Medicaid in New York, in plain words: who qualifies, the look-back, spend-down, and trusts

What Medicaid is

Medicaid is health coverage for people with limited income and assets, paid by the state and federal government and run in New York by the Department of Health through each county's Department of Social Services. For older adults, it is the program that pays for long-term nursing home care, the Assisted Living Program, and ongoing help at home. Medicare does not do those things; Medicaid does.

Nothing here is legal advice. Medicaid rules are detailed, they change, and small facts about your family change the answer. This page is so you can understand what the attorney and the county are talking about.

How eligibility is decided, in general

For someone 65 or older, or disabled, the county looks at two things: monthly income and countable resources (savings, investments, extra property). Some things do not count, like the home in many situations, one car, and personal belongings. The exact limits are set each year in state notices; for 2026 the state's Medicaid levels notice (GIS 26 MA/03) is the source, and the county can tell you today's figures. Do not rely on a number from a blog, including this one.

Spend-down

If income is over the limit, New York lets a person still qualify by paying the excess toward medical bills each month, called a spend-down or surplus. For home care, many people instead put the surplus into a pooled trust (below) so it can pay ordinary bills.

The look-back

When someone applies for nursing home Medicaid, the county reviews 60 months of financial records for gifts and transfers for less than fair value. A transfer can cause a penalty period during which Medicaid will not pay for the nursing home. New York passed a 30-month look-back for home care and community-based care in 2020, but as of this writing (September 2026) the state has not started applying it; the Department of Health's page still shows the implementation as deferred. Ask an attorney where it stands when you apply.

Pooled trusts and special needs trusts

The Department of Health explains that a supplemental needs trust or a pooled trust run by a nonprofit, set up under specific rules, is not counted as a resource, and income put into it is not counted as income. Money in the trust can pay bills for the person's benefit. When the person dies, remaining funds go to the state up to what Medicaid paid, or stay with the nonprofit. The Center for Elder Law and Justice in Buffalo runs a pooled trust program for Western New York; an attorney can say whether one fits.

For a married couple

Federal spousal impoverishment rules protect the spouse who stays home. For 2026 in New York the community spouse can keep between $74,820 and $162,660 in resources, depending on the couple's total, and a monthly income allowance of $4,066.50. These change each January. There are also rules about the house, including a home equity limit of $1,130,000 in 2026.

After death: estate recovery

Medicaid may seek repayment from the estate of someone who received Medicaid at age 55 or older or who lived permanently in a facility. Recovery is deferred while a spouse, a minor child, or a blind or disabled child survives, and can be waived for hardship. This is one of the main reasons to plan with an attorney while there is time.

Two changes to know about

• Starting January 1, 2027, some people on Medicaid will need to show work, school, training, or community activity to keep coverage. The state says who is affected; the state's page says who is affected; ask when you apply.
• Starting September 1, 2025, new applicants for home care through Medicaid must meet Minimum Needs Requirements: help with more than two activities of daily living, or more than one for someone with dementia.

How to apply

People 65 and older and people applying because of disability apply through the county Department of Social Services, not the NY State of Health marketplace. The state Medicaid Helpline, (800) 541-2831, answers general questions Monday through Friday 8 to 8 and Saturday 9 to 1. Cardinal does not complete Medicaid applications, but your advisor will tell you when it is time and who does it well.

Questions for an elder law attorney

• Based on what we have, roughly when would Medicaid become possible?
• What can be protected for the spouse at home, and what about the house?
• Does a pooled trust make sense for the monthly surplus?
• What gifts or transfers in the last five years could cause a problem?
• What is your fee for the application itself, and what is included?