Medicaid Planning Attorneys in New York
New York has one of the most generous Medicaid long-term care programs in the region, and also one of the most complicated. A single applicant may keep more than $33,000 in resources, retirement accounts in payout status are not counted, a spouse may lawfully refuse to contribute, and home care through Medicaid is available today without any look-back on prior gifts. At the same time, nursing home care in the New York metropolitan area costs $15,000 or more a month, the nursing home look-back is a full 60 months, and every one of New York’s planning tools has technical requirements that the local Department of Social Services or the New York City Human Resources Administration will enforce.
Medicaid planning in New York is the process of using those rules deliberately: arranging your assets, income, and legal documents so that you or a family member qualifies for Medicaid nursing home or home care benefits at the right time while preserving your home and savings for your spouse and children. Milvidskiy Law Group P.C. represents New York families in advance planning, in crisis planning when care is needed immediately, and through the application and fair hearing process.
Key Takeaways:
- New York allows a single Medicaid applicant to keep $33,038 in countable resources in 2026, excludes the home up to $1,130,000 of equity, and does not count retirement accounts that are in payout status.
- The 60-month look-back applies to nursing home Medicaid. New York’s 30-month look-back for community Medicaid home care has been enacted but, as of this writing, has not been implemented, so home care remains available without a transfer penalty.
- Spousal refusal, pooled income trusts, Medicaid Asset Protection Trusts, and the gift-and-promissory-note strategy are all recognized in New York, but each must be executed precisely to withstand review.
How New York Medicaid for Long-Term Care Works
New York Medicaid is administered by the State Department of Health and, for eligibility purposes, by the local social services district in each county and by the Human Resources Administration in New York City. Long-term care falls into two broad programs. Nursing home Medicaid, sometimes called chronic care or institutional Medicaid, pays for care in a skilled nursing facility. Community Medicaid pays for care at home, in adult day programs, and in assisted living programs, largely through Managed Long Term Care plans. The financial rules for the two programs overlap but differ in critical ways.
Resource Limits and Exempt Assets
For 2026, a single applicant may hold $33,038 in countable resources and a couple applying together may hold $44,796. The primary residence is exempt while the applicant or a spouse lives in it, provided the applicant’s equity does not exceed $1,130,000; the equity limit does not apply when a spouse or a minor, blind, or disabled child lives in the home. Retirement accounts in payout status are exempt as resources, with the distributions counted as income. One vehicle, household goods, an irrevocable prepaid funeral agreement, and a modest burial fund are also exempt.
Income: The Allowance, the Surplus, and the Pooled Trust
A nursing home resident on Medicaid pays nearly all monthly income to the facility, keeping a $50 personal needs allowance and any amount needed to support a spouse at home. Community Medicaid works differently. A single recipient may keep $1,836 a month in 2026. Income above that figure is a “surplus” or “spend-down” that would ordinarily have to be paid toward care each month. New York permits a disabled recipient to deposit the surplus into a pooled income trust operated by a nonprofit, where it can be used to pay the recipient’s own living expenses. The pooled trust is the reason many New Yorkers with pensions and Social Security well above the allowance receive Medicaid home care while keeping their income.
The 60-Month Look-Back and Regional Rates
An applicant for nursing home Medicaid must disclose every transfer made by the applicant or spouse during the 60 months before the application. Transfers for less than fair market value create a penalty period calculated by dividing the total uncompensated value by the regional rate for the region where the facility is located. For 2026, the regional rate is $15,282 a month in New York City and $15,024 in the Northern Metropolitan region, which includes Westchester, Rockland, Putnam, Orange, Dutchess, Sullivan, and Ulster Counties. The penalty period begins only when the applicant is in a nursing home, has applied, and is otherwise eligible.
Community Medicaid Has No Look-Back Today
New York enacted a 30-month look-back for community-based long-term care in 2020, reaching transfers made on or after October 1, 2020. Implementation requires federal approval that has not been granted, and as of this writing no local district applies a transfer penalty to home care applications. Families who act now can transfer assets and qualify for Medicaid home care without a waiting period. Because the rule could be implemented with limited notice, planning for home care should be completed rather than postponed.
Medicaid Planning Strategies We Use in New York
New York offers more planning tools than most states. The right combination depends on whether care is needed now or later, whether the applicant is married, and whether the goal is home care, nursing home care, or both. Select a strategy below to learn how it works under New York’s rules.
Medicaid Asset Protection Trusts
An irrevocable Medicaid Asset Protection Trust (MAPT) holds your home and investments outside your countable resources while allowing you to keep the income the assets produce and the right to live in your home. In New York the trust must prohibit any distribution of principal to you, but it may pay you income, permit you to change beneficiaries through a limited power of appointment, and preserve the STAR and other property tax exemptions on your residence. Assets transferred to the trust start the 60-month clock for nursing home Medicaid; because community Medicaid currently has no look-back, the same trust can support a home care application immediately. Assets in a properly drafted MAPT generally receive a step-up in basis at death, pass to your beneficiaries without probate, and are generally beyond the reach of New York’s estate recovery claim. Learn more on our Medicaid Asset Protection Trust page.
Spousal Refusal
New York is one of the few states in which a community spouse may sign a written refusal to make his or her income and resources available to the spouse who needs care. Under Social Services Law § 366(3)(a), the district must then determine the applicant’s eligibility based on the applicant’s own income and resources alone. Spousal refusal may allow a couple to preserve assets above the Community Spouse Resource Allowance and is used for both nursing home and home care applications. The refusing spouse must still disclose his or her finances, and the statute gives the district a right to seek contribution from the refusing spouse under an implied contract. Districts vary in how they pursue recovery, and any claim may be subject to negotiation. Spousal refusal is a strategic decision that we evaluate case by case.
Pooled Income Trusts for Home Care
A pooled income trust is a supplemental needs trust operated by a nonprofit organization that accepts monthly deposits of a community Medicaid recipient’s surplus income. Deposited income is disregarded in the Medicaid budget and may be used by the trust to pay the recipient’s rent, mortgage, utilities, food, and other living expenses. To use a pooled trust, the recipient must be certified disabled, which for applicants 65 and older typically requires a disability determination by the local district. We select the trust, prepare the joinder agreement and disability documentation, and coordinate the monthly deposits so that home care can begin without an income spend-down.
Gift and Promissory Note Planning
When nursing home care is needed now and no advance planning was done, New York permits a strategy often called “half-a-loaf.” The applicant gifts roughly half of the excess assets and lends the other half to a family member under a promissory note that meets federal and New York requirements: a fixed repayment term within the lender’s life expectancy, equal payments, no cancellation at death, and a reasonable interest rate. The gift creates a penalty period, and the note payments fund care during that period. When the penalty ends, Medicaid begins and the gifted portion is preserved. The calculation depends on the regional rate, the cost of the facility, and the applicant’s income, and must be precise. Read our detailed discussion on our Gifting and Promissory Note page.
Protecting the Home
Federal and New York law allow a home to be transferred without penalty to a spouse, to a child under 21, to a blind or disabled child, to a sibling with an equity interest who lived in the home for at least one year, and to a caretaker child who lived in the home for at least two years and provided care that kept the applicant out of a nursing home. Where none of those exceptions applies, the home can be transferred to a MAPT, or in some cases deeded to children with a retained life estate. A life estate deed is simpler but exposes the remainder interest to the children’s creditors and, if the home is sold during the parent’s lifetime, gives the parent a countable share of the proceeds. Because New York’s estate recovery reaches only the probate estate, a home that passes by trust or by operation of law is generally not subject to recovery, which makes the choice of vehicle especially important.
Retirement Accounts in Payout Status
New York does not count an IRA, 401(k), or similar retirement account as a resource if it is in payout status, meaning the owner is receiving regular periodic distributions. The distributions are counted as income, which in a nursing home case is paid to the facility and in a home care case can be directed to a pooled trust. Since 2026, districts may no longer require applicants to take the maximum periodic payment available; a required minimum distribution schedule is sufficient. Structuring the payout correctly can keep a large retirement account from being counted as a resource, without any transfer and without a penalty period.
Caregiver Agreements
A parent may pay an adult child for care under a written personal services agreement without the payments being treated as gifts, provided the agreement is signed before services begin, describes the services, sets compensation at a rate comparable to what an agency would charge, and is followed by contemporaneous records of the hours worked. Payments under a compliant agreement reduce countable resources at fair market value and, for nursing home cases, generally do not create a penalty. We draft caregiver agreements with those requirements in mind and advise the caregiver on the income tax reporting that accompanies them.
Spend-Down on Exempt Assets and Prepaid Expenses
Excess resources may be converted into exempt assets without penalty: paying off a mortgage or other debt, making repairs and accessibility improvements to the home, purchasing an irrevocable prepaid funeral agreement, replacing a vehicle, and prepaying for medical equipment or services. Combined with New York’s comparatively high resource allowance, a planned spend-down often eliminates the need for more complex strategies in modest estates.
Medicaid Home Care in New York: MLTC and CDPAP
Most New Yorkers who qualify for Medicaid home care receive it through a Managed Long Term Care (MLTC) plan. Eligibility requires a financial determination by the local district and a functional assessment through the New York Independent Assessor, which since September 2025 has applied a minimum needs standard for new applicants. Care may be provided by a licensed home care agency or through the Consumer Directed Personal Assistance Program (CDPAP), which allows the recipient to hire a family member or friend as a paid personal assistant. Since August 2025, all CDPAP payroll and administration runs through a single statewide fiscal intermediary. We guide families through both the financial and functional sides of the process and coordinate with the MLTC plan once care begins.
The New York Medicaid Application Process
A nursing home Medicaid application in New York requires 60 months of statements for every account, records of every closed account, deeds, life insurance and annuity contracts, retirement account statements, income verification, and an explanation of every significant withdrawal or transfer. The district may take months to review the file and will issue requests for additional documentation with short deadlines. Community Medicaid applications are shorter but must be paired with the disability determination, pooled trust enrollment, and functional assessment needed to start services. When a district denies an application or miscalculates a penalty or spousal allowance, the applicant is entitled to a fair hearing before the State Office of Temporary and Disability Assistance, and we represent clients at those hearings.
Medicaid Estate Recovery in New York
After a Medicaid recipient who received benefits at age 55 or older dies, New York may recover the cost of care from the recipient’s estate. New York defines the estate narrowly as property passing under a will or by intestacy. Assets held in a properly drafted trust, jointly owned property, accounts with named beneficiaries, and property subject to a retained life estate pass outside the probate estate and are generally not subject to recovery. Recovery is also deferred while a surviving spouse or a minor, blind, or disabled child is living, and may be waived for undue hardship. Structuring a plan so that assets avoid probate is therefore one of the most effective protections available in New York.
Why Choose Milvidskiy Law Group P.C. for New York Medicaid Planning
- Focus on New York’s tools: Spousal refusal, pooled income trusts, promissory note planning, and MAPTs are core parts of our Medicaid practice.
- Home care and nursing home planning: We plan for both settings and for the transition between them, so that a home care plan does not compromise later nursing home eligibility.
- Application and fair hearing representation: We prepare and file applications with the local district or HRA and appear at fair hearings when the district gets it wrong.
- Multi-state families: We help New York clients coordinate an estate plan with property and family interests in other states. When another state’s law or local work is involved, we identify the additional legal assistance needed.
Schedule a New York Medicaid Planning Consultation
We serve clients throughout New York State from our Tarrytown office in Westchester County, and by video conference and phone. If you or a loved one may need long-term care, contact us to schedule a consultation with a New York Medicaid planning attorney.
This page is provided for general informational purposes only and does not constitute legal advice. Medicaid figures are adjusted annually and rules change. For advice about your situation, consult a qualified attorney.
Frequently Asked Questions
What is the Medicaid resource limit in New York for 2026?
For 2026, a single applicant for New York Medicaid long-term care may keep $33,038 in countable resources, and a couple applying together may keep $44,796. The primary residence (up to $1,130,000 of equity, with no limit when a spouse or a minor, blind, or disabled child lives there), retirement accounts in payout status, one vehicle, household goods, and an irrevocable prepaid funeral agreement are not counted.
What is the income limit for Medicaid home care in New York?
In 2026 a single community Medicaid recipient may keep $1,836 a month. Income above that amount is a surplus that would otherwise have to be spent on care each month. A recipient who is certified disabled may instead deposit the surplus into a pooled income trust, which can pay the recipient’s living expenses while Medicaid pays for home care.
How long is the Medicaid look-back period in New York?
New York reviews 60 months of transfers for nursing home Medicaid. A 30-month look-back for community Medicaid home care was enacted in 2020 but has not been implemented as of this writing, so home care applications are currently reviewed without a transfer penalty. Because implementation could occur with limited notice, families planning for home care should complete their planning now.
How is the Medicaid transfer penalty calculated in New York?
The total value of uncompensated transfers during the look-back is divided by the regional rate for the region where the nursing home is located. For 2026, the regional rate is $15,282 a month in New York City and $15,024 in the Northern Metropolitan region, which includes Westchester County. The result is the number of months of ineligibility, and the penalty period begins only once the applicant is in a facility, has applied, and is otherwise eligible.
What is spousal refusal in New York?
Spousal refusal is a written declaration by the spouse living at home that he or she will not make income and resources available to the spouse applying for Medicaid. Under Social Services Law § 366(3)(a), the district must then evaluate the applicant on his or her own finances. The refusing spouse must still disclose finances, and the district may seek contribution under an implied contract, so the decision to use spousal refusal is strategic and should be made with counsel.
How much can my spouse keep if I need nursing home care in New York?
Without spousal refusal, the community spouse may keep a Community Spouse Resource Allowance of between $74,820 and $162,660 in 2026, depending on the couple’s combined resources, plus a monthly income allowance of up to $4,066.50. With spousal refusal, the community spouse may retain resources above those amounts, subject to the district’s right to seek contribution.
Are IRAs and 401(k) accounts counted for New York Medicaid?
Not if they are in payout status, meaning the owner is receiving regular periodic distributions. The account principal is exempt and the distributions are counted as income. As of 2026, local districts may no longer require an applicant to take the maximum periodic payment available.
What is a Medicaid Asset Protection Trust in New York?
A Medicaid Asset Protection Trust is an irrevocable trust that holds your home and investments outside your countable resources. You may keep the income and the right to live in your home, but you may not receive principal. Assets in a properly drafted trust are protected for nursing home Medicaid after 60 months, are available for community Medicaid planning immediately under current rules, generally receive a step-up in basis at death, and pass to your beneficiaries without probate and generally outside estate recovery.
What is the gift and promissory note strategy?
Often called half-a-loaf planning, it is a crisis strategy for someone entering a nursing home now. Roughly half of the excess assets are gifted and the other half are lent to a family member under a promissory note that meets Medicaid requirements. The gift creates a penalty period and the note payments fund care during that period, after which Medicaid begins and the gifted portion is preserved.
How does Medicaid home care work in New York?
Most recipients enroll in a Managed Long Term Care (MLTC) plan after a financial determination by the local district and a functional assessment by the New York Independent Assessor. Care can be provided by an agency or through the Consumer Directed Personal Assistance Program (CDPAP), which allows a family member or friend to be hired and paid as a personal assistant through the statewide fiscal intermediary.
Can New York recover Medicaid benefits from my estate?
Yes, but only from the probate estate of a recipient who received benefits at age 55 or older. New York defines the estate as property passing under a will or by intestacy. Assets in a properly drafted trust, jointly held property, accounts with named beneficiaries, and property passing under a retained life estate are generally not subject to recovery, and recovery is deferred while a surviving spouse or a minor, blind, or disabled child is living.
Is it too late to plan if my parent is already in a nursing home?
No. Crisis planning in New York may still preserve a portion of assets through spousal refusal for married applicants, gift and promissory note planning, exempt transfers of the home, spend-down on exempt assets, and correct handling of retirement accounts. The sooner an attorney is involved after admission, the more options remain.
