or sliding-scale dollar fee is usually the better structure at high deposits. Compare two or three administrators before enrolling.

What Expenses Can the Trust Pay?

One rule governs everything here, and it comes straight from New York's OHIP-0119 notice: money paid directly to someone else for your benefit is not counted as your income, while money paid directly to you is. The notice gives food, shelter, telephone bills, education, and entertainment as examples of the first kind. So the trust pays your vendors, not you.1

In practice that covers ordinary living costs: rent and utilities, groceries, household items, phone and internet, transportation, and recreation. Beyond those, each administrator sets its own permitted-expense list and disbursement rules, including whether it will reimburse something you already paid and how many payments a month your fee covers. Ask for that list before you enroll; another administrator's list will not apply.3

The hard limit: the trust should not hand you cash. A payment made directly to the beneficiary counts as the beneficiary's income, which is the result the trust exists to avoid.1

Tax and SSI Implications

Income tax: pooled trust sub-accounts are commonly structured so the beneficiary, not the trust, reports the income on a personal return, but the mechanics vary by trust document and Brevy carries no verified tax ruling for any particular account. Depositing income into the trust does not remove it from your tax return. Get the administrator's annual statement and confirm the treatment with a tax advisor.

SSI in-kind support and maintenance (ISM): the same third-party rule governs SSI. Money the trust pays directly to someone else for the beneficiary's benefit is not counted as the beneficiary's income; money paid directly to the beneficiary is.1

A change that helps as of 2026: effective September 30, 2024 (SSA final rule, 89 FR 21199, Mar. 27, 2024), SSA removed food entirely from In-Kind Support and Maintenance, counting only shelter expenses (room, rent, mortgage, real-property taxes, heating fuel, gas, electricity, water, sewerage, garbage collection services). So pooled trust payments for groceries no longer reduce an SSI benefit.1

How the Pooled Trust Coordinates with Other Medicaid Mechanisms

vs. the Excess Income (Surplus Income) Program: both answer the same problem, income above the Medicaid income level. You either spend the surplus on medical bills or place it in the trust; the same dollar cannot do both.2

vs. the 60-month institutional look-back: SSA policy exempts from the transfer penalty a trust established for the sole benefit of someone under 65 who is blind or disabled. At 65 and over, SSA POMS SI 01150.121 leaves the penalty on the table if institutional care is sought, and the federal look-back for nursing home Medicaid is 60 months.1,2

vs. the New York 30-month community look-back: New York authorized a 30-month look-back for community-based long-term care (home care, MLTC, CDPAP) in an April 2, 2020 statutory change stated to be effective October 1, 2020, sought federal approval through an 1115 waiver amendment, and said the earliest date it would seek implementation was March 31, 2024. Brevy could not verify from a state or federal source whether that look-back is operative today, so do not assume home-care transfers carry no penalty. Confirm the current transfer rules with your local district or a New York elder-law attorney before making any gift or transfer.2

vs. Spousal Refusal: spousal refusal under New York Social Services Law § 366(3)(a) is a separate mechanism: the community spouse's right to refuse to make their own income and resources available toward the applicant spouse's care. It is not a substitute for the pooled trust, and the two do not simply stack, because a married applicant budgeted under spousal impoverishment post-eligibility rules loses the trust's income exclusion. (New York's 2026 minimum monthly maintenance needs allowance for a community spouse is $4,066.50.) Married cases belong with an elder-law attorney rather than a guide.2,1

Death and Remainder Rules

Federal law (42 U.S.C. § 1396p(d)(4)(C)(iv)) requires that on the beneficiary's death, the trust either retain the remainder for other disabled beneficiaries or pay it to the state Medicaid program up to the total medical assistance paid. Which applies to your account is set by the Joinder Agreement you sign, and agreements vary, so read that clause before enrolling.1

Critical Pitfalls and Common Mistakes

The mistakes that cost the most:

1. Depositing late. The exclusion applies only to income placed into the trust during the same month it is received; there is no retroactive deposit for prior months. A missed month is income counted as available that month.
2. Missing the married / spousal-impoverishment carve-out. If eligibility is determined under spousal impoverishment budgeting with post-eligibility rules (an MLTC enrollee, in the state's own example), trust deposits count. Settle this before paying an enrollment fee.
3. Confusing the (d)(4)(C) Pooled Trust with other vehicles. The (d)(4)(A) Self-Settled SNT holds the assets of an individual under 65. The Pooled Income Fund under IRC § 642(c)(5) is an unrelated charitable-remainder vehicle that shares the name only.
4. Letting the monthly bookkeeping slide. Most administrators require you to forward bills each month, and a missed month means unpaid rent or a utility shutoff.
5. Assuming the trust helps with nursing home Medicaid. It does not. The funds count toward what you contribute to nursing home care, and funding a trust at 65 or older carries transfer-penalty exposure.
6. Assuming age alone proves disability. The trust is for certified disabled individuals of any age. Without an SSA, SSI, or SSDI determination you need New York's own, so start MAP-3177 and the DOH packet alongside the Joinder.
7. Failing to anticipate the buffer requirement at Life's WORC and others, where a double deposit is required before expenses can be paid.3
8. Not checking how the deposit affects your other coverage. If you have Medicare, confirm the deposit amount with your district and check the New York Medicare Savings Program thresholds first.

Pooled Income Trust vs. Excess Income Program: A Practical Comparison

How the two options compare:

The trust wins for most people; the exception is very high ongoing medical costs, where the surplus would have gone to bills anyway. Note the resource side too: the 2026 non-MAGI resource limits are $33,038 for a household of one and $44,796 for a household of two, so the trust matters most to people who clear the resource test and fail only the income test.2

Where to Get Help

Learn More

Find personalized help with New York Pooled Income Trusts 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.