Long-Term Care Medicaid in New York: 2026 Guide

In New York, Medicaid is run by the New York State Department of Health (DOH). Applications for long-term care are handled by your county’s Local Department of Social Services (LDSS), or in New York City by the Human Resources Administration (HRA). Medicaid can pay for nursing home care and for care at home through Managed Long Term Care plans. New York’s rules differ from most states in several ways, which this guide explains in plain language.

At a glance: New York 2026 figures

Item	2026 figure
Income limit (applicant)	Nursing home: no fixed cap; income above the allowances goes toward the cost of care. Home care: $1,836 a month for one person ($2,489 for a couple), with a spend-down or pooled trust above that
Asset limit (single applicant)	$33,038
Asset limit (couple, both applying)	$44,796
Home equity limit	$1,130,000
Spouse at home: resource allowance (CSRA)	The greater of $74,820 or half of the couple’s assets, up to $162,660
Spouse at home: monthly income allowance	Up to $4,066.50
Personal needs allowance (nursing home)	$50 a month ($55 if SSI-eligible)
Look-back period	Nursing home: 60 months. Home care: no look-back is in force yet (a 30-month look-back was passed but has not started)
Penalty divisor	Regional monthly rates: NYC $15,282; Long Island $15,193; Northern Metro $15,024; Northeastern $14,783; Central $14,146; Western $13,765; Rochester $15,675

Figures last updated for 2026. Sources are listed at the end of this page.

Figures change periodically. Double-check current amounts with New York State Medicaid (your local LDSS or HRA) before relying on them.

What Long-Term Care Medicaid covers in New York

Nursing home care. Medicaid pays for care in a Medicaid-certified nursing home. You pay your income, minus allowances, to the home each month (in New York this is called the Net Available Monthly Income, or NAMI), and Medicaid pays the rest.

Care at home and in the community. Most adults who have both Medicare and Medicaid and need long-term care at home get it through a Managed Long Term Care (MLTC) plan. Services can include home care (personal care aides and home health aides), adult day care, nursing, home-delivered meals, medical equipment, and up to 3 months of nursing home care. To join an MLTC plan, a person generally must need these services for more than 120 days and be able to live safely at home.

Other programs include:

Personal Care Services and Consumer Directed Personal Assistance Program (CDPAP): in CDPAP, the person (or a representative) chooses and directs their own aide, who can be a family member in many cases.
PACE and Medicaid Advantage Plus: plans that combine Medicare and Medicaid.

Assisted living. New York’s Assisted Living Program (ALP) can pay for care services in certain licensed adult homes and enriched housing programs. Medicaid generally does not pay rent in other assisted living residences.

Who qualifies

A person generally must:

be 65 or older, or blind or disabled;
live in New York and be a U.S. citizen or qualified non-citizen;
need long-term care. For home care and MLTC, the New York Independent Assessor (NYIA) does a Community Health Assessment and a clinical appointment.
meet the income and asset rules below.

Income rules

New York does not use an income cap for long-term care. It uses a medically needy approach:

Nursing home: there is no income limit. Your income, minus a personal needs allowance of $50 a month, health insurance premiums and any allowance for a spouse at home, is paid to the nursing home. Medicaid covers the rest.
Home care: the 2026 income level for one person age 65 or older is $1,836 a month for one person and $2,489 a month for a couple. If income is higher, you can still qualify with a spend-down: the extra income (the “surplus”) is spent on medical bills each month. Many people instead put their surplus into a pooled income trust run by a nonprofit, which can pay their rent and other bills, so they keep more for living at home.

Asset rules

New York’s asset limits are much higher than most states’. In 2026, a single person can keep $33,038 and a couple $44,796 in countable assets.

Countable assets include cash, bank accounts, CDs, stocks, bonds, mutual funds, and real estate other than the home. Retirement accounts that are paying out regularly may be treated differently.

Usually exempt:

Your home, with equity up to $1,130,000 in 2026, if you live there or plan to return, or a spouse or dependent relative lives there
One vehicle
Household goods and personal belongings
Irrevocable prepaid funeral agreements and burial spaces
A small burial fund

Spousal protections

Assets: The spouse at home can keep the greater of $74,820 (New York’s own minimum, higher than the federal one) or half of the couple’s combined countable assets, up to $162,660 in 2026. The home, a car and belongings are not counted.
Income: The spouse at home keeps their own income. If it is low, part of the applicant’s income can be given to them so their total reaches up to $4,066.50 a month.
New York also allows a spouse at home to decline to make their assets available (“spousal refusal”). Medicaid can still be approved for the person needing care, but the county may then ask the spouse at home to contribute. Rules and county practice vary, so get advice before relying on it.

Look-back and penalties

When you apply, New York looks back at the 60 months (5 years) before the application date. This is called the look-back period. The state checks whether you, or your spouse, gave away money or property, or sold something for less than it was worth, during that time.

Common examples of transfers that can cause a problem:

Cash gifts to children or grandchildren, even small yearly gifts. (A gift that is fine for federal gift-tax purposes can still count for Medicaid.)
Adding a child’s name to a house deed or bank account in a way that gives them part ownership.
Selling a house or car to a relative for much less than it is worth.
Paying a family member for care without a written agreement made at the time.

Some transfers are allowed, such as transfers between spouses, or transferring a home to a child who is blind or disabled.

How the penalty works. If the state finds a transfer that is not allowed, it does not deny Medicaid forever. Instead, it sets a penalty period: a stretch of time when Medicaid will not pay for long-term care. The state divides the amount given away by the penalty divisor (a regional monthly rate, from $13,765 to $15,675 depending on where you live).

Example: In New York City, a $50,000 gift divided by $15,282 is about 3.3 months without Medicaid payment for nursing home care.

The penalty period starts only once you have applied, are otherwise eligible, and are in (or need) long-term care. This is why gifts made while someone is healthy can still matter years later. If a gift is returned in full, the penalty can be removed.

Home care is different in New York. A 30-month look-back for community (home care) Medicaid was written into state law in 2020, but as of fall 2026 it has not started. Until it does, transfers are generally not penalized for home care Medicaid. This can change.

Estate recovery in New York

Estate recovery in New York is done by the Office of the Medicaid Inspector General (OMIG).

Whose estates: people who were 55 or older, or permanently in a nursing home or similar facility.
What is recovered: nursing facility care, home and community-based services, related hospital and drug costs, and monthly payments to managed care plans (including MLTC).
Liens: a lien may be placed on a deceased person’s property so the claim can be paid when it is sold.
When it is put off: while a spouse is alive, or if there is a child under 21 or a child who is blind or disabled.
New York currently recovers only from the probate estate (property that passes through the court process), not from property that passes outside probate.

How to apply

Outside New York City: apply at your county Department of Social Services office. Find it through the Department of Health’s local office list.
In New York City: apply through HRA (nyc.gov/hra), online, by phone or at a Medicaid office.
For home care: after Medicaid (with community long-term care coverage) is in place or being processed, call the New York Independent Assessor to schedule the assessment. The LDSS can review finances while the assessment happens.

Gather what you can before you apply. The caseworker may ask for:

Photo ID, Social Security card and Medicare card
Proof of age and of U.S. citizenship or immigration status
Proof that you live in the state (for example, a utility bill or lease)
Proof of all income: Social Security award letter, pension statements, annuity statements
Bank, credit union and investment statements (often for the full 60-month look-back period)
Deeds, property tax bills and the value of any real estate
Life insurance policies (showing cash value) and prepaid funeral or burial contracts
Vehicle titles
Health insurance cards and long-term care insurance policies
Power of attorney or guardianship papers, if someone is applying for you
For a spouse at home: their income and assets too, since both spouses’ assets are counted at the start

If you cannot find a document, apply anyway and tell the caseworker. They can explain what else is accepted.

For nursing home applications, expect to provide statements for the full 60-month look-back.

Free public help in New York

Your LDSS or NYC HRA: Medicaid applications and eligibility questions.
NY Medicaid Choice: helps people choose and enroll in an MLTC plan.
Area Agencies on Aging (Offices for the Aging) and NY Connects: free information about long-term care options in each county.
HIICAP (Health Insurance Information, Counseling and Assistance Program): New York’s free Medicare counseling program (SHIP), through the NYS Office for the Aging.
New York Long-Term Care Ombudsman Program: free advocates for residents of nursing homes and adult care facilities.

Recent and upcoming changes

A 2025 federal law (Public Law 119-21) makes two changes that affect Long-Term Care Medicaid in every state, including New York:

Retroactive coverage gets shorter on January 1, 2027. Today, Medicaid can pay bills from up to 3 months before the month you apply, if you would have qualified then. For applications from January 1, 2027, this window shrinks to 2 months for older adults and people with disabilities. In plain terms: from 2027, it matters more to apply soon after care starts, so that earlier bills are not left unpaid.
Home equity cap on January 1, 2028. States will no longer be able to set a home equity limit above $1,000,000 (except for some farm property). See below for what this means in New York.

The federal amounts that change each year (for example, the allowances for a spouse at home) will be updated on this page for 2027 once they are published.

What this means in New York: New York’s 2026 home equity limit, $1,130,000, is above the new federal cap. From January 1, 2028, New York will have to lower it to no more than $1,000,000.

State programs

Each program below has its own page with who qualifies, services, how to apply and waiting lists:

Frequently asked questions

Is there an income limit for nursing home Medicaid in New York? No fixed limit. Most of your income goes toward the nursing home bill, and Medicaid pays the rest.

Can I get home care if my income is over $1,836 a month? Yes, through a spend-down, or by putting the extra income into a pooled income trust.

Does New York look back at gifts for home care? Not yet. The 30-month home care look-back passed in 2020 has not started. Nursing home Medicaid has a 60-month look-back.

How much can my spouse keep? In 2026, at least $74,820 and up to $162,660 in assets, plus the home, a car and belongings, and income up to $4,066.50 a month.

Who decides if I need home care? The New York Independent Assessor (NYIA), through an assessment and a clinical appointment.

Will New York take my house after I die? Not while a spouse, a child under 21 or a disabled child survives. Otherwise, OMIG can seek repayment from the probate estate, which can include the home.

Figures change periodically. Double-check current amounts with New York State Medicaid (your local LDSS or HRA) before relying on them.

Sources

NY DOH, Managed Long Term Care
NY DOH, Overview of MLTC
NY DOH, 22 OHIP/ADM-01, New York Independent Assessor
NY OMIG, Estate Recovery
NY Social Services Law sec. 369
NYC HRA, Health Assistance
NYS Office for the Aging, HIICAP
CMS, 2026 SSI and spousal impoverishment standards
Public Law 119-21 (2025)

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.