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

A Medicaid New York Pooled Income Trust is how a certified disabled 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 Our national guide to special needs trusts and pooled trusts compares the two trust types.

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.2 The pooled trust is the alternative to spending that money on medical bills.

Consider an unmarried, certified disabled 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 down that $1,164 a month on medical expenses 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.2,1

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. Federal Medicaid law's trust exception to the transfer penalty, 42 U.S.C. § 1396p(c)(2)(B)(iv), reaches only a trust established solely for the benefit of a disabled individual under 65, so funding a trust at 65 or older can trigger a transfer-penalty period if institutional care is sought.1

Choosing a Medicaid New York Pooled Income Trust Administrator

The trust must be established and managed by a nonprofit association, so the real decision is which nonprofit administers your account.1 Brevy does not list individual administrators, their phone numbers, or their fees here, because we could not confirm them from a state or federal source. Ask your local social services district or a New York elder-law attorney which administrators serve your area, then put the same questions to each one and get the answers in writing:

1. Will it take monthly income to reduce a Medicaid spend-down? Make sure the answer is about monthly surplus income, not only a lump-sum or third-party deposit.
2. Who can join? Ask whether you must live in a particular county or region.
3. Is there a minimum balance or buffer? Ask whether you must keep money in the account, or deposit extra up front, before the trust starts paying your bills.
4. What will it pay for, and how? Ask for the permitted-expense list, how many payments a month the fee covers, and how you send bills in.
5. What happens to the balance at your death? Federal law lets the trust either keep the remainder for other disabled beneficiaries or pay the state back up to the total Medicaid paid. Ask which this trust's documents provide.1

How to Enroll: The 4-Step Process

In outline, enrollment runs in four steps:

Fees: What to Ask Before You Enroll

Pooled trusts charge for running your account, and the fee schedule is the administrator's own, so read it before you sign. Ask about each of these:

1. A one-time enrollment or setup fee, and whether any part of it is refundable.
2. The monthly administrative fee, and how it is calculated: a percentage of your monthly deposit, a flat dollar amount, or a dollar amount that rises with the deposit. Ask what the fee would be at your exact deposit, and whether there is a minimum or a cap.
3. Any annual fee, whether it is called an audit, accounting, tax, or renewal fee.
4. Per-payment charges for bills above whatever number of payments a month the base fee covers.

Practical tip: the larger your surplus, the more a percentage-based fee costs you in dollars, so compare what each administrator would charge at your own deposit amount. 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 means ordinary living costs paid to the vendor: the landlord, the grocer, the phone company. Beyond that, ask the administrator for its own permitted-expense list and disbursement rules before you enroll, including whether it will reimburse something you already paid and how many payments a month your fee covers.

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: Brevy carries no verified source on how pooled trust sub-accounts are taxed, so do not assume a deposit changes your tax return. Ask the administrator what annual tax statement it provides, and confirm the treatment with a tax advisor.

SSI in-kind support and maintenance (ISM): if you receive SSI, the question is separate from Medicaid's income rule, and it turns on in-kind support and maintenance. 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: the federal Medicaid exception for transfers to a trust, 42 U.S.C. § 1396p(c)(2)(B)(iv), reaches only a trust established solely for the benefit of a disabled individual under 65. At 65 and over, funding the trust can trigger a transfer penalty 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.2,1,3

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. Ask which one your trust's documents provide, and 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, so income you do not deposit that month is not excluded.1
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. The trust pays your vendors, so your bills have to reach the administrator every month; a missed month can mean 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 trust paperwork.
7. Not asking about a minimum balance or buffer. Ask whether the administrator needs a starting balance or an extra deposit before it pays your first bills, and budget for it.
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 level is $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. Ask your district what counts toward that level before assuming you are over it.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.