New York Medicaid Programs for Seniors: 2026 Guide

If you or a parent is 65 or older in New York and need help paying for health care, long-term care, or help at home, New York Medicaid for seniors has a path. But it is not one program. It is a layered system: Community Medicaid for everyday acute care, Institutional Medicaid for nursing facility stays, Managed Long Term Care for help at home, MAP and PACE for fully integrated Medicare and Medicaid, NHTD and TBI waivers for specialized populations, CDPAP for self-directed family caregiving, and pooled income trusts as the workaround when your income runs over the limit.

This guide walks through every New York Medicaid program that matters for seniors in 2026: what each one pays for, who qualifies, what changed September 1, 2025, and where to apply (the rules differ between New York City and the rest of the state).

By Brevy Care Team · Last verified May 7, 2026

Who Runs New York Medicaid

New York Medicaid is administered by the New York State Department of Health (NYSDOH) under the federal 1115 Medicaid Redesign Team Demonstration (CMS ID 11-W-00114/2, current renewal approved March 23, 2022 and running through March 31, 2027). Eligibility determinations are made at two different desks depending on where you live:

• In New York City (5 boroughs), applications go to the Human Resources Administration (HRA) Medical Assistance Program (also called "MAP," confusingly the same acronym as Medicaid Advantage Plus, the integrated plan). HRA operates the ACCESS HRA portal at access.nyc.gov and runs the Surplus Income Unit that processes pooled-trust budgets.
• Everywhere else, applications go to your Local Department of Social Services (LDSS), the county welfare office.

For non-MAGI populations (seniors, people with disabilities, anyone applying for long-term care), the paper application is Form DOH-4220. NY State of Health (the online marketplace) handles MAGI populations only and does not process non-MAGI long-term care applications.

Three statewide infrastructure pieces matter no matter which county you live in:

• NY Medicaid Choice (NYMC), the MLTC enrollment broker, operated by Maximus. Phone 1-855-222-8350. This is who walks you through MLTCP, MAP, and PACE plan options once you're Medicaid-eligible.
• NY Independent Assessor Program (NYIAP), also operated by Maximus, conducts the three-stage clinical assessment that gates MLTC enrollment.
• ICAN (Independent Consumer Advocacy Network), 1-844-614-8800, operated by the Community Service Society of New York. ICAN is the structurally independent ombudsman for MLTC consumers, and the right call when something goes wrong with a plan or assessment.

That last piece matters. Maximus operates BOTH the enrollment broker AND the independent assessor. Consumer advocates have repeatedly flagged the structural conflict-of-interest concern. ICAN exists precisely because the federally required ombudsman function has to live outside Maximus.

The 2026 Financial Eligibility Numbers

Most senior-focused New York Medicaid pathways use one of two financial frameworks: Community Medicaid (for people who live at home and need acute or community LTSS) or Institutional Medicaid (for nursing-facility residents). All figures below are for 2026.

A few things to notice that distinguish New York from most other states:

• No Miller Trust. New York is a medically-needy state under federal § 1902(a)(10)(C), one of 33. If your income exceeds the limit, you do not file a Qualified Income Trust the way you would in Texas, Florida, or Tennessee. Instead, you either spend down on medical bills (Surplus Income Program) or, more commonly for seniors who need ongoing home care, deposit the excess into a pooled income trust under 42 USC § 1396p(d)(4)(C).
• Spousal protections at the federal max. New York adopts the federal maximum Community Spouse Resource Allowance (CSRA) of $162,660 and the federal max Minimum Monthly Maintenance Needs Allowance (MMMNA) of $4,066.50 (effective January 1, 2026 per CMS CIB 12/9/2025). The CSRA floor is $74,820, well above the federal floor of $32,532. The Personal Needs Allowance for a nursing-home resident is $50/month, frozen since the 1980s under 18 NYCRR § 360-4.6(b)(1).
• Probate-only estate recovery. New York repealed expanded estate recovery in 2012 and operates as a probate-only state under 18 NYCRR § 360-7.11 and NY Social Services Law § 369. Joint accounts with right of survivorship, MAPT-titled property, life estates, and beneficiary-designated assets are not subject to recovery.
• Home equity exclusion at the federal max ($1,130,000). The home itself is exempt while a spouse, child under 21, or permanently disabled child lives there, or while the applicant documents intent to return.

The 60-Month Institutional Lookback (and the Lookback That Isn't)

Applications for Institutional Medicaid trigger the federal 60-month (5-year) lookback on asset transfers under 42 USC § 1396p(c). Gifts, below-market transfers, and certain trust funding moves made within that window can create a transfer-penalty period during which Medicaid will not pay for nursing-facility care.

The 2026 transfer-penalty divisors are set by NYSDOH GIS 25 MA/14 (December 22, 2025) and vary by region:

The often-misreported piece: the 30-month community Medicaid lookback is NOT in effect. Enacted in NY SSL § 366(5)(d) by Part DD of Chapter 56 of the Laws of 2020, the 30-month community lookback has been postponed every year since. As of May 2026 it is still not operative. New Yorkers applying for community-based MLTC, CDPAP, NHTD, or other home-care Medicaid pathways currently face no functioning transfer lookback. Only the 60-month institutional lookback applies, and only when the applicant enters a nursing facility.

The Long-Term Services and Supports Landscape

Most New York seniors who need ongoing help receive it through one of three Managed Long Term Care product lines, plus a handful of 1915(c) HCBS waivers. Together these are the LTSS chassis.

Managed Long Term Care Partial Capitation (MLTCP)

This is the largest LTSS pathway in New York: roughly 22 plans, 250,000 to 270,000 members. MLTCP is authorized at NY Public Health Law § 4403-f and operationally regulated under 10 NYCRR Part 98 Subpart 98-1. It covers Medicaid LTSS only (personal care, CDPAP, adult day, home-delivered meals, durable medical equipment, nursing-home placement for the first 3 months of a long-term stay), and it pairs with original Medicare or a separate Medicare Advantage plan for medical services.

Who qualifies: Dual-eligible seniors (Medicare + Medicaid) age 21+ who need community-based LTSS for 120 or more days. Enrollment is mandatory in all 62 counties for this population, with statutory exclusions at PHL § 4403-f(7)(f) for OPWDD-certified individuals, ICF/IID residents, primary mental-health diagnoses eligible for HARP, and certain immigration statuses.

The Long-Stay Nursing Home Rule (PHL § 4403-f(7-a)): MLTCP plans cover the first 3 months of a "long-term nursing home stay" (LTNHS) designation, then disenroll the member to fee-for-service Medicaid. This rule does NOT apply to MAP or PACE; both of those products cover full long-stay placement.

Lock-in: 90-day grace period after enrollment (you can switch plans freely), then a 9-month lock-in under MLTC Policy 21.04 (often misreported as 21.02 in older trade sources). Good Cause exceptions exist for plan-quality issues, network adequacy, and a few other categories. PACE has no lock-in.

Medicaid Advantage Plus (MAP / FIDE-SNP)

MAP is the fully integrated Medicare + Medicaid product: one plan, one ID card, one care coordinator. Roughly 12 carriers and ~78,000 enrollees in 2026. Federal authority sits at 42 CFR 422.2 (FIDE-SNP) and 42 CFR 422.514(h) Exclusively Aligned Enrollment (mandatory federal alignment effective 1/1/2025); state authority sits at PHL § 4403-f.

Major 2026 MAP carriers (verified):

• Wellcare Fidelis Dual Align (largest, statewide 59 counties)
• VNS Health Total in Better Health (5-star CMS rating, 13 counties)
• Elderplan Plus LTC / MJHS (NYC + Long Island + Westchester + Hudson Valley)
• Anthem HealthPlus Full Dual Advantage LTSS / LTSS 2 (absorbed Centers Plan effective 1/1/2026)
• Senior Whole Health of NY / Molina

How to enroll: Members must first enroll in the same parent organization's MLTCP, then elect MAP effective the first of the following month. You cannot jump straight from original Medicare into MAP without first being on the partner MLTCP plan.

Critical 2026 change for appeals. Effective January 1, 2026, MAP integrated appeals bifurcated: Medicaid-side denials route to OTDA Fair Hearing within 60 days; Medicare-side denials follow the standard Medicare appeal pathway (Livanta QIO, Maximus IRE, etc.). The legacy Integrated Administrative Hearing Officer (IAHO) pathway is available only for service requests dated before 1/1/2026, with a final filing deadline of 4/19/2026.

PACE (Program of All-Inclusive Care for the Elderly)

PACE is the gold standard for fully integrated Medicare + Medicaid + day-center care for seniors age 55+ who can live safely in the community with substantial support. Authority is permanent under SSA §§ 1894 and 1934 (NOT 1115-dependent), regulations at 42 CFR Part 460. New York operates 10 PACE programs and roughly 10,500 enrollees in 2026.

Active New York PACE programs (2026): ArchCare Senior Life (NYC + Westchester); CenterLight Healthcare (NYC + Westchester + Nassau); Catholic Health LIFE (Western NY/Buffalo); Fallon Health Weinberg PACE (Erie County); Complete SeniorCare (Capital Region); Total Senior Care (Western NY rural); ElderONE / Rochester Regional (Monroe + 6 counties); Eddy SeniorCare / St. Peter's (Capital Region); PACE at Hudson Headwaters (opened 2/1/2025).

What makes PACE different:

• Exempt from the September 1, 2025 Minimum Needs Requirement. PACE eligibility uses the older Nursing Facility Level of Care test only. If you cleared NF-LOC but might not clear the new 3-ADL/2-ADL-with-dementia floor, PACE is your route into integrated care.
• No lock-in. You can disenroll from PACE at any time.
• Covers full long-stay nursing-home placement. Unlike MLTCP, PACE doesn't disenroll you after 3 months.
• Day-center attendance is part of the model. PACE programs are built around an adult day health center where members go several times a week for primary care, therapy, meals, and socialization.

The September 1, 2025 Minimum Needs Requirement

This is the most consequential MLTC change of the last decade. Under MLTC Policy 25.04 (issued June 30, 2025; revised August 22, 2025) and 25 OHIP/ADM-03, new MLTCP and MAP enrollees on or after 9/1/2025 must demonstrate one of the following:

• Limited assistance with 3+ Activities of Daily Living (ADLs), OR
• Supervisory assistance with 2+ ADLs IF a documented Alzheimer's or dementia diagnosis is on file.

ADLs are the standard six: bathing, dressing, toileting, transferring, eating, and continence. Limited assistance means hands-on help; supervisory assistance means cueing, reminding, or standing-by support.

PACE is exempt (uses NF-LOC only). Pre-9/1/2025 enrollees keep Legacy Status as long as they stay continuously enrolled in their MLTCP or MAP plan. If a Legacy member voluntarily disenrolls and tries to re-enroll later, they face the new floor.

For families who would have qualified for MLTC under the prior standard but don't clear the new floor, the practical alternatives are: (a) PACE, where eligible by age and geography; (b) the 1915(c) waivers (NHTD, TBI, OPWDD); (c) the 1915(k) Community First Choice Option, an entitlement that layers on top of waiver services; or (d) traditional Community Medicaid + private home care.

The 1915(c) HCBS Waivers

Outside MLTC, New York operates four 1915(c) Home and Community-Based Services waivers serving distinct populations. Two of them (NHTD and TBI) remain carved out of MLTC in 2026, meaning waiver enrollment is the operative pathway, not MLTC.

NHTD: Nursing Home Transition and Diversion (CMS NY.0444)

For people age 18–64 with documented physical disability OR age 65+ who would otherwise need nursing-facility-level care. NHTD is operated by NYSDOH through Regional Resource Development Centers (RRDCs).

Critical 2026 status: Enrollment is frozen. CMS approved a 9,400-participant cap effective November 23, 2025; actual enrollment had already exceeded that (~12,700 by mid-January 2026 per provider testimony at the NYS Joint Legislative Budget Hearing 2/2/2026). NYSDOH has suspended new referrals and explicitly chosen NOT to maintain a formal waiting list. Roughly 50 slots open per month through attrition.

The fallback pathway: Community First Choice Option under 1915(k). New York elected CFCO in 2018-2019 (operationalized by 19-ADM-01). It is an entitlement (no waiting list), comes with a +6 percentage-point FMAP, and layers on top of any 1915(c) waiver. For families locked out of NHTD by the cap, CFCO is the operative substitute in 2026.

TBI: Traumatic Brain Injury Waiver (CMS NY.0269)

For people who experienced TBI onset between ages 18 and 64 (enrollment continues past age 64 once approved). Roughly 3,000 participants. No cap, no enrollment freeze, operating normally in 2026. The often-cited CMS number "NY.0014" is not the correct waiver ID; the operative number is NY.0269.

OPWDD Comprehensive Waiver (CMS NY.0238)

For all-ages individuals with intellectual or developmental disabilities diagnosed before age 22 (per Mental Hygiene Law § 1.03(22)). Roughly 100,000 participants, the largest of New York's 1915(c) waivers. Operated by OPWDD through DDROs and Care Coordination Organizations.

June 1, 2026 change: CANS (under-18) and CAS (18+) tools become required. Without a valid CANS or CAS, OPWDD will not review participant budgets.

Children's Waiver (CMS NY.4125)

For children and youth under 21 with behavioral health, medical fragility, or foster-care HCBS need. The April 2026 amendment ended the Maximus C-YES role for Medicaid-enrolled children (Health Homes now perform HCBS Eligibility Determination) and rolled Day Habilitation into Community Habilitation.

CDPAP: Self-Directed Family Caregiving

The Consumer Directed Personal Assistance Program lets a Medicaid recipient hire and direct their own personal assistants, including most family members. Authority sits at NY Social Services Law § 365-f and 18 NYCRR § 505.28. Roughly 280,000 New Yorkers participated in 2026.

Who can be your paid PA:

• Adult children (any age)
• Siblings, in-laws, friends, neighbors
• Parents of an adult consumer age 21+ (Chapter 511 of Laws of 2015 explicitly permits this)

Who cannot:

• A spouse of the consumer (NY-elected exclusion under § 365-f(2)(c))
• Parents of a consumer under 21
• The consumer's Designated Representative (a single person cannot fill both roles, per § 505.28(b)(11))

Public Partnerships LLC (PPL) is now the sole statewide Fiscal Intermediary. Effective April 1, 2025 under § 365-f(4-a), PPL replaced the prior network of approximately 600 fiscal intermediaries. The transition was contested: Engesser v. McDonald (EDNY 1:25-cv-01689) reached final approval October 3, 2025 (ECF 140) with protections for affected consumers and PAs. Two parallel wage-theft class actions, Calderon v. PPL (EDNY) and Flanagan v. PPL (6:25-cv-06225 WDNY), are still pending as of May 2026.

2026 CDPAP wages (effective 1/1/2026):

A few things consumer guides routinely get wrong:

• There is NO 60-hour weekly cap in any NYSDOH directive, statute, or regulation as of May 2026. The NYIAP Independent Review Panel review trigger at 12+ hours per day (or any live-in case) is medical-necessity review, not a service cap.
• EVV runs through the PPL Time4Care app, not HHA Exchange. Consumer or Designated Representative timesheet approvals are due 12:00 noon Eastern on Sundays.
• Live-in care follows the Andryeyeva 13-hour rule (Andryeyeva v. New York Health Care, Inc., 33 N.Y.3d 152 (2019)): a 24-hour live-in shift pays 13 hours (with 8 sleep hours, 5 of them uninterrupted, and 3 hours of meal breaks).
• Difficulty-of-care payments are tax-excludable for live-in PAs under IRS Notice 2014-7 / IRC § 131(c). New York State conforms; SSI, SNAP, and SSDI exclude. HUD does not.

Pooled Income Trusts: The Over-Income Workaround

For seniors whose income exceeds the $1,836/month Community Medicaid threshold, the practical path to MLTC, CDPAP, or other community-based Medicaid is a pooled income trust under 42 USC § 1396p(d)(4)(C). New York's GIS 19 MA/04 and GIS 20 MA/03 Att. 1 confirm that excess income deposited to a (d)(4)(C) trust is disregarded for community Medicaid eligibility, including for individuals age 65+ who are SSA-certified disabled.

How it works:

1. You enroll with a New York pooled-trust administrator (NYSARC Trust Services is the oldest and largest; others include Center for Disability Rights, Life's WORC Community Trust 3, KTS, LIFE Inc., AHRC NYC Foundation, YAI, and many more).
2. Each month, you deposit your over-the-limit income (anything above $1,836 single, or $2,489 couple) into your sub-account at the trust.
3. The trust pays your everyday living expenses out of the deposited income: rent, utilities, food, household goods, clothing, transportation, uncovered medical costs, additional home-care hours not covered by Medicaid, prescription co-pays, even gifts to third parties and recreation.
4. Whatever remains in your sub-account at death is retained by the trust for other disabled beneficiaries (per § 1396p(d)(4)(C)(iv)). New York pooled-trust administrators routinely retain remainders rather than pay the state, and in practice New York does not recover from these self-settled pooled sub-accounts.

Critical limitations:

• Pooled trusts work only for COMMUNITY Medicaid. They do NOT work for Institutional/Nursing Home Medicaid. Once an applicant enters a nursing facility, deposits to a pooled trust are fully countable income for Institutional budgeting, AND a 65+ depositor who then enters a nursing facility within 5 years faces a federal transfer penalty under § 1396p(c)(2)(B)(iv) and SSA POMS SI 01150.121.
• NYC vs. rest-of-state: HRA's MAP Surplus Income Unit requires continuous resubmission of MAP-751W with each deposit verification. Many upstate LDSS accept a single annual recertification.
• Disability certification required. SSA-certified individuals (with an SSI or SSDI award letter) clear automatically. Other applicants need NYC HRA Form MAP-3177 + DOH-5143 (physician) + DOH-5139 (functional questionnaire) + DOH-5173 (HIPAA) + 12 months of medical records.

For a deeper look at how to set up a pooled trust, which administrators serve which counties, and worked examples for common income scenarios, see our New York Pooled Income Trust deep guide.

Medicare-Coordination Programs

Most New York seniors with Medicaid also have Medicare. Three federal Medicare Savings Programs (MSPs) help with Medicare cost-sharing:

• Qualified Medicare Beneficiary (QMB): Pays Medicare Part A and B premiums, deductibles, and coinsurance. Income up to ~100% FPL.
• Specified Low-Income Medicare Beneficiary (SLMB): Pays Part B premium only. Income 100–120% FPL.
• Qualifying Individual (QI): Pays Part B premium only. Income 120–135% FPL.

New York-specific: New York eliminated the MSP asset test in 2008. There is no asset limit for QMB, SLMB, or QI in New York, only an income test.

For 2026, the Medicare Part A inpatient deductible is $1,736 and the SNF coinsurance for days 21–100 is $217/day. QMB members pay none of this; SLMB and QI members still owe Part A deductibles and coinsurance.

New York's state-funded prescription assistance program for seniors 65+ is EPIC (Elderly Pharmaceutical Insurance Coverage), which coordinates with Medicare Part D and provides wraparound coverage. EPIC operates separately from Medicaid and the MSPs.

Other New York Medicaid Pathways

A few additional pathways round out the senior landscape:

• Assisted Living Program (ALP). Covered through MLTC capitation rates: state-plan personal care plus Medicaid-funded room and board capped at the SSI Congregate Care Level III rate. For Medicaid-eligible seniors who need NF-LOC services but can be safely served in licensed assisted-living settings.
• Medicaid Buy-In for Working People with Disabilities (MBI-WPD). For working New Yorkers with disabilities age 16–64 with earned income above SSI but below ~250% FPL. Authorized under NY SSL § 366(1)(a)(12) and the 1115 MRT demonstration.
• HARP (Health and Recovery Plan) and CORE Services. Mainstream managed care product for adults 21+ with serious mental illness or substance-use disorder. HARP and MAP enrollment are mutually exclusive. Adult Behavioral Health HCBS run under the 1115 MRT demonstration (not a stand-alone 1915(i)).
• Money Follows the Person (MFP) / Open Doors Transition Center. Reauthorized under the One Big Beautiful Bill Act (P.L. 119-21, July 4, 2025). Has supported 10,000+ cumulative transitions from institutional to community settings through 2024. Community partner: New York Association on Independent Living (NYAIL).

How to Apply

Application channel depends on what you're applying for and where you live. A full step-by-step is in our How to Apply for New York Medicaid guide.

For NYC residents (5 boroughs):

1. Online: ACCESS HRA at access.nyc.gov for non-MAGI applications; NY State of Health for MAGI.
2. In person: HRA Medical Assistance Program (MAP) borough offices in Manhattan, Brooklyn, the Bronx, Queens, and Staten Island.
3. Paper: Form DOH-4220 mailed to the appropriate HRA office.

For the rest of the state (57 counties):

1. Online: NY State of Health for MAGI populations only.
2. In person: Your county Local Department of Social Services (LDSS).
3. Paper: Form DOH-4220 mailed to your county LDSS.

For long-term care (nursing-home Medicaid, MLTC, CDPAP, waivers), the paper Form DOH-4220 plus the long-term care supplement DOH-4220A is the standard route. NY State of Health does NOT process non-MAGI long-term-care applications.

Once Medicaid eligibility is established, MLTC enrollment goes through NY Medicaid Choice (Maximus, 1-855-222-8350) with an NYIAP three-stage clinical assessment: Community Health Assessment (using the UAS-NY tool), Independent Practitioner Panel review, and (for cases averaging 12+ hours/day or any live-in case) an Independent Review Panel under 22 OHIP/ADM-01.

Federal processing timelines: 45 days for non-disability applications, 90 days for disability-based.

Your Appeal Rights

When something goes wrong (a service reduction, a denial, a plan disenrollment), New York's Medicaid managed care framework gives you a three-layer appeal:

1. Plan internal appeal. Federal rules at 42 CFR § 438.402 require the plan to offer an internal appeal level. New York's FY 2017 budget reform permits Medicaid managed care members to proceed directly to a State Fair Hearing without exhausting the plan internal appeal first.
2. External Review under PHL § 4914. An independent review organization reviews medical-necessity denials.
3. State Fair Hearing under 18 NYCRR Part 358. Through the NY OTDA Office of Administrative Hearings (1-800-342-3334). Aid Continuing under 18 NYCRR § 358-3.6 must be requested before the effective date of the action OR within 10 days of the notice, whichever is later.

The controlling notice-adequacy precedent in New York is Mayer v. Wing, 922 F. Supp. 902 (SDNY 1996): MLTC service-reduction notices must explain the specific evidence and reasoning behind the reduction, not just cite a general policy or assessment.

ICAN (1-844-614-8800) is your independent ombudsman for any of these issues. They're operated by the Community Service Society of New York and structurally separate from Maximus and NYSDOH.

Effective for rating periods beginning January 1, 2026, the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) reduces standard service-authorization decision time from 14 days to 7 calendar days. Expedited authorization remains 72 hours.

What's Changing in 2026

A few timely policy changes worth tracking:

• MLTC Policy 26.01 (effective June 1, 2026): Standardizes involuntary disenrollment notices and timelines. NYSDOH has signaled possible delay; verify before relying on it.
• MAP integrated appeals bifurcation (1/1/2026): Already discussed above. Last legacy IAHO filing date is 4/19/2026 for service requests dated before 1/1/2026.
• OBBBA (P.L. 119-21): Section 71117 ratchets the federal MCO-tax safe harbor from 6% down to 3.5% by 2032 (in 0.5%/year increments starting FY 2028). Section 71121 creates new 1915(c) flexibility effective 7/1/2028 (no institutional-LOC requirement). Section 71112 work requirements for ACA-expansion adults begin 12/31/2026; aged, blind, and disabled categorically exempt.
• S2332-A / A6346-A (Home Care Savings & Reinvestment Act). Pending bill that would repeal MLTCP entirely effective April 1, 2028 (or earlier upon a Commissioner of Health certificate of readiness). Trade press still cites an outdated April 1, 2026 date. The operative date is 4/1/2028.
• 1115 MRT renewal: Current waiver expires 3/31/2027. NYSDOH was due to submit the renewal package to CMS by 4/1/2026; as of May 2026 the public renewal package had not yet been posted.

Common Misconceptions

"FIDA is still active in New York." False. The Fully Integrated Duals Advantage demonstration was discontinued December 31, 2019. FIDA-IDD continued separately but was discontinued in 2024. The federal Financial Alignment Initiative MMP termination (12/31/2025 nationally) is irrelevant to New York and a common misattribution in national coverage. The operative integrated product in New York is MAP / FIDE-SNP.

"Maximus is independent." Maximus operates BOTH NY Medicaid Choice (the enrollment broker) AND the NYIAP independent assessor. For an independent voice, route members to ICAN (1-844-614-8800).

"New York MLTC enrollment is around 220,000 to 260,000." Stale figure. Current 2026 figure is ~280,000 to 300,000 (MLTCP 250,000–270,000; MAP 25,000–30,000; PACE ~10,500).

"You can use a pooled trust for nursing-home Medicaid." False. (d)(4)(C) trusts work for community Medicaid only. Institutional Medicaid budgeting fully counts deposited income, and 65+ depositors face transfer-penalty exposure under 42 USC § 1396p(c)(2)(B)(iv) if NF placement occurs within 5 years.

"New York is a 209(b) state." False. New York is a 1634 state under SSA POMS SI 01715.020: SSI receipt automatically confers Medicaid. The 209(b) states are CT, HI, IL, MN, MO, NH, ND, and VA only. Some KFF state directories miscategorize New York.

"New York recovers from non-probate assets." False. New York repealed expanded estate recovery in 2012 and operates as a probate-only state under 18 NYCRR § 360-7.11 / NY SSL § 369. Joint accounts with right of survivorship, MAPT-titled property, life estates, and beneficiary-designated assets are NOT subject to recovery.

Where to Get Help

• ICAN (Independent Consumer Advocacy Network): 1-844-614-8800, your independent MLTC ombudsman, operated by the Community Service Society of New York.
• NY Medicaid Choice (Maximus): 1-855-222-8350, MLTC plan enrollment.
• NYS OTDA Office of Administrative Hearings: 1-800-342-3334, fair hearings under 18 NYCRR Part 358.
• NY Legal Assistance Group (NYLAG): 1-212-613-5000, free legal help with Medicaid issues, including MICAP for Medicare counseling.
• Empire Justice Center: statewide policy and legal support for low-income New Yorkers.
• Medicare Rights Center: 1-888-466-9050, Medicare and dual-eligible counseling.
• HIICAP / NY Medicare Help: 1-800-701-0501, free Medicare counseling.
• NYSOFA Area Agencies on Aging (statewide): 1-800-342-9871, local senior services.

Related Terms

• Managed Long Term Care (MLTC): New York's primary chassis for community-based long-term services.
• Pooled Income Trust: The (d)(4)(C) workaround for over-income community Medicaid applicants.
• Community Spouse Resource Allowance (CSRA): Federal asset protection for the at-home spouse.
• Activities of Daily Living (ADLs): The functional measures that gate the September 2025 MLTC test.
• Medicaid spend-down: New York's medically-needy pathway.
• Estate Recovery: New York's probate-only recovery framework.

Learn More

• How to Apply for New York Medicaid
• What You Need to Know About New York MLTC
• New York CDPAP
• New York Pooled Income Trust
• New York Long-Term Care Medicaid (Nursing Home)
• New York HCBS Waivers (NHTD, TBI, OPWDD)
• New York MAP / FIDE-SNP

Find personalized help navigating New York Medicaid for seniors 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. New York Medicaid rules, income limits, plan rosters, and policy memos change every year, and several major changes are expected in 2026 and 2027. Always verify current details with NYSDOH, your county LDSS, NYC HRA, ICAN, or a New York elder-law attorney. Brevy is not a law firm, financial advisor, or healthcare provider.