New York

What is New York Medicaid Long-Term Care?

Medicaid is a health care program for low-income individuals of all ages. While it serves various eligibility groups such as pregnant women, children, and disabled individuals, this article focuses on long-term care Medicaid eligibility for elderly New Yorkers (aged 65 and over). In addition to nursing home care, New York Medicaid provides non-medical services and supports to assist frail seniors in living at home or in the community. The Medicaid long-term care programs in New York include:

What are the Main Types of Medicaid Long-Term Care Programs?

• What is Institutional / Nursing Home Medicaid?
  This is an entitlement program where anyone who meets the eligibility criteria will receive assistance. Care is provided only in nursing home settings.
• What are Medicaid Waivers / Home and Community-Based Services (HCBS)?
  These are not entitlement programs, meaning there are limited participant slots and waitlists may exist. The services aim to delay nursing home admissions and are provided at home, in a loved one’s home, adult day care, or assisted living facilities.
• What is Regular Medicaid for the Aged, Blind, or Disabled (DAB)?
  This is an entitlement program for those who meet the eligibility requirements. Various long-term care services such as personal care assistance and adult day care may be available.

What is Medicaid Managed Care in New York?

Medicaid in New York is sometimes referred to as Medicaid Managed Care. Medicaid for the Disabled, Aged 65+, or Blind (DAB) is also known as NON-MAGI (Modified Adjusted Gross Income) Medicaid. New York’s Department of Health (DOH), in collaboration with local Departments of Social Services (DSS), administers the program.

What Are the Income and Asset Limits for Eligibility?

Each category of Medicaid long-term care programs has varying functional and financial eligibility requirements. These financial criteria change annually, vary based on marital status, and are affected by New York’s alternative pathways to eligibility.

What is the Simplified Eligibility for a Single Nursing Home Applicant?

In 2025, a single Nursing Home Medicaid applicant must meet the following criteria:
– Income: Under $1,800/month
– Assets: Under $32,396
– Care Level: Requires Nursing Home Level of Care

What Are the Income and Asset Limits for Different Medicaid Types?

*Income exceptions apply to the Personal Needs Allowance of $50/month and certain Medicare premiums.
†Income limits may differ based on living setting.
‡SSI recipients are automatically eligible for Regular Medicaid.

What is the Definition of Income and What are the Exceptions?

What is Countable vs. Non-Countable Income?

Almost all sources of income are counted towards Medicaid’s income limit, including employment wages, pensions, alimony, Social Security benefits, gifts, and IRA distributions. However, exceptions exist, such as Holocaust restitution payments and VA Aid and Attendance benefits.

How is Income Treated for Married Couples?

When only one spouse applies for Nursing Home Medicaid or HCBS Waiver, the income of the non-applicant spouse is disregarded. The non-applicant spouse is entitled to a minimum amount of monthly income to prevent impoverishment, called the Community Spouse Monthly Income Allowance (CSMIA), which is $3,948 in 2025.

For Regular Medicaid, both spouses’ incomes are calculated towards eligibility, but there is no CSMIA for the non-applicant spouse.

What are the Asset Limits and Exceptions for Medicaid?

What are Countable vs. Non-Countable Assets?

Countable assets are considered towards Medicaid’s asset limit and include cash, stocks, bonds, vacation homes, and bank accounts. Non-countable assets include one’s primary home (up to certain equity limits), personal belongings, vehicles, burial funds, and certain life insurance policies.

How are Assets Treated for Married Couples?

The assets of a married couple are considered jointly owned. However, the Community Spouse Resource Allowance (CSRA) allows the non-applicant spouse to retain a portion of the couple’s assets, up to a maximum of $157,920 in 2025.

What is Medicaid’s Look-Back Rule?

New York enforces a 60-month Look-Back Period for Nursing Home Medicaid, which scrutinizes asset transfers to ensure none were gifted or sold under fair market value. This rule does not apply to Regular Medicaid or HCBS Waivers, but violating it may result in Medicaid ineligibility.

What Are the Home Exemption Rules for Medicaid in New York?

The Medicaid applicant or their spouse must live in their home for it to be exempt from the asset limit. If neither lives in the home, the applicant must have Intent to Return. There is a home equity interest limit of $1,097,000 in 2025, and the home may be subject to Medicaid’s Estate Recovery Program after the applicant’s death.

What are the Functional Need Requirements for Medicaid?

Applicants must have a functional need for long-term care, assessed by a Nursing Facility Level of Care (NFLOC) for Nursing Home Medicaid and HCBS Waivers. For Regular Medicaid, a functional need for Activities of Daily Living may be required but does not necessitate a NFLOC.

How Can Seniors Qualify for Medicaid If They Exceed the Limits?

• What is the Medically Needy Pathway?
  New York has a Spenddown Program for seniors with income over the limit. By applying the “excess income” to medical bills, they can become eligible for Medicaid.
• What Are Pooled Income Trusts?
  Seniors can deposit excess income into a Pooled Income Trust to become income-eligible without the need to spend down.
• What is an Asset Spend Down?
  Seniors with assets over the Medicaid limit can reduce their assets by paying medical bills, making home improvements, or prepaying funeral expenses.
• What is Medicaid Planning?
  Medicaid Planning involves working with a professional to create strategies to qualify for Medicaid and protect assets like the family home.

What Are the Specific Medicaid Programs in New York for Seniors?

• What is the Managed Long Term Care (MLTC) Program?
  This program provides services for seniors who require a Nursing Facility Level of Care but prefer to remain at home or in an assisted living facility.
• What is the Community First Choice Option (CFCO)?
  This option allows seniors to receive Home and Community-Based Services under the Medicaid state plan.
• What is the Assisted Living Program (ALP)?
  This program pays for services in adult care facilities for seniors who need a Nursing Home Level of Care.
• What is the Nursing Home Transition and Diversion (NHTD) Waiver?
  This program helps nursing home residents transition back into community living with assistance for moving costs and home furnishings.

How Can One Apply for New York Medicaid?

Seniors can apply for Medicaid in person at their Local Department of Social Services (LDSS) office or by phone. There is no option to apply online for individuals aged 65 and older. Applicants may also get assistance from local Area Agencies on Aging or Medicaid Helplines.