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 (MLTC) for help at home, Medicaid Advantage Plus (MAP) and the Program of All-Inclusive Care for the Elderly (PACE) for fully integrated Medicare and Medicaid, the Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) waivers for specialized populations, the Consumer Directed Personal Assistance Program (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).

Key Takeaways

• New York Medicaid is medically-needy, not income-cap. A single senior whose income exceeds $1,836/month can still qualify by spending down on medical bills (Surplus Income Program) or, if unmarried, by depositing the excess into a 42 USC § 1396p(d)(4)(C) pooled income trust. The trust route carries one exception big enough to plan around: a married applicant whose eligibility is figured under spousal-impoverishment post-eligibility rules, which is how a married MLTC enrollee is budgeted, gets no income disregard from the trust at all.1,2
• Managed Long Term Care (MLTC) is the dominant long-term-services chassis. Most New Yorkers who need ongoing community-based long-term care receive it through MLTC, authorized at NY Public Health Law § 4403-f. Three operative product lines run today: MLTCP (Medicaid only), MAP (fully integrated Medicare and Medicaid), and PACE (age 55+, all-inclusive). The Fully Integrated Duals Advantage (FIDA) demonstration was discontinued December 31, 2019.3,4
• September 1, 2025 raised the floor for MLTC. Under MLTC Policy 25.04, new MLTCP and MAP applicants must need limited assistance with 3+ ADLs, OR supervisory assistance with 2+ ADLs if there is a documented Alzheimer's or dementia diagnosis. PACE is exempt. Pre-9/1/2025 enrollees retain Legacy Status as long as they stay continuously enrolled.3
• The 30-month community lookback is NOT yet in effect. Enacted in 2020 but postponed every year since, the 30-month community-Medicaid lookback is still inoperative: as of July 30, 2026 the CMS demonstration record still lists New York's request as a pending application. Only the federal 60-month institutional lookback applies. Many trade sources report the community lookback as active. It is not, but confirm the current transfer rules with your district or an elder-law attorney before you make any gift, because implementation is one CMS approval away.3,1
• New York City and the rest of the state apply differently. New York City residents apply through the Human Resources Administration (HRA) Medical Assistance Program (ACCESS HRA online or in person at borough offices). Every other county applies through its Local Department of Social Services (LDSS) or NY State of Health for MAGI populations. The New York Independent Assessor Program (NYIAP) three-stage assessment (assessment line 1-855-222-8350) and the NY Medicaid Choice enrollment broker operate statewide.3,5

Who Runs New York Medicaid for Seniors

New York Medicaid is administered by the New York State Department of Health (NYSDOH) under the federal Section 1115 Medicaid Redesign Team (MRT) Demonstration (Centers for Medicare & Medicaid Services demonstration identifier 11-W-00114/2; the current extension was approved March 23, 2022 and runs from April 1, 2022 through March 31, 2027).3 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.1

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

• NY Medicaid Choice, the MLTC enrollment broker. This is who walks you through MLTCP, MAP, and PACE plan options once you are Medicaid-eligible.
• New York Independent Assessor Program (NYIAP), created through a NYSDOH contract with Maximus Health Services, conducts the clinical assessment that gates MLTC enrollment. Its assessment line is 1-855-222-8350.3
• The statewide Medicaid Helpline, 1-800-541-2831, for questions about an application, a coverage decision, or which office handles your case.6

The order matters: the assessment and the plan-enrollment call are separate steps, and nothing about plan choice moves until the assessment is done.3,5

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 2026.1

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

• Over the limit is not the end of it. New York runs a medically-needy income standard rather than a hard dollar cap, so an applicant whose income sits above the Medicaid Income Level spends down to that level. In practice you either spend down on medical bills each month (Surplus Income Program) or, for an unmarried senior who needs 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 maximum Minimum Monthly Maintenance Needs Allowance (MMMNA) of $4,066.50 (effective January 1, 2026 per the CMS Informational Bulletin of December 9, 2025). The at-home spouse keeps the greater of $74,820, New York's state-elected minimum, or half the couple's countable resources, capped at $162,660. The Personal Needs Allowance for a nursing-facility resident is $50/month under 18 NYCRR § 360-4.6. A waiver participant or MLTC enrollee budgeted under spousal-impoverishment rules gets a different and far larger allowance: $653/month effective January 1, 2026.1
• Estate-only recovery, and only for some recipients. The revised regulation at 18 NYCRR § 360-7.11 that had implemented an expanded definition of estate expired effective December 6, 2011, so districts must not count assets that pass outside the probate estate. OMIG's claim runs against the deceased recipient's estate assets only and pertains only to assets in the recipient's name, so jointly owned assets, life estates, living-trust assets, and beneficiary-designated accounts are not reached. Recovery applies only to recipients who were 55 or older, or permanently institutionalized, at death, and it is deferred rather than waived while a surviving spouse, a child under 21, or a blind or disabled child of any age is living.1,7
• Home-equity cap at the federal maximum ($1,130,000). New York elects the highest cap federal law allows; the 2026 federal range runs from $752,000 to $1,130,000. Read the direction of that rule carefully: under 42 USC § 1396p(f)(2) the cap does not apply at all when the applicant's spouse, or a child who is under 21, blind, or permanently and totally disabled, is lawfully residing in the home.1

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.1

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

One piece that trade sources often get wrong: the 30-month community Medicaid lookback is not in effect. Enacted by section 13 of Part MM of Chapter 56 of the Laws of 2020 (amending NY Social Services Law § 366(5)(e)), the 30-month community lookback has never been implemented. NYSDOH stated the earliest date the State would seek implementation was March 31, 2024, and as of July 30, 2026 the CMS demonstration record still lists New York's CBLTC amendment request, submitted March 25, 2021, as a pending application. So New Yorkers applying for community-based MLTC, CDPAP, NHTD, or other home-care Medicaid pathways currently face no functioning transfer lookback, and only the federal 60-month institutional lookback applies, and only when the applicant enters a nursing facility. One caution before anyone acts on that: this changes on a CMS approval, and a gift made today would sit inside the window if it does. Confirm the current CBLTC transfer rules with your local district or a New York elder-law attorney before moving money.3,1

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.3,4

Managed Long Term Care Partial Capitation (MLTCP)

This is the largest long-term-care pathway in New York, with 13 partially capitated plans listed in the state plan directory as of a July 10, 2026 snapshot (that is a tally of directory rows rather than a published count, and it shifts with consolidations, so verify against the live NYSDOH MLTC Plan Directory before choosing a plan). MLTCP is authorized at NY Public Health Law § 4403-f. It covers Medicaid long-term services and supports only (personal care, CDPAP, adult day health, home-delivered meals, durable medical equipment, and short-stay nursing-facility care), and it pairs with original Medicare or a separate Medicare Advantage plan for medical services.3

Who qualifies: Medical assistance recipients age 21 or older who need community-based long-term care services for a continuous period of more than 120 days. Enrollment is mandatory statewide for this population, effectuated through the 1115 waiver rather than self-executing, since the statute directs the commissioner to obtain the waivers needed to require it. PHL § 4403-f(7)(b)(v) lists the exclusions, which include people enrolled in Office for People With Developmental Disabilities (OPWDD) waiver programs, Assisted Living Program participants, TBI- and NHTD-waiver participants, hospice recipients 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. The CMS-approved Special Terms and Conditions add residents of ICF/IIDs and residents of psychiatric facilities with stays over 30 days.3

The long-stay nursing-home rule: Under the 1115 MRT waiver amendment CMS approved in December 2019 and NYSDOH policy MRT-11202, a partially capitated MLTCP enrollee permanently placed in a nursing home for three calendar months is disenrolled from the plan and returned to fee-for-service Medicaid. NYSDOH states the limitation "only impacts the NH benefit for Partial Capitation plans" and that there is "no impact to the nursing home benefit for MAP, PACE, FIDA, or Medicaid Managed Care." That is a statement about what the rule does not touch, not a promise of unlimited coverage, so ask a MAP or PACE plan directly what it pays for a long-stay placement.3

Lock-in: Under MLTC Policy 21.04, for MLTCP enrollment effective on or after December 1, 2020, there is a 90-day grace period after the enrollment effective date (you can switch plans freely), then a 9-month lock-in unless you can demonstrate Good Cause. After the lock-in ends, you may transfer at any time for any reason. Lock-in binds a narrower group than it sounds: Policy 21.04 says it does not apply to dual eligible enrollees age 18 to 20 or to non-dual enrollees age 18 and older, does not apply to the integrated plans (MAP, PACE, FIDA-IDD), does not stop a transfer from an MLTCP plan to an integrated plan, and does not affect transfers to mainstream Medicaid managed care, HARP, an HIV-SNP, a waiver program, or fee-for-service.3

Medicaid Advantage Plus (MAP / FIDE-SNP)

MAP is the fully integrated Medicare and Medicaid product for full-benefit dual eligibles age 18 or older: one plan, one care coordinator, covering Medicare, Medicaid, long-term care, and drug benefits under one organization. The state plan directory listed 11 MAP plans in a July 10, 2026 snapshot. Federal authority sits at 42 CFR 422.2 (the Fully Integrated Dual Eligible Special Needs Plan, or FIDE-SNP, definition), with exclusively aligned enrollment; state authority sits at PHL § 4403-f.4,3

MAP carriers operating in New York include Wellcare Fidelis Dual Align, VNS Health Total, Elderplan Plus LTC, Anthem HealthPlus Full Dual Advantage, and Senior Whole Health of New York. The roster and each plan's service area change with consolidations, so confirm against the live NYSDOH MLTC Plan Directory before choosing a plan.

How to enroll: You must be assessed as needing community-based long-term services and supports for more than 120 days and enroll in the MAP plan's aligned Medicare Advantage Dual Special Needs Plan (exclusively aligned enrollment). Because enrollment has to be exclusively aligned, the MAP plan and its D-SNP are two enrollments inside the same organization, not one.4

The 2026 change for MAP appeals. New York's integrated administrative fair-hearing layer for MAP, launched in 2020, has now been phased out: the demonstration ended effective December 31, 2025, and April 19, 2026 was the latest date a member could submit an initial (Level I) plan appeal for 2025 benefits and services under that legacy system. Since January 1, 2026, MAP plans aligned with an Applicable Integrated Plan D-SNP (the AIP definition sits at 42 CFR 422.561) continue to use unified appeals and grievance procedures at the plan level, then split at Level II: a Medicaid-covered service goes to a New York State Office of Temporary and Disability Assistance (OTDA) fair hearing, which you (or your authorized representative) must now ask for yourself within 120 days of the plan's Level I decision, while a Medicare-covered service goes automatically to an Independent Review Entity. To keep services unchanged while the fair hearing is pending (Aid Continuing), request it within 10 calendar days of the Level I decision or by the date that decision takes effect, whichever is later. This is the end of New York's integrated external fair-hearing demonstration, not the elimination of plan-level integrated appeals, which continue for aligned plans.8

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

PACE is the gold standard for fully integrated Medicare, Medicaid, and day-center care for seniors age 55 or older who can live safely in the community with substantial support. Its authority is permanent under Social Security Act §§ 1894 and 1934 (42 USC §§ 1395eee, 1396u-4), not 1115-dependent, and it uses the nursing-facility level-of-care test. The state plan directory listed 10 PACE organizations in a July 10, 2026 snapshot.3

New York PACE organizations include ArchCare Senior Life, CenterLight Healthcare, Catholic Health LIFE, Fallon Health Weinberg PACE, Complete Senior Care, Total Senior Care, ElderONE, Eddy SeniorCare, and PACE at Hudson Headwaters. Service areas vary, so confirm coverage for your county.

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.
• Not subject to the MLTCP three-month nursing-home rule. NYSDOH says the partial-capitation limit has no impact on the nursing-home benefit for PACE. That is silence about a limit rather than a stated guarantee, so ask the PACE organization what its long-stay coverage is before you rely on it.
• 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) and the companion personal-care directive 25 OHIP/ADM-03 (revised August 22, 2025), new MLTCP and MAP applicants on or after September 1, 2025 must demonstrate one of the following:3,5

• At least limited assistance with physical maneuvering for more than two Activities of Daily Living (ADLs), OR
• At least supervision with more than one ADL, 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; supervision 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 (HCBS) waivers serving distinct populations.9

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

The Nursing Home Transition and Diversion (NHTD) waiver serves people who meet a nursing-facility level of care and want to live in the community. It is operated by NYSDOH through Regional Resource Development Centers.

Current 2026 status: referrals are closed. New York amended the waiver to set a maximum of 9,400 participants (approved December 23, 2025), then raised the maximum to 14,079 participants for waiver years 2025-26 through 2027-28 (amendment accepted May 15, 2026). Because the program has reached its approved maximum, NYSDOH is not processing additional NHTD referrals at this time and closes new referrals by letter.9

The fallback pathway: the Community First Choice Option (CFCO) under § 1915(k). New York elected CFCO through State Plan Amendment 13-35 (operationalized by 19-ADM-01), which makes long-term services that were previously waiver-only into Medicaid State Plan services. Because they are State Plan services, CFCO benefits are an entitlement with no cap or waiting list, and they can layer on top of any 1915(c) waiver. For families locked out of NHTD by the cap, CFCO is the operative substitute in 2026.9

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

The Traumatic Brain Injury (TBI) waiver serves people who experienced a traumatic brain injury. Its correct CMS identifier is NY.0269 (the obsolete NY.0014 that appears in some older references is not the operative number).9

OPWDD Comprehensive Waiver (CMS NY.0238)

The Office for People With Developmental Disabilities (OPWDD) Comprehensive waiver serves people with an intellectual or developmental disability and is the largest of New York's four 1915(c) waivers.9

Children's Waiver (CMS NY.4125)

The Children's Waiver serves children and youth under 21. Effective with the amendment approved April 1, 2026, Maximus no longer performs the Independent Entity / C-YES HCBS-eligibility-determination function for Medicaid-enrolled children; Health Homes now do it, while a state-operated C-YES program serves children not yet enrolled in Medicaid.9

CDPAP: Self-Directed Family Caregiving

The Consumer Directed Personal Assistance Program (CDPAP) lets a Medicaid recipient (or a designated representative) hire, train, and direct their own personal assistants, including many family members and friends, who are paid as employees. Authority sits at NY Social Services Law § 365-f and 18 NYCRR § 505.28. As of March 31, 2025, roughly 255,000 CDPAP consumers had taken action ahead of the April 1 transition deadline, about 195,000 of whom had started or completed registration with the new statewide fiscal intermediary.5

Who can be your paid personal assistant:

• Adult children and other adult relatives
• Siblings, in-laws, friends, and neighbors
• A parent of an adult consumer age 21 or older

Being eligible is not the same as being approved. For an adult relative, the district or managed-care plan still has to find that the services are consistent with the plan of care and cost no more in the aggregate than the same services from a non-relative.

Who cannot:

• A spouse of the consumer (NY Social Services Law § 365-f and 18 NYCRR § 505.28)
• A person legally responsible for the consumer's care and support, including a parent of a consumer under 21
• The consumer's designated representative (a single person cannot fill both roles)

Public Partnerships LLC (PPL) is now the single statewide fiscal intermediary. Effective April 1, 2025, PPL became the only entity authorized to provide fiscal-intermediary services for CDPAP, replacing the roughly 600 prior fiscal intermediaries. The fiscal intermediary is the joint employer of the personal assistant, responsible for wages and benefits, income-tax and other wage withholding, and employment records, and PPL runs its own time-verification system to satisfy the federal Electronic Visit Verification mandate.5

2026 CDPAP wages. The New York Department of Labor home-care-aide minimum wage, effective January 1, 2026, sets the floor for CDPAP personal assistants:

A few related points worth knowing:

• Functional eligibility is determined through the New York Independent Assessor Program (NYIAP) under 22 OHIP/ADM-01, a multi-stage process (Community Health Assessment, Independent Practitioner Panel order, and, for a case newly needing more than 12 hours of care per day on average, a secondary medical review by the Independent Review Panel). The September 1, 2025 Minimum Needs Requirement also reaches new CDPAP applicants, though NYSDOH's two statements of its scope do not fully agree on the age cut-off, so confirm that with your plan or district. Anyone assessed and authorized for personal care or CDPAS before September 1, 2025 has Legacy Status and is not subject to it.5
• Do not assume the difficulty-of-care tax exclusion applies. IRS Notice 2014-7 treats Medicaid waiver payments as difficulty-of-care payments excludable under IRC § 131. CDPAP is a Medicaid State Plan service rather than a 1915(c) waiver program, and for a state program outside an HCBS waiver the IRS says excludability "will depend on the nature of the payments and the purpose and design of the program." A live-in personal assistant should confirm the treatment with a tax professional rather than assume it.5

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 and older who are SSA-certified disabled. Only income placed in the trust during the same month it is received is excluded; deposits cannot be made retroactively for a prior month.2,1

How it works:

1. You enroll with a New York pooled-trust administrator that accepts monthly income for a Medicaid spend-down. Not every organization on the NY Health Access roster of pooled trusts does (several run asset or third-party trusts only), so check that before you call. Administrators the roster marks as accepting monthly income include NYSARC, Inc. Trust Services (its Community Trust II is the pooled trust for spending down income above the Medicaid limits), the Center for Disability Rights, and Life's WORC Community Trust 3. Confirm fees and county coverage directly with the administrator before enrolling, since fee schedules can change mid-year.10
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.1
3. The trust pays bills for your benefit out of the deposited income. Money the trust pays directly to a third party for your benefit is not counted as your income; money paid directly to you is counted. Ask the administrator which expenses it will and will not pay before you enroll.
4. Whatever remains in your sub-account at death is, under 42 USC § 1396p(d)(4)(C)(iv), either retained by the trust for the benefit of other disabled beneficiaries or paid to the State up to the total Medicaid paid on your behalf. Which of the two applies is a term of the trust you sign, so read that clause.

Critical limitations:

• A married applicant under spousal-impoverishment budgeting gets nothing from the trust. The consumer notice issued with GIS 20 MA/03 is explicit: if you are married and your Medicaid eligibility is determined under spousal impoverishment budgeting with post-eligibility rules, which is how a Medicaid MLTC enrollee is budgeted, any income you place in a trust still counts. Before a married MLTC applicant pays an enrollment fee, confirm with the district which budgeting rules apply.
• 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.
• Rebudgeting is a paperwork step, and districts run it differently. To have income rebudgeted you give the local social services district a copy of the trust and a written statement of the monthly amount you will deposit. Ask your district how often it wants deposit verification after that, because New York City and county offices do not all handle it the same way.
• 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) plus supporting 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. New York runs its Medicare Savings Program (MSP) at two benefit levels, and NYSDOH states that neither carries an asset limit, so eligibility turns on income alone.6

• Qualified Medicare Beneficiary (QMB): pays the Medicare Part A and/or Part B premium, and also pays the Part A and Part B coinsurance and deductibles. Income at or below 138% of the Federal Poverty Level, which for 2026 is $1,836/month single and $2,489/month couple measured after deductions, or $1,856 and $2,509 as the figure to screen gross monthly income against once the standard $20 disregard is added.6
• Qualifying Individual (QI): pays the Part B premium only. Income below 186% FPL, which for 2026 is $2,474/month single and $3,355/month couple after deductions, or $2,494 and $3,375 with the $20 disregard. QI requires you to have Part A, and QI cannot be combined with Medicaid, which matters if you are reading this page for a parent who already has full Medicaid coverage.6

Further deductions can apply, so income somewhat above these figures does not automatically disqualify anyone, and SSA's guidance is to encourage people to apply anyway. Applications go through your local Department of Social Services, HRA in New York City, or NY State of Health, and every paper MSP application is mailed to the local district. The statewide Medicaid Helpline is 1-800-541-2831.6

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

Other New York Medicaid Pathways for Seniors

A few additional pathways round out the senior landscape:

• Assisted Living Program (ALP). Among the services MLTC plans cover, for Medicaid-eligible seniors who need nursing-facility level-of-care services but can be safely served in a licensed assisted-living setting.3
• Medicaid Buy-In for Working People with Disabilities (MBI-WPD). For working New Yorkers with disabilities (roughly ages 16 to 64) whose earned income is above the SSI level but within the program's higher buy-in income band. Authorized under NY SSL § 366 and the 1115 MRT demonstration.
• HARP (Health and Recovery Plan) and CORE Services. A mainstream managed-care product for adults 21 and older with serious mental illness or substance-use disorder. HARP and MAP enrollment are mutually exclusive. New York does not operate a stand-alone § 1915(i) authority; adult behavioral-health HCBS run under the 1115 MRT demonstration.9
• Money Follows the Person (MFP) / Open Doors Transition Center. Helps Medicaid recipients move from institutional settings back into the community. The community partner is the 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 a senior applying for long-term care, the path runs like this:3,1

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:3

1. Plan internal appeal, and this one comes first. For a Medicaid managed-care or MLTC service dispute you must first request a Plan Appeal and receive the plan's Final Adverse Determination, or be deemed to have exhausted it because the plan missed its own notice or timeframe requirements (42 CFR §§ 438.402(c)(1)(i) and 438.408(c)(3)). Going straight to the State without that determination is how a fair-hearing request gets dismissed.11
2. External review. An independent review organization reviews medical-necessity denials.
3. State Fair Hearing through the NY OTDA Office of Administrative Hearings. After the Final Adverse Determination you have no less than 120 days to request the hearing (42 CFR § 438.408(f)(2)). For a direct fee-for-service Medicaid action rather than a plan dispute, New York gives you a shorter window: 60 days from the date of the notice, which sits inside the 90-day ceiling federal law allows a state. You can request a hearing online through OTDA's request form, by phone at 1-800-342-3334, by fax to 518-473-6735, by mail, or in person. Managed-care and MLTC requests go to OAH's Managed Care Hearing Unit.11

Aid Continuing keeps your services in place until the decision, but only if you request the hearing before the effective date of the action or within 10 days of the notice's postmark date. Know the catch before you ask for it: a beneficiary who receives aid continuing and then loses the hearing may have to repay the assistance received while waiting.11

Effective for compliance beginning January 1, 2026, the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) requires Medicaid managed-care prior-authorization decisions within seven calendar days for standard requests and within 72 hours for expedited (urgent) requests.3

What's Changing in 2026

A few timely policy changes worth tracking:

• MLTC Policy 26.01 (effective June 1, 2026): Standardizes involuntary-disenrollment guidance for MLTCP, PACE, and MAP plans.3
• MAP integrated fair-hearing phase-out (now complete): New York's legacy integrated appeals demonstration ended effective December 31, 2025, and April 19, 2026 was the last date to submit an initial (Level I) plan appeal for 2025 benefits and services under it. Medicaid-side Level II disputes now go through the OTDA fair-hearing system, which the enrollee has to request within 120 days of the plan's Level I decision.8
• Faster prior authorization: Effective for compliance beginning January 1, 2026, the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) requires Medicaid managed-care prior-authorization decisions within 72 hours for expedited (urgent) requests and seven calendar days for standard requests.3
• S2332-A / A6346-A (Home Care Savings & Reinvestment Act). This pending bill would repeal the partially capitated MLTC product line; its remaining sections could take effect upon delivery of a certificate of readiness by the Commissioner of Health, on or after April 1, 2028 (not April 1, 2026, as some trade-press summaries report). As of the 2025-2026 session the bill remains in committee and has not passed either house.3
• 1115 MRT renewal: The current waiver runs through March 31, 2027, so a renewal package is expected at CMS before then.

Common Misconceptions

"FIDA is still active in New York." False. The Fully Integrated Duals Advantage demonstration was discontinued December 31, 2019. FIDA-IDD remains active under separate CMS authority. 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.

"The assessment decides which plan I get." It does not. The New York Independent Assessor decides whether you meet the clinical standard for community-based long-term care; choosing among MLTCP, MAP, and PACE is a separate step you take afterward through NY Medicaid Choice.3

"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: an SSI application is also a Medicaid application, and SSI recipients are enrolled in Medicaid with no separate filing. The eight 209(b) states are Connecticut, Hawaii, Illinois, Minnesota, Missouri, New Hampshire, North Dakota, and Virginia.

"New York recovers from non-probate assets." No. OMIG's claim runs against the deceased recipient's estate assets only and pertains only to assets in the recipient's name, so jointly owned assets, life estates, living-trust assets, and beneficiary-designated accounts are not reached, and heirs and surviving spouses are not personally responsible for the claim.7

Where to Get Help

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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.

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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.