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

If your monthly income is over New York's Community Medicaid limit of $1,836 but you need home care, there is a mechanism almost no other state offers. You can deposit your excess income each month into a Pooled Income Trust administered by a New York nonprofit, and that deposited income is treated as if you never received it for Medicaid budgeting purposes, letting you keep Managed Long Term Care or other Community Medicaid services without spending down.

The trust pays your rent, utilities, food, and other living expenses directly. You qualify for Medicaid. You keep the value of your income for personal use rather than burning it on medical bills under the Excess Income (Spend-Down) Program.

This guide walks through the legal authority under 42 USC § 1396p(d)(4)(C), the eligibility rules, the major NY pooled trust administrators (NYSARC, Center for Disability Rights, Life's WORC, and 15+ others), the 2026 fee schedules, the enrollment process, what the trust can and cannot pay, the tax treatment, the SSI rules, and the most common pitfalls that NY elder-law attorneys see families walk into.

What Is a Pooled Income Trust, Exactly?

A Pooled Income Trust (also called a Pooled Supplemental Needs Trust, Pooled SNT, Medicaid Spend-Down Trust, or Surplus Income Trust) is a specific legal vehicle authorized by federal Medicaid law. The full statutory citation is 42 U.S.C. § 1396p(d)(4)(C), typically just called a "(d)(4)(C) trust."

The federal statute does five things:

1. It exempts from Medicaid resource counting any trust established and managed by a nonprofit association.
2. It requires the trust to maintain a separate sub-account for each disabled beneficiary, even though the funds are pooled together for investment and management efficiency.
3. It allows contributions from the beneficiary themselves, OR from a parent, grandparent, legal guardian, or court.
4. It requires that on the beneficiary's death, the remainder either be retained by the nonprofit for the benefit of other disabled beneficiaries, OR paid to the state Medicaid program up to the total amount of medical assistance paid on behalf of the beneficiary.
5. It does not impose any cap on the amount that can be held in the trust.

There is a related but different vehicle, the (d)(4)(A) Self-Settled Special Needs Trust, which is for a single individual under age 65, requires court or family-member establishment, and works differently. Don't confuse the two. There is also a completely unrelated vehicle called a Pooled Income Fund under IRC § 642(c)(5), which is a charitable remainder trust used for estate planning. Same name, totally different concept. This guide is exclusively about the (d)(4)(C) Pooled Income Trust.

Why Pooled Income Trusts Are So Important in New York

Most states make seniors with excess income choose between two bad options: spend down the excess on medical bills each month under the Excess Income (Medically Needy) Program, or simply not qualify for Medicaid. New York gives you a third option that is dramatically better.

Consider the math for a New York senior with $3,000/month in Social Security plus pension, applying for Community Medicaid in 2026:

• Income limit: $1,836/month.
• Excess income: $1,164/month.
• Without a pooled trust: The senior must spend $1,164/month on medical expenses (or pay it directly to LDSS as a "pay-in") to receive Medicaid coverage. That $1,164 is gone every month, and goes only to medical bills.
• With a pooled trust: The senior deposits $1,164 into a Pooled Income Trust each month. The trust pays the senior's rent, utilities, groceries, and similar living expenses. Medicaid budgeting treats the senior as having only $1,836/month of countable income. The senior qualifies for Medicaid AND keeps the value of the $1,164, just used for housing instead of medical bills.

Over a year, that's $13,968 of household income preserved. Over five years, $69,840. The Pooled Income Trust is one of the highest-leverage planning tools in NY Medicaid.

Eligibility: Who Can Use a NY Pooled Income Trust?

Three things must be true:

1. You must be a New York resident. Pooled trusts are administered by NY-based 501(c)(3) nonprofits and tied to the NY Medicaid program.

2. You must be certified disabled under SSA standards OR aged 65+. SSA disability is established through any of the following:

   • You receive Social Security Disability Insurance (SSDI) benefits.
   • You receive Supplemental Security Income (SSI) benefits.
   • You have an SSA disability award letter on file.
   • You are aged 65+ (NY's GIS 19 MA/04 and GIS 20 MA/03 specifically permit pooled trust use by individuals 65+ for Community Medicaid budgeting).

   For applicants 65+ who do not have an SSDI/SSI award letter, NY State conducts its own disability determination via NYC HRA Form MAP-3177 (Disability Determination Request), DOH-5143 (physician certification), DOH-5139 (functional questionnaire), and DOH-5173 (HIPAA release), plus 12 months of medical records or LDSS-486T. Processing takes 30–90 days.

3. You must have monthly income exceeding the 2026 Community Medicaid threshold of $1,836/month single or $2,489/month couple. If you're under the threshold, you don't need a pooled trust.

Important limit: the Pooled Income Trust works for Community Medicaid only. Community Medicaid in New York includes:

• Home care services.
• Managed Long Term Care (MLTC) plans.
• Consumer-Directed Personal Assistance Program (CDPAP).
• Assisted Living Program (ALP).
• Immediate Need Personal Care Services.
• Adult Day Health Care.

The trust does NOT work for Institutional/Nursing Home Medicaid. If a beneficiary enters a nursing home as a permanent resident, the deposited income is fully counted as income for institutional budgeting (used to calculate the patient liability), and federal law imposes a 5-year transfer penalty on assets moved to a pooled trust by anyone 65 or older if institutional care is needed within five years (per 42 U.S.C. § 1396p(c)(2)(B)(iv) and SSA POMS SI 01150.121).

The Major NY Pooled Income Trust Administrators (2026)

There are 18+ active NY pooled trust administrators. Here is the practical landscape, with current contact information and 2026 fee structures.

Statewide and Largest

NYSARC, Inc. Trust Services

• Headquarters: Latham, NY. Phone: (518) 439-8323. Email: trustdept@nysarc.org. Web: nysarctrustservices.org.
• The oldest and largest NY pooled trust. Established 1972; the (d)(4)(C) Community Trust II launched following OBRA-93.
• 2026 fees: $200 enrollment, $300 minimum initial deposit, $100 minimum balance (effective Oct. 1, 2024). Sliding-scale monthly admin $30–$420 by deposit size or 0.9% annualized, plus 0.68% co-trustee fee (reduced Jan. 2025), plus $75 accounting. NO annual renewal fee.
• 48-hour approval after complete paperwork. e-deposit program available.
• Death remainder: 100% retained by NYSARC for charitable purposes benefiting other disabled New Yorkers.

Center for Disability Rights (CDR) Pooled Trust

• Rochester, NY (statewide enrollment). Phone: (585) 546-7510. Email: JoinPooledTrust@cdrnys.org.
• 2026 fees: $200 enrollment (waived for current CDR consumers or transfers from another pooled trust), $20 minimum initial deposit, $20/month admin fee covering 4 disbursements ($10 per additional), $50 annual audit fee deducted Jan. 15.
• Online portal for member account management.

Life's WORC Community Trust 3

• Garden City, Long Island. Phone: (516) 741-9000 ext. 225. Email: trustservices@lifesworc.org.
• 2026 fees: $250 enrollment, $300 minimum, $30–$350/month sliding scale. Notable: requires "double the monthly deposit" before expenses can be paid (a one-month buffer).

NYC and Long Island

LIFE Inc.

• Cedarhurst, NY. Phone: (516) 374-4564 ext. 3. Web: lifetrusts.org.
• 2026 fees: $300 signup (sometimes waived), $200 annual, $35–$350/month. "Trust established in 2 business days."

KTS Pooled Trust

• Brooklyn. Phone: (718) 475-5000. Email: carlos@ktstrust.org.
• 2026 fees: $250 enrollment, 10% of deposit ($30–$200), $100 annual. Debit cards and ACH transfers available.

Everfund

• Spring Valley. Phone: (845) 202-9000.
• 2026 fees: $250 enrollment, 10% of deposit ($30–$250), $100 annual.

Senior Community Service (SCS) Pooled Trust

• Brooklyn. Phone: (718) 971-2509.
• 2026 fees: $250 enrollment, 10% of deposit ($25–$200), $100 annual.

UCS Trust Services

• Brooklyn. Phone: (718) 854-9300.
• 2026 fees: $250 enrollment, 10% of surplus ($30–$250), $100 annual. Prepaid card available.

LCG Community Trust III

• Brooklyn. Phone: (718) 466-2200 ext. 510.
• 2026 fees: $250 enrollment, 8.5% of deposit ($42.50 minimum), $100 annual. $500 minimum monthly deposit (relevant for higher-income members).

Protect Your Family

• Lynbrook. Phone: (516) 837-3737.
• 2026 fees: $300 application, $200 annual, sliding-scale monthly.

OHEL Halpern Lifetime Care Foundation Pool III

• Far Rockaway. Phone: (718) 686-3170.
• 2026 fees: $900 annual, $10 per check beyond 3/month.

Theresa Foundation

• Lido Beach (under new management 2024 by CLC Foundation). Phone: (516) 391-0390.
• 2026 fees: $150 enrollment, $25–$125/month.

Community Living Corporation Pool 3

• Mount Kisco. Phone: (914) 241-2076.
• 2026 fees: $350 setup, $125/month flat.

Upstate and Western NY

Future Care

• Rochester / Monroe County. Phone: (585) 402-7840 ext. 2.
• Monroe and surrounding counties only.

Western New York Coalition Pooled Trust

• Erie / Niagara / 9 western NY counties. Phone: (866) 362-5081.
• Trustees include People Inc., Legal Services for Elderly/Disabled/Disadvantaged, and Key Bank.
• 2026 fees: $100 initiation, sliding-scale monthly. Over-65 trust available.

Region- or Population-Specific

Westchester ARC, White Plains. (914) 428-8330 ext. 3336. ACLD, Bethpage. (516) 822-0028. AHRC NYC Foundation Community Trust II, (212) 780-2690. UJA-Federation Community Trust IV, NYC. (212) 836-1150. YAI, (212) 563-7474.

Trusts NOT Currently Active for NY Enrollments

Two administrators sometimes mentioned in older guides are not currently active for NY enrollments per the NY Health Access pooled trust registry:

• UCP/NYC, not currently listed as an active administrator.
• Disabled and Aged Pooled Trust (DAPT) administered by Family of Vincennes, Indiana-based, not active for NY enrollments.

How to Enroll: The 4-Step Process

The enrollment sequence is roughly the same across administrators:

Step 1, Establish the trust account. Complete the trust administrator's notarized Joinder Agreement. Submit your Social Security disability award letter (if you have one) or NY State disability determination (if 65+ without SSI/SSDI). Provide guaranteed funds for the initial deposit. Most administrators require $200–$500 in upfront fees and a $200–$300 minimum initial deposit.

Step 2, File with NYC HRA or county LDSS. Submit the Master Trust Agreement, your signed Joinder, deposit verification, HIPAA release, MAP-751W (if you're already on Medicaid and adding the trust), and MAP-3177 (Disability Determination Request, if 65+ without SSI/SSDI).

Step 3, Disability determination (if needed). For non-SSA-certified applicants 65+, submit medical records, DOH-5143 (physician certification), DOH-5139 (functional questionnaire), and DOH-5173 (HIPAA release). Processing takes 30–90 days.

Step 4, Verify rebudgeting. After Medicaid approves the trust, confirm the rebudgeting reflects the correct effective date (the date deposits began). Federal regulations allow LDSS up to 90 days to process when the trust is filed with the Medicaid application, but processing separately routinely takes 1.5–6 months.

Speed of account opening varies dramatically by administrator. NYSARC and LIFE Inc. advertise 48-hour to 5-business-day account opening once paperwork is complete. CDR and others may take 5–10 business days.

Fees: What You'll Actually Pay in 2026

Three categories of fees:

1. Enrollment / setup fee: One-time, typically $100–$350 (some waivers available, CDR waives for current consumers, LIFE Inc. sometimes waives for direct-pay applicants).
2. Monthly administrative fee: This is where administrators differ most. Three common structures:
   • Percentage of monthly deposit (most common): typically 10% of the monthly deposit, with a minimum floor (often $25–$30) and a maximum cap (often $200–$250). This works out well for moderate excess income; less well for very large or very small surpluses.
   • Sliding-scale dollar fee: NYSARC, Life's WORC, LIFE Inc., fees range $20–$420 monthly depending on deposit tier.
   • Flat monthly fee: CDR ($20 covering 4 disbursements), CLC Pool 3 ($125), OHEL ($900 annual = $75/month).
3. Annual fee or audit/accounting fee: $50–$200 annually. NYSARC has no annual renewal fee. Most administrators charge $100/year.

Per-bill processing fees are common above a base allotment of bills (typically 3–4 disbursements/month free, then $5–$10 each).

Practical tip: If you have a moderate excess income ($500–$2,000/month) and a typical bill mix, CDR's flat $20/month and NYSARC's sliding-scale $30–$50/month range are usually the most cost-efficient options. For very large excess income ($3,000+/month), the percentage-based administrators charge proportionally more, sliding-scale dollar fees become more attractive.

What Expenses Can the Trust Pay?

The trust pays expenses directly to vendors, by check or ACH, in the member's name. Permitted expense categories include:

Housing

• Rent
• Mortgage payments and property taxes
• Homeowner's or renter's insurance
• Utilities (electric, gas, water/sewer, telephone, internet, cable)

Daily Living

• Food and groceries
• Household supplies (cleaning, paper goods, detergent, toiletries)
• Clothing
• Transportation: Access-A-Ride co-pays, taxi/Uber/Lyft, gas, car insurance, registration, repairs, vehicle purchase (one vehicle is exempt from Medicaid resource counting)

Health (Above What Medicaid Covers)

• Uncovered dental, vision, hearing-aid, podiatry expenses
• Prescription co-pays and OTC medications
• Durable medical equipment Medicaid won't cover
• Additional home care hours beyond Medicaid authorization
• Specialist visits not covered by Medicaid

Personal

• Recreation and entertainment
• Tuition and educational expenses
• Pet care, including vet bills and food
• Holiday and birthday gifts (purchased by the trust for third parties)

Financial / Legal

• Funeral preplanning trusts
• Attorney, accountant, or guardian fees

What Expenses CANNOT Be Paid?

Several categories are prohibited or restricted:

• Cash distributions to the beneficiary. Direct cash to the senior would be re-counted as income. The trust pays third-party vendors, not the beneficiary.
• Reimbursements for items the beneficiary already paid out-of-pocket. Most administrators refuse to reimburse, pay the bill before paying yourself.
• Alcohol, tobacco, firearms, illegal items.
• Third-party debts unrelated to the beneficiary (you cannot use the trust to pay your daughter's mortgage).
• Services already covered by Medicaid (don't double-pay).
• Lump-sum gifts to others, these would be treated as transfers and could trigger penalty review.

Tax and SSI Implications

Federal income tax: A (d)(4)(C) trust is generally treated as a grantor trust for federal income tax purposes under IRC §§ 671–679. This means the income is taxed to the beneficiary on Form 1040, NOT to the trust. The trustee files an informational Form 1041 with grantor letter and may issue Schedule K-1.

The beneficiary continues to receive their gross Social Security or pension income on a 1099 and must report it whether or not deposited to the trust. The deposit itself is not a deductible charitable contribution.

NY State income tax: Same flow-through treatment. The beneficiary files IT-201 and reports the same income.

SSI in-kind support and maintenance (ISM): This is the critical question for SSI recipients (low-income seniors who get a small SSI payment in addition to Social Security retirement). Under federal regulations and SSA POMS SI 01120.200/SI 01120.201, distributions from a (d)(4)(C) trust to third-party vendors for the beneficiary's expenses are not "income" to the beneficiary, the assets in the trust are exempt resources, not the beneficiary's own funds.

Even better news for 2026: Effective Sept. 30, 2024 (per 89 Fed. Reg. 24139, Mar. 27, 2024), SSA narrowed the ISM rule to count only shelter expenses (rent, mortgage, property tax, heating fuel, gas, electric, water, sewer, garbage), removing food entirely from ISM analysis. So pooled trust payments for groceries no longer affect SSI at all, and even shelter payments are typically structured to avoid ISM reduction.

How the Pooled Trust Coordinates with Other Medicaid Mechanisms

vs. Excess Income / Surplus Income Program: Mutually exclusive in any given month, you either spend down with medical bills OR deposit to the trust, not both for the same income. The trust is generally far superior because it converts the surplus into rent/utilities/food rather than medical bills.

vs. 5-year (60-month) institutional look-back: Federal law (42 U.S.C. § 1396p(c)(1)(B)) does NOT treat deposits to a (d)(4)(C) trust as transfers when made by an under-65 disabled person. For depositors 65+, the federal statute is silent and SSA POMS SI 01150.121 confirms a transfer penalty MAY apply if institutional care is sought within 5 years. Plan accordingly.

vs. NY 30-month Community Medicaid look-back: As of May 2026, the 30-month Community Medicaid look-back authorized by Part MM of the 2020 Medicaid Redesign Team II legislation REMAINS UNIMPLEMENTED. NYS DOH has issued no enforcement guidance, federal SPA approval is not finalized, and home-care applicants currently face NO functioning transfer look-back. Once enforced (no published date), proposed rules suggest pooled trust deposits and transfers by individuals 65+ to a pooled trust will likely remain exempt because the trust pays fair-market consideration for the beneficiary's expenses.

vs. Spousal Refusal: Spousal refusal under NY SSL § 366(3)(a) (a unique-to-NY tool, also Florida and Ohio) operates compatibly with the pooled trust. The ill spouse deposits surplus income to the trust while the well spouse refuses to contribute under spousal-refusal, and the community spouse's MMNA ($4,066.50/month in 2026) is honored regardless.

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 use by other disabled beneficiaries OR pay it to the state Medicaid program up to the total medical assistance paid.

In practice, all the major NY administrators retain 100% of the remainder for their charitable mission, NY does not receive direct Medicaid recovery from these self-settled pooled sub-accounts. Remainders are typically modest because the surplus-income model deposits and disburses on a roughly net-zero monthly basis.

The trust account also terminates if the beneficiary becomes a permanent nursing home resident (income flips to institutional budgeting and the trust no longer functions).

Critical Pitfalls and Common Mistakes

NY elder-law attorneys see the same mistakes repeatedly:

1. Waiting too long to establish the trust. Deposits in the month of receipt of income are required; you cannot retroactively deposit prior months' income. Missed months mean income is counted as available, and Medicaid is denied or coverage is gapped.
2. Confusing the (d)(4)(C) Pooled Trust with a (d)(4)(A) Self-Settled SNT. A (d)(4)(A) has no NY-administrator network, requires a court order or grandparent/parent/guardian to establish, and is limited to under-65 beneficiaries. Different vehicle, different procedure.
3. Confusing the (d)(4)(C) Pooled Trust with a Pooled Income Fund under IRC § 642(c)(5). Entirely unrelated charitable-remainder vehicle. Same name, different concept.
4. Failing to keep monthly bookkeeping. Most administrators require members to forward bills/invoices each month. Missed months mean unpaid rent or utility shutoffs.
5. Assuming the Pooled Trust will work for nursing home Medicaid. It does not, and 65+ depositors face transfer-penalty exposure if they enter a NH within 5 years.
6. Not filing the MAP-3177 disability determination at the same time as the joinder. NYC HRA processes pooled trust budgeting much faster when disability is pre-certified.
7. Failing to anticipate the "double-deposit" rule at Life's WORC and others where the first month's deposit is held back as a buffer.
8. Misunderstanding that Social Security retirement income alone is NOT "disability" for the trust. A 65+ retiree must affirmatively obtain a NY State disability determination, which can take 30–90 days.
9. NYC HRA quirks. Pooled trust budgeting cases are routed to the Medical Assistance Program – Surplus Income Unit and require continuous resubmission of MAP-751W with each deposit verification (some upstate LDSS accept a single annual recertification).
10. Failing to coordinate with Medicare Savings Programs. If the trust deposit reduces budgeted income below the QI/SLMB/QMB thresholds, Medicaid will require a larger trust deposit so as not to inadvertently shift the consumer onto MSP-only coverage (per GIS 19 MA/04).

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

For most NY seniors with excess income, the choice is between the Pooled Income Trust and the Excess Income (Spend-Down) Program. Here's how they compare on six dimensions:

For most NY seniors, the Pooled Income Trust is dramatically more efficient. The exception is seniors with very high ongoing medical costs (frequent specialist visits, costly DME, large prescription co-pays) where the excess income would have gone to medical bills anyway, for these seniors, the Excess Income Program may be administratively simpler with minimal economic loss.

Recent Regulatory Developments

• Sept. 30, 2024: SSA ISM rule change removed food from ISM analysis (89 Fed. Reg. 24139, Mar. 27, 2024), affects how pooled trust payments interact with SSI benefits.
• Oct. 1, 2024: NYSARC raised its Community Trust II minimum balance to $100 and revised fee schedule effective Jan. 1, 2025.
• Through 2026: NYS DOH continues to delay 30-month Community Medicaid look-back implementation. Most observers expect final implementation no earlier than late 2026 or 2027.
• The 2026 NY Community Medicaid asset and CSRA limits ($33,038 single / $44,796 couple / $162,660 CSRA / $4,066.50 MMNA) make pooled trusts increasingly relevant for middle-income seniors who exceed only the income test.

• No pending federal legislation as of May 2026 alters (d)(4)(C) pooled trust authority.

Where to Get Help

For trust enrollment: Contact 2-3 administrators directly to compare fees and processing times. Common starting points are NYSARC (largest, most established), CDR (lowest flat fees), and Life's WORC (LI/NYC focus).

For trust + Medicaid application coordination: A New York elder-law attorney is almost always worth the cost, particularly for applicants 65+ without SSI/SSDI (where the disability determination is non-trivial), for spousal-impoverishment cases, or for any case involving complex assets. The New York State Bar Association Elder Law and Special Needs Section maintains a referral directory.

For self-help research: NY Health Access (nyhealthaccess.org) maintains the most comprehensive consumer-facing pooled trust registry in the state, with current fee schedules and contact information for every active administrator.

For NY Medicaid application: NYC residents apply through HRA (1-888-692-6116). Outside NYC, apply through your county's LDSS. NY State Medicaid Helpline: 1-800-541-2831. NYIA (for MLTC enrollment): 1-855-222-8350.

Learn More

• New York Community Medicaid
• New York Managed Long Term Care (MLTC)
• How CDPAP Pays You to Care for a Loved One in New York
• New York Medicaid Eligibility & Income Limits
• New York Spousal Refusal
• How to Apply for New York Medicaid

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.