There's a document on my desk that's been sitting there for three weeks. It's a printout of a press release from the New York State Department of Health, dated February 2026, announcing yet another extension of the transition timeline for the Consumer Directed Personal Assistance Program. I've read it four times. Each time I read it, I think about the 200,000 New Yorkers currently receiving home care through CDPAP and the thousands of family caregivers who went weeks without a paycheck during the transition to a single fiscal intermediary. Then I think about the 89-year-old woman in Queens whose daughter called me in tears last month because the payroll system lost her timesheets. Then I set the document down and pick it up again.
New York's Medicaid program is, by almost every measure, the most generous in the country. It spends more per beneficiary than any other state. It covers services most states don't offer. It has planning tools (spousal refusal, pooled income trusts, no look-back for community-based care) which make elder law attorneys in other states genuinely envious. And it is, without close competition, the most complicated Medicaid system I've encountered in 35 years of financial planning.
I'm the fifth state guide deep now. I've written the playbooks for Michigan, Florida, and California. Each state has its quirks. But New York doesn't have quirks. New York has an entire parallel universe of rules that don't exist anywhere else. If your parent lives in New York and needs long-term care, the guide below explains every one of them.
Two Different Medicaid Programs: Community vs. Institutional
Before anything else, know this: New York effectively runs two separate Medicaid long-term care programs with different rules. Getting them confused is the most common mistake families make and the one costing the most money.
Community Medicaid covers home care services: personal care aides, home health aides, Consumer Directed Personal Assistance Program (CDPAP) workers, and adult day care. Your parent stays home and receives care there.
Institutional Medicaid (also called Nursing Home Medicaid) covers the cost of a skilled nursing facility.
Why does this distinction matter so much? Because the eligibility rules are different. Dramatically different.
Community Medicaid (Home Care):
- Income limit: $1,836/month for an individual (2026)
- Asset limit: $33,038 for an individual (2026)
- Look-back period: None. New York does not apply a look-back to Community Medicaid applications
- Managed Long-Term Care (MLTC) plan enrollment: Required for anyone needing 120+ days of care
Institutional Medicaid (Nursing Home):
- Income limit: $1,836/month for an individual (2026)
- Asset limit: $33,038 for an individual (2026)
- Look-back period: 30 months (increased from none, effective for applications after April 1, 2024)
- Penalty divisor: Varies by region, approximately $14,460/month in NYC, $7,500-$9,000/month upstate
The no-look-back rule for Community Medicaid is the single most important thing in this article. In Florida, every gift your parent made in the past five years gets scrutinized. In Michigan, same thing. Sixty months of bank statements, every check explained. In New York, for Community Medicaid, the state does not review your parent's prior financial transactions at all. If your parent gave $100,000 to your brother last Tuesday and applies for Community Medicaid on Wednesday, the gift has no effect on eligibility. None!
I'll say it more plainly. If your parent qualifies financially today, with income at or below $1,836/month and assets at or below $33,038, they qualify for Community Medicaid regardless of what they did with their money yesterday, last year, or ten years ago.
Enormous implications follow from that single rule. It changes everything about how families plan.
Income and Asset Rules in Detail
New York's 2026 numbers:
- Individual income limit: $1,836/month (both Community and Institutional)
- Individual asset limit: $33,038
- Couple income limit (both applying): $2,694/month
- Couple asset limit (both applying): $48,372
- Community Spouse Resource Allowance (CSRA): Up to $162,660 (when one spouse applies)
- Minimum Monthly Maintenance Needs Allowance (MMMNA): $2,643.75/month
- Home equity limit: $1,071,000
- Personal needs allowance (nursing home): $50/month
That $33,038 asset limit is among the highest in the country. Compare this to Florida's $2,000 or the federal floor of $2,000 used by most states. California eliminated its asset test entirely, which is more generous on paper, but New York's combination of a high asset limit plus no look-back for Community Medicaid creates planning flexibility even California can't match.
What counts as an asset: Bank accounts, stocks, bonds, CDs, non-exempt life insurance cash value, investment property, IRAs not in payout status.
What's exempt: The primary home (equity under $1,071,000), one vehicle, household goods, personal belongings, irrevocable prepaid funeral (up to $1,500 for burial reserve plus the funeral agreement), term life insurance, whole life insurance with face value under $1,500, and retirement accounts in payout status.
IRA treatment works the same as most states: an IRA or 401(k) in Required Minimum Distribution status is treated as income, not an asset. The monthly distribution counts toward the $1,836 income cap. An IRA not yet in RMD status? The entire balance is a countable asset. Put it in payout status before applying.
Pooled Income Trusts: New York's Income Solution
If your parent's monthly income exceeds $1,836, most states would require a Qualified Income Trust, a Miller Trust. New York has those too. But New York also has something better: pooled income trusts.
A pooled income trust is administered by a nonprofit organization. Your parent deposits their excess income (the amount above $1,836) into the trust each month. The trust pays your parent's bills (rent, utilities, groceries, medical costs, insurance premiums) from those deposited funds. Because the money goes into the trust before it reaches your parent, it's no longer counted as available income for Medicaid purposes.
Where pooled trusts pull ahead of Miller Trusts is flexibility. A Miller Trust can only pay for very specific things: the patient's share of care costs, Medicare premiums, and a small personal allowance. A pooled income trust can pay for virtually any expense benefiting your parent: rent, cable, phone bill, groceries, prescription copays, clothing, even personal care items. The funds are managed by the nonprofit trustee, but you submit bills and the trust pays them.
Loretta was 78, a retired school crossing guard from the Bronx. Her Social Security was $2,140 per month, $304 over the Medicaid income limit. Without a pooled trust, she was ineligible for Community Medicaid despite having only $4,200 in her savings account. Her daughter found NYSARC Trust Services, one of the largest pooled trust administrators in the state. Setup took about two weeks. Now Loretta deposits $304 each month into the trust, the trust pays her ConEd bill and her cell phone, and Medicaid covers her home care aide five days a week.
Setup costs vary by trust organization but typically run $0 to $150 for the initial joinder agreement. Some trusts charge a small monthly administrative fee of $25 to $50. Compare this to the cost of home care without Medicaid: $6,000 to $8,000 per month in New York City, $4,000 to $6,000 upstate. (For context, see our breakdown of what it really costs to age in place.)
Major pooled trust administrators in New York:
- NYSARC Trust Services (statewide): nysarctrustservices.org
- Disability Rights New York (DRNY)
- Community Pooled Trust administered by various local nonprofits
One critical rule: your parent must deposit excess income into the pooled trust on the same day they receive it, or within a reasonable period. If they cash the Social Security check and spend the excess before depositing it, Medicaid can count the income and potentially terminate benefits. Set up automatic deposits. Don't leave this to memory.
CDPAP: Revolutionary Program, Chaotic Transition
CDPAP — the Consumer Directed Personal Assistance Program — is unlike anything in any other state's Medicaid system. Under CDPAP, your parent can hire almost anyone as their paid caregiver: a family member, a friend, a neighbor. The caregiver doesn't need to be a certified home health aide. They don't need medical training. Your parent directs the care. The state pays the caregiver.
A daughter in Brooklyn caring for her mother with dementia. A husband in Buffalo helping his wife with MS. A grandson in Syracuse assisting his grandfather after hip replacement surgery. All of them can be paid through CDPAP for care they might otherwise provide for free, or care they couldn't afford to provide because they'd have to quit their jobs to do it.
At its peak, CDPAP served approximately 200,000 New Yorkers through over 700 fiscal intermediary agencies. Served. Past tense is relevant here.
In 2023, New York's legislature passed a law consolidating all CDPAP fiscal intermediary operations under a single entity: Public Partnerships LLC (PPL). The transition, which began in early 2025, has been — and I'm choosing my words carefully — a disaster.
Chester, 84, a retired Transit Authority bus driver in Jamaica, Queens, had been receiving CDPAP services for three years. His daughter Carolyn was his caregiver, paid through a local fiscal intermediary called Concepts of Independence. When PPL took over, Carolyn's timesheets from the first two pay periods simply vanished. Not rejected. Not delayed. Gone. She went six weeks without a paycheck. Six weeks while she continued bathing her father, managing his medications, cooking his meals, and helping him to the bathroom four times a night! Chester's MLTC plan couldn't help because the billing system was PPL's, not theirs. Carolyn used a credit card to cover her rent. The interest is still accruing.
I wish Chester's story were unusual. It isn't. The PPL transition generated thousands of complaints to the Governor's office, multiple lawsuits, and a state legislative hearing in late 2025. As of early 2026, most of the payment processing issues have been resolved, but new enrollments still face longer processing times than under the old multi-agency system, and some caregivers report ongoing problems with timesheet submissions through PPL's online portal.
If your parent is currently receiving CDPAP services, here's what you need to know:
- PPL is now the sole fiscal intermediary. All caregivers must be enrolled through PPL.
- The PPL portal for timesheet submission is at pplfirst.com/cdpap.
- If paychecks are late, call PPL's CDPAP helpline: 1-833-253-4427.
- If PPL can't resolve it, file a complaint with the New York State Department of Health at health.ny.gov or call 1-800-206-8125.
- Document everything. Every call, every missed payment, every submitted timesheet. If you need to escalate, paper trails matter.
Despite the transition chaos, CDPAP remains one of the most valuable Medicaid programs in the country. Don't let the administrative headaches discourage your family from enrolling. The program works. The bureaucracy around it is catching up.
Managed Long-Term Care (MLTC) Plans
Any New York Medicaid beneficiary who needs home care services for more than 120 days must enroll in a Managed Long-Term Care plan. Not optional. MLTC enrollment is a prerequisite for receiving ongoing Community Medicaid home care, including CDPAP.
An MLTC plan works like a managed care insurance plan specifically for long-term care services. Your parent chooses a plan, and the plan coordinates and authorizes all long-term care services: personal care aides, CDPAP, adult day health care, home-delivered meals, medical transportation, and nursing services.
Major MLTC plans operating in New York include:
- Aetna Better Health MLTC
- Centers Plan for Healthy Living
- Elderplan
- Fidelis Care at Home
- GuildNet
- Healthfirst CompleteCare
- VNSNY Choice MLTC (Visiting Nurse Service of New York)
- VillageCareMAX
- Senior Whole Health
Not all plans operate in all regions. The plans available to your parent depend on the county where they live. NYC residents typically have 8 to 12 options. Upstate residents may have 3 to 5.
Choosing the right MLTC plan matters more than most families realize. Plans differ in how many home care hours they authorize, which CDPAP fiscal intermediary they work with (now PPL for all, but authorization processes vary), which adult day programs they include, and how responsive their care coordinators are. Before choosing, ask:
- How many hours of home care does this plan typically authorize for someone with my parent's needs?
- What is the appeals process if I disagree with the number of hours authorized?
- Does this plan serve the geographic area where my parent's preferred caregiver lives?
- What adult day health care centers are in-network?
To enroll in an MLTC plan, call the New York Medicaid Choice helpline at 1-888-401-6582. An enrollment broker will walk you through the available plans in your parent's county.
The 3-ADL Requirement: A New Barrier
In 2025, New York implemented a significant new eligibility requirement for MLTC enrollment. Applicants must now demonstrate a need for assistance with at least three Activities of Daily Living (ADLs) to qualify for enrollment in an MLTC plan.
The six ADLs are: bathing, dressing, toileting, transferring (moving from bed to chair), continence, and eating.
Before this change, applicants who needed help with just one or two ADLs could enroll in MLTC and receive home care services. The 3-ADL requirement shut out thousands of seniors who need real help but don't meet the higher threshold.
Norma, 80, lives alone in a fourth-floor walkup in Washington Heights. She needs help bathing (she can't safely step over the tub ledge) and she needs help with dressing because severe arthritis in both hands makes buttons and zippers impossible. Two ADLs. Under the old rules, she'd qualify for MLTC and receive a home care aide several hours a day. Under the 3-ADL rule, she doesn't qualify. She falls between the cracks: too impaired to safely manage alone, not impaired enough for the state to help.
Her son Lester drives up from Jersey City three mornings a week to help her dress and bathe. He's 56 and works night shifts at a warehouse. He's exhausted. She knows it and feels guilty about it. Neither of them has a good solution.
If your parent is denied MLTC enrollment because they don't meet the 3-ADL threshold, two options exist:
- Request a fair hearing. The state's assessment may not have captured your parent's full functional limitations. A fair hearing allows you to present additional medical evidence: a letter from your parent's doctor, physical therapy evaluations, hospital records documenting falls or injuries.
- Apply for non-MLTC Medicaid home care. Medicaid can still authorize short-term home care (under 120 days) without MLTC enrollment. This doesn't solve the long-term problem, but it provides a bridge while you appeal or while your parent's condition changes.
The 3-ADL requirement has been challenged in court. As of March 2026, litigation is ongoing, and the rule remains in effect. Watch for legislative updates. Several bills in the state legislature would lower the threshold back to two ADLs or eliminate it entirely.
Spousal Refusal: New York's Power Move
No other planning strategy makes attorneys in 48 other states shake their heads quite like spousal refusal.
New York (along with Florida, though Florida uses it far less frequently) allows something called spousal refusal, and it works like this.
Normally, when one spouse applies for Medicaid, the couple's combined assets are evaluated. The community spouse keeps the CSRA (up to $162,660 in 2026), and the applying spouse must spend down to $33,038. But in New York, the community spouse can sign a letter, typically called a "spousal refusal letter," refusing to make their income and assets available to the applying spouse for Medicaid eligibility purposes.
When the community spouse refuses, Medicaid must evaluate the applying spouse's eligibility based only on the applying spouse's own income and assets. The community spouse's $500,000 brokerage account, $300,000 home, and $3,800 monthly pension? Medicaid can't count any of it.
The applying spouse qualifies based on their own finances alone.
Warren and Shirley lived in Scarsdale. He was 83, a retired corporate attorney. She was 79, a retired school principal. Combined assets: approximately $1.2 million, excluding their home. Warren needed nursing home care after a series of strokes left him unable to walk or manage basic self-care.
Under standard Medicaid rules, Shirley would keep $162,660. The remaining assets, roughly $1,037,000, would need to be spent down to $33,038 before Warren could qualify. At the Westchester County nursing home rate of $16,000 per month, the spend-down would take about five years of private-pay.
Instead, their elder law attorney drafted a spousal refusal letter. Shirley signed it, refusing to make her assets available for Warren's care. Warren applied for Medicaid showing only his own assets: a checking account with $12,000 and a small IRA worth $18,000. He qualified.
Is this aggressive? Yes. Is it legal? In New York, yes. The right to spousal refusal is codified in New York Social Services Law Section 366(3)(a). Medicaid accepts the application and then has the option to sue the refusing spouse to recover costs. In practice, these lawsuits are rare, and when they do occur, they typically result in negotiated settlements that are far less than what the family would have spent in a full spend-down.
Two critical caveats:
- You need an attorney. Spousal refusal is not a DIY strategy. The letter must be properly drafted and submitted with the Medicaid application. The attorney must understand New York-specific case law, including the potential for a Medicaid recovery action.
- The refusing spouse may face a lawsuit. The Department of Social Services has the right to sue the refusing spouse under the "doctrine of necessaries" or to recover Medicaid expenditures. Most counties don't pursue these cases aggressively, but some do. Your attorney should assess the risk in your specific county. Families in this situation should also understand how Social Security survivor benefits work as part of the broader financial picture.
Spousal refusal is most commonly used for Institutional Medicaid (nursing home), where the costs are highest and the financial stakes are largest. It works for Community Medicaid too, but the community spouse's assets are rarely the barrier for home care, since the Community Medicaid asset limit is already $33,038 with no look-back.
Regional Penalty Divisors: NYC vs. Upstate
For Institutional Medicaid, New York applies a look-back period of 30 months (as of 2024). When the state finds transfers made for less than fair market value during the look-back, it calculates a penalty period using regional penalty divisors.
Penalty divisors vary significantly by region because nursing home costs vary significantly by region:
- New York City and Long Island: Approximately $14,460/month
- Northern Metropolitan Area (Westchester, Rockland, Putnam, Dutchess, Orange): Approximately $13,000-$14,000/month
- Western New York (Buffalo, Rochester): Approximately $8,500-$9,500/month
- Central New York (Syracuse, Utica): Approximately $7,500-$8,500/month
- Capital Region (Albany, Schenectady): Approximately $9,000-$10,000/month
What this means in practice: a $50,000 gift during the look-back period creates a penalty of approximately 3.5 months in New York City but approximately 6.3 months in Syracuse. The same gift, the same dollar amount, but the penalty lasts nearly twice as long upstate because the penalty divisor is lower.
Stanley, 79, a retired plumber from Astoria, gave his daughter $42,000 two years before entering a nursing home in Queens. The NYC penalty divisor of $14,460 meant a penalty period of about 2.9 months, roughly three months of nursing home costs his family had to cover privately. At Queens nursing home rates averaging $15,000/month, that's about $45,000 out of pocket.
Had Stanley lived in Buffalo and made the same gift, the penalty period would have been approximately 4.7 months at a divisor of around $9,000. But the monthly nursing home cost in Buffalo averages $11,000, so the total out-of-pocket cost would have been about $51,700. The math is counterintuitive: the lower the penalty divisor, the longer the penalty period, but the lower the monthly cost. The net effect varies.
Remember: these penalty calculations only apply to Institutional Medicaid. Community Medicaid has no look-back, so gifts and transfers are irrelevant for home care eligibility.
How to Apply: The Step-by-Step Process
Step 1: Determine which Medicaid program you need.
Does your parent need home care (Community Medicaid) or nursing home care (Institutional Medicaid)? The answer determines the application process, the look-back review, and the planning strategies available.
Step 2: Gather financial documents.
For Community Medicaid (no look-back), you need current financial information:
- Bank statements (most recent 1 to 3 months)
- Investment account statements
- Social Security award letter
- Pension documentation
- Life insurance policies (face value and cash surrender value)
- Property tax bills
- Most recent tax return
For Institutional Medicaid (30-month look-back), you need 30 months of financial records:
- All bank statements for 30 months
- Investment account records
- Records of any property transfers, gifts, or financial transactions
- Trust documents
Step 3: Calculate income and set up a pooled income trust if needed.
Should your parent's income exceed $1,836/month, contact a pooled income trust administrator immediately. NYSARC Trust Services handles the largest volume in the state: call 518-439-8323 or visit nysarctrustservices.org. The joinder agreement takes one to two weeks to finalize.
Step 4: Apply for Medicaid.
Application procedures differ by location:
In New York City: Apply through the Human Resources Administration (HRA). The online portal is ACCESS HRA at a069-access.nyc.gov. You can also apply in person at a Medicaid office in your parent's borough, or by mail using the Access NY Health Care application (DOH-4220). The HRA Infoline number is 718-557-1399.
Outside New York City: Apply through the local Department of Social Services (DSS) in your parent's county. Every county has a DSS office handling Medicaid applications. You can download the DOH-4220 from the NY Department of Health website or pick up a copy at the county DSS office. The statewide Medicaid helpline is 1-800-541-2831.
Step 5: Complete the medical assessment.
MLTC enrollment requires your parent to be assessed to determine their level of care needs. The assessment evaluates ADLs, cognitive function, and medical conditions. Under the current 3-ADL requirement, your parent needs help with at least three ADLs. Bring detailed medical records, a list of medications, documentation of falls or hospitalizations, and any cognitive assessments. If you haven't already, now is also the time to ensure your parent has a medical power of attorney and healthcare directive in place.
Step 6: Enroll in an MLTC plan (for Community Medicaid home care).
Once Medicaid is approved and the medical assessment confirms eligibility, call 1-888-401-6582 (New York Medicaid Choice) to select an MLTC plan. Research plans in advance. Ask about care hour authorizations and caregiver network.
Step 7: Set up CDPAP if using a family caregiver.
When a family member will serve as your parent's caregiver, apply for CDPAP through your parent's MLTC plan. The MLTC plan authorizes the hours; PPL handles payroll. The caregiver must complete enrollment through PPL at pplfirst.com/cdpap or call 1-833-253-4427.
Step 8: Follow up relentlessly.
Medicaid applications in New York City take 45 to 90 days. Upstate processing may be faster. Respond immediately to every request for additional documentation. If you haven't heard anything in 30 days, call. Then call again. The squeaky wheel gets processed in New York Medicaid.
PACE in New York
A well-established PACE (Program of All-Inclusive Care for the Elderly) network operates in the state, primarily in and around New York City.
PACE provides comprehensive medical and long-term care services through a single program. Your parent receives primary care, specialists, therapy, medications, personal care, adult day health, transportation, and home care all coordinated by one team. For dual-eligible seniors (Medicare and Medicaid), PACE costs nothing. Zero premiums, zero copays.
PACE providers in New York include:
- Montefiore Hudson Valley Collaborative PACE: Bronx and Westchester
- Center Light Health System PACE: New York City metro area
- Complete Senior Care (Archcare PACE): New York City
- Eddy Senior Care PACE: Capital District (Albany area)
- Independent Living for Seniors PACE: Rochester area
- Total Senior Care (AgeWell PACE): multiple NYC locations
PACE eligibility: age 55+, living in a PACE service area, and certified as needing a nursing home level of care. The trade-off: your parent receives all medical care through the PACE center's team. They can't keep their current physician.
Many families, especially those juggling multiple specialists and care providers, find that PACE simplifies everything. For families with a parent who has a long-standing relationship with a specific doctor, the transition may not be worth it. Neither choice is wrong. The right answer depends on your parent's priorities.
Protecting the Home
New York's home equity limit for Medicaid is $1,071,000 in 2026, one of the highest in the country. If your parent's home equity is under that threshold and they intend to return home (or a spouse resides there), the home is exempt from the asset calculation.
But after death, New York's Medicaid Estate Recovery Program can pursue a claim against the estate for the cost of Medicaid services provided. The target: the house.
Protection strategies in New York:
Irrevocable Medicaid Asset Protection Trust. Your parent transfers the home into an irrevocable trust. After a waiting period (30 months for Institutional Medicaid look-back), the home is no longer part of your parent's estate. This must be done before the look-back period begins. Advance planning, not crisis planning.
Life estate deed with retained life estate. Similar to the Lady Bird deeds in Michigan but handled differently in New York. Your parent transfers the home to a beneficiary while retaining a life estate (the right to live there for life). The transfer triggers the Institutional Medicaid look-back, so timing is essential. For Community Medicaid, remember, no look-back.
Caregiver child exemption. If an adult child lived in the home with your parent for at least two years before your parent entered a nursing home and provided care delaying the nursing home admission, the home can be transferred to that child without a Medicaid penalty. This exemption is powerful but requires documentation.
Sibling exemption. If a sibling of your parent has an equity interest in the home and has lived there for at least one year before your parent was institutionalized, the home can be transferred to the sibling without penalty.
Families concerned about whether Medicaid pays for assisted living should know that MLTC plans do cover services in adult care facilities (the New York term for assisted living), though the coverage applies to care services only, not room and board. Room and board costs come from your parent's income, with Medicaid covering the support services on top.
If You're Denied: The Fair Hearing
Fair hearings are administered by the Office of Temporary and Disability Assistance (OTDA). You have 60 days from the date on the denial notice to request a hearing.
How to request a fair hearing:
- Online: otda.ny.gov/oah
- Phone: 1-800-342-3334
- Fax: 518-473-6735
- Mail: Office of Administrative Hearings, NYS OTDA, P.O. Box 1930, Albany, NY 12201
An administrative law judge reviews the case. You can present evidence, bring witnesses, and have an attorney represent you.
Unusually strong legal aid resources exist statewide for Medicaid appeals:
- Legal Aid Society (NYC): 212-577-3300, legalaidnyc.org
- New York Legal Assistance Group (NYLAG): 212-613-5000, nylag.org
- Center for Elder Law & Justice (Western NY): 716-853-3087, elderjusticeny.org
- Legal Services of the Hudson Valley: 877-574-8529, lshv.org
- Empire Justice Center: 585-454-4060, empirejustice.org
Fair hearings are frequently won in New York. In cases where the denial was based on an incorrect asset calculation, a failure to account for a pooled income trust, or an ADL assessment the family disputes, success rates with proper legal representation are high. Don't accept a denial as final.
Your Resource List: Every Number, Website, and Form
State Agencies:
- New York Medicaid Helpline: 1-800-541-2831
- NYC HRA Infoline: 718-557-1399
- ACCESS HRA (NYC online portal): a069-access.nyc.gov
- NY Medicaid Choice (MLTC enrollment): 1-888-401-6582
- NY Department of Health: health.ny.gov
- OTDA Fair Hearings: 1-800-342-3334
Key Forms:
- DOH-4220: Access NY Health Care Application (primary Medicaid application)
- MAP-3057: NYC Medicaid supplement form
- DOH-5178: MLTC Enrollment Form
CDPAP:
- PPL CDPAP Portal: pplfirst.com/cdpap
- PPL CDPAP Helpline: 1-833-253-4427
- NY DOH CDPAP complaints: 1-800-206-8125
Pooled Income Trusts:
- NYSARC Trust Services: 518-439-8323, nysarctrustservices.org
Legal Help:
- Legal Aid Society (NYC): 212-577-3300
- NYLAG: 212-613-5000
- Center for Elder Law & Justice (Buffalo): 716-853-3087
- Legal Services of Hudson Valley: 877-574-8529
- NY State Bar Elder Law Section: nysba.org
- NAELA (National Academy of Elder Law Attorneys): naela.org
- Eldercare Locator: 1-800-677-1116
PACE Providers:
- CenterLight PACE: centerlight.org
- Archcare PACE: archcare.org
- Eddy Senior Care PACE: sphp.com/eddy-senior-care
- AgeWell PACE: agewellny.com
For Veterans:
- VA Aid and Attendance: 1-800-827-1000
- NY Division of Veterans Services: veterans.ny.gov
Benefits Screening:
- BenefitsCheckUp: benefitscheckup.org
- NY Connects (long-term care resource): nyconnects.ny.gov, 1-844-697-3505
What I Keep Coming Back To
Maggie and I were sitting in the kitchen last Sunday evening after I'd driven back from visiting my mother Ruth in Hartford. I was quiet. Maggie didn't ask why. She's been married to me long enough to know when the Sunday drive leaves me in my own head.
After a while she said, "You're thinking about the New York article."
She was right. I'd been thinking about it since the Throgs Neck Bridge, specifically about how to close a guide this long without making it sound like I was wrapping up a lecture. The Michigan guide ends at a kitchen table. The Florida guide ends there too. The California guide ends with what I'd tell Sarah and David.
What I keep coming back to with New York is this: the system is extraordinarily generous if you know how to use it, and extraordinarily punishing if you don't. Community Medicaid with no look-back is a gift to families who plan. CDPAP is a gift to families who provide care. Pooled income trusts are a gift to seniors whose Social Security is $300 too high. Spousal refusal is a gift to couples who would otherwise lose everything they built together.
But every one of those tools requires someone to tell you it exists.
Chester's daughter Carolyn didn't know about CDPAP until a social worker at Jamaica Hospital mentioned it in passing. Loretta didn't know about pooled income trusts until her daughter found NYSARC through a Google search at 11 PM. Norma in Washington Heights still doesn't know that legal aid organizations will represent her at a fair hearing for free.
If you're reading this because your parent is in New York and needs help, here's what to do Monday morning:
- Call 1-800-541-2831, the New York Medicaid helpline. Tell them your parent's county and situation.
- If income exceeds $1,836/month, call NYSARC Trust Services at 518-439-8323 to set up a pooled income trust.
- If your parent needs home care, call NY Medicaid Choice at 1-888-401-6582 to begin the MLTC enrollment process.
- Find an elder law attorney. Use NAELA (naela.org) or the NY State Bar Elder Law Section. Budget $2,000 to $5,000 for a full planning package. Compare this to the $15,000/month cost of a New York City nursing home.
- If a family member will be the caregiver, ask about CDPAP. Your family member can be paid for care they're already providing!
Ruth met me at the door Sunday and asked if the drive was bad. I said it was fine. Twenty minutes later she asked again. "Was the traffic terrible?" I said, "No, Mom. It was a good drive." She squeezed my arm and went back to her chair by the window.
She doesn't live in New York. But 200,000 people's mothers do, and their families are trying to figure out the same things mine figured out years ago: how do we get help, how do we pay for it, and how do we make sure the person we love is safe.
Pull up the NY Medicaid website. Call that number. Write down the name of whoever answers. That's your first foothold.
Frequently Asked Questions
Does New York Medicaid have a look-back period for home care?
No. New York does not apply a look-back period to Community Medicaid, which covers home care services. Gifts and asset transfers made before applying have no effect on Community Medicaid eligibility. However, Institutional Medicaid (nursing home) does have a 30-month look-back period for applications made after April 1, 2024.
What is the Medicaid income limit in New York for 2026?
The income limit for both Community Medicaid and Institutional Medicaid is $1,836 per month for an individual. If your parent's income exceeds this amount, a pooled income trust can shelter excess income and preserve Medicaid eligibility.
What is CDPAP and can a family member be a paid caregiver?
CDPAP (Consumer Directed Personal Assistance Program) allows Medicaid recipients to hire their own caregivers, including family members (except spouses in most cases). The caregiver does not need professional certification. All CDPAP services are now administered through Public Partnerships LLC (PPL) as the sole fiscal intermediary.
What is spousal refusal in New York Medicaid?
Spousal refusal allows the community spouse to sign a letter refusing to make their income and assets available for the applying spouse's Medicaid eligibility determination. The applying spouse is then evaluated based on their own finances alone. This strategy is legal under New York Social Services Law Section 366(3)(a) and can protect significant assets from spend-down.
What is a pooled income trust?
A pooled income trust is administered by a nonprofit organization and allows Medicaid applicants to deposit excess income above the $1,836 limit into the trust. The trust pays the applicant's bills, and the deposited income is not counted for Medicaid eligibility. Major administrators include NYSARC Trust Services.
How many ADLs does my parent need for MLTC enrollment?
As of 2025, New York requires applicants to demonstrate a need for help with at least three Activities of Daily Living (ADLs) to enroll in a Managed Long-Term Care plan. This requirement is being challenged in court. If your parent is denied, request a fair hearing.
What is the asset limit for New York Medicaid in 2026?
The individual asset limit is $33,038 for 2026, one of the highest in the country. The home (equity under $1,071,000), one vehicle, household goods, and irrevocable prepaid funeral arrangements are exempt from this limit.
