Medicaid long-term care in New York: 2026 limits, forms, and how to apply

By Bennett Dixon, founder of MedicaidChecklist · Every figure cited to an official source · Last verified 2026-07-14

Long-term-care Medicaid in New York — the coverage that pays for nursing-home care and, through waiver programs, care at home — runs through New York State Medicaid (Institutional / Nursing Home Medicaid) and Managed Long Term Care (MLTC) and Community Medicaid with Community-Based Long-Term Care. It is administered by New York State Department of Health (Office of Health Insurance Programs); applications handled by Local Departments of Social Services (HRA in New York City). This page collects the published 2026 rules in one place, each figure linked to its official source.

New York's published 2026 figures

Income limit (single applicant)

$1,836/mo

Being over this figure is not the end of the story — see the income-limit page for New York's published pathway.

Asset limit (single applicant)

$33,038

Countable assets only; the home (below the equity cap), one vehicle, and household goods are typically exempt.

Look-back period

60 months for nursing-home applications; no look-back currently applies to community (home-care) applications

Home equity cap

$1,130,000

Protected for a spouse at home (CSRA)

$74,820–$162,660

The community-spouse resource allowance — assets protected for a husband or wife who stays home.

Spouse-at-home income allowance

$4,066.50–$4,066.50/mo

Deeper dives: the New York income limit, the asset limit and what's exempt, and the 60-month look-back.

How to apply in New York

Applying is free, directly through the state. You file the application — New York accepts it through these channels:

Processing time: Generally a decision within 45 days of application; up to 90 days if a disability determination is needed (per NYS DOH). Nursing home applications with 60-month lookback documentation often take longer in practice.

The official forms

Access NY Health Care Application(DOH-4220)

The Access NY application for the non-MAGI eligibility group (age 65+, blind, or disabled).

The main application for this program.

official form

Access NY Supplement A(DOH-5178A)

Supplement A — collects the resource documentation, including the 60-month lookback records for nursing home coverage.

Required for applicants who are 65+, blind, disabled, or applying for nursing home coverage.

official form

These are New York's own forms, linked at the source — never substitutes.

Documents caseworkers commonly request

Proof of identity and date of birth (e.g., birth certificate, driver's license)
Proof of citizenship or immigration status
Social Security card / number
Proof of residence in New York State
Proof of all income (Social Security award letter, pension statements, pay stubs)
Bank and financial account statements — 60 months for nursing home applicants
Life insurance policies and burial/funeral agreements
Deeds and property records for any real estate
Medicare card and other health insurance cards / premium proof
Trust documents, if any
Proof of spouse's income and resources (if married)

Gathering these is most of the real work — see the full document guide for why each category matters.

Rules specific to New York

Excess Income (Spend-Down / Surplus Income) Program

New York is a medically-needy state, so having income above the Medicaid level does not disqualify you. The amount over the limit is your 'excess income,' which works like a monthly deductible: once you show medical bills equal to that amount in a given month, Medicaid pays your remaining covered bills for that month. You can also use the Pay-In option and pay the excess amount directly to your local social services district. For hospital/inpatient coverage, you must show bills equal to six months of excess income.

official source

Pooled Trust to Eliminate the Spend-Down

A person who is certified disabled (any age, including 65+) can deposit their monthly excess income into a pooled supplemental needs trust run by a non-profit. Income placed in an approved pooled trust is disregarded in the Medicaid budget, so the person qualifies without paying a spend-down, and the trust can pay their living expenses. The trust document and proof of monthly deposits must be submitted to the local social services district for approval. This is widely used to qualify for Medicaid home care (community Medicaid) with income over the limit.

official source

60-Month Lookback and Transfer Penalty (Nursing Home)

When you apply for Medicaid nursing home coverage, New York reviews all asset transfers made in the 60 months before the application. Gifts or below-market transfers create a penalty period during which Medicaid will not pay for nursing facility care. The penalty is calculated by dividing the amount transferred by a regional monthly rate; for 2026 the regional divisors are: New York City $15,282, Long Island $15,193, Northern Metropolitan $15,024, Northeastern $14,783, Central $14,146, Rochester $15,675, Western $13,765 (GIS 25 MA/14). The penalty clock does not start until the person is in a nursing home, otherwise eligible, and has applied.

official source

30-Month Community/HCBS Lookback: Authorized but NOT in Effect

A 2020 New York law authorized a 30-month lookback and transfer penalty for community-based long-term care (home care, MLTC, CDPAP, assisted living program). As of mid-2026 it has still not been implemented: CMS approvals and state implementation guidance are outstanding, and no start date has been announced. That means community/HCBS Medicaid applications currently have NO lookback and no transfer penalty — only nursing home applications face the 60-month lookback. This could change, so plans relying on this window should be reviewed regularly.

official source

The figures on this page are New York's published 2026 rules, cited to the official source and last verified 2026-07-14. Eligibility decisions are made only by New York State Department of Health (Office of Health Insurance Programs); applications handled by Local Departments of Social Services (HRA in New York City) — no checklist, calculator, or company can decide for it. Applying is always free through the state agency.

A note on limits of this page: whether and how any rule applies to a specific family is a question only the state agency — or an elder-law attorney — can answer. MedicaidChecklist publishes the rules and helps you prepare and organize the application; it does not give legal advice, and nothing here is a recommendation to move, transfer, or restructure money or property.

New York guide New York income limit New York asset limit New York look-back period

Sources

2026 Medically Needy Income Level $1,836/month (individual) and $2,489 (couple); resource limits $33,038 (individual) and $44,796 (couple); institutional personal needs allowance $50 — NYS Income and Resource Standards chart attached to GIS 26 MA/05, effective January 1, 2026 — www.health.ny.gov
GIS 26 MA/05 (2/13/2026) adopts the 2026 Federal Poverty Levels for Medicaid budgeting effective January 1, 2026 — www.health.ny.gov
2026 Maximum Federal Community Spouse Resource Allowance $162,660; Minimum State Community Spouse Resource Allowance $74,820; community spouse MMMNA $4,066.50; home equity limit for nursing facility and community-based long-term care $1,130,000 — GIS 26 MA/03 (1/23/2026) — www.health.ny.gov
2026 regional nursing home rates (transfer penalty divisors): NYC $15,282; Long Island $15,193; Northern Metropolitan $15,024; Northeastern $14,783; Central $14,146; Rochester $15,675; Western $13,765 — GIS 25 MA/14, effective January 1, 2026 — www.health.ny.gov
Excess Income (spend-down/surplus income) program mechanics, including outpatient monthly spend-down, six-month inpatient rule, and Pay-In option — www.health.ny.gov
Pooled trusts established for a certified disabled person: income placed in the trust is not counted in the Medicaid budget; trust and monthly deposit statement must be provided to the local district — www.health.ny.gov
DOH-4220 is the Medicaid application for the Non-MAGI (65+, blind, disabled) group and DOH-5178A Supplement A is required for these applicants; 45-day general / 90-day disability processing timeframes — www.health.ny.gov
Supplement A (DOH-5178A): nursing home applicants must document resources for the past 60 months; community-based LTC applicants document current resources — www.health.ny.gov
30-month community-based long-term care lookback (2020 MRT-II law) still not implemented as of early 2026; no start date set; CMS approvals and DOH implementation directives outstanding — nyhealthaccess.org
2026 income/resource levels summary table including institutional income allowance $50/month and home equity $1,130,000 (corroboration) — frblaw.com
2026 NY Medicaid long-term care eligibility summary: $1,836/month income, $33,038 assets (single); medically needy / excess income pathway (corroboration) — www.medicaidplanningassistance.org