Medicaid Eligibility in New York (NY) for Seniors

Understanding and navigating Medicaid eligibility in New York for long-term care for seniors can be lengthy and confusing. The application process often involves complex paperwork and detailed requirements that can quickly become overwhelming. At Senior Planning, we understand how stressful this can be. That’s why our knowledgeable team, backed with years of experience, is dedicated to simplifying the process and offering reliable support from start to finish.

Read on to learn about long-term care eligibility, the process for applying for Medicaid for nursing home care in New York state, and the Medicaid requirements in NY.

 

Medicaid Requirements In New York

Medicaid is intended to ease the financial burden of paying for nursing home care and other long-term care services, which can be incredibly costly. However, gaining access to these benefits comes with several important requirements. 

To receive New York Medicaid eligibility for seniors, applicants must be legal U.S. citizens or qualified non-citizens, reside within the state, and meet specific income and asset limits. Additionally, individuals must be at least 65, legally blind, or have a permanent disability to qualify for Medicaid coverage for nursing home care.

Medicaid Asset and Income Limit New York

New York's Medicaid long-term programs have different financial and functional eligibility rules that vary by marital status and can change annually. However, even if someone doesn’t meet the standard criteria, alternative paths to eligibility may be available. 

Medicaid Income Limits in NY (2025)

The Medicaid income limits in New York, as of 2025, for seniors over 65 vary by marital status and program type. Outlined below is the Medicaid eligibility income chart that New York seniors can use to understand their qualifying income levels.

In the case of Institutional/Nursing Home Medicaid, most of the recipient’s monthly income must go towards nursing home costs, except for a monthly $50 Personal Needs Allowance.

Most income sources are counted towards Medicaid’s income limits in NY, including wages, pensions, Social Security benefits, alimony, gifts, and IRA distributions. For married couples where only one is applying for Nursing Home Medicaid or HCBS Waiver, the non-applicant spouse’s income is not counted. 

To prevent financial hardship, the non-applicant spouse is allowed a minimum monthly income, known as the Community Spouse Monthly Income Allowance (CSMIA), which is $3,948 as of 2025. If the non-applicant spouse’s income falls short of this, they can receive funds from the applicant spouse to reach the allowance limit.

However, if their income exceeds it, a portion may be directed to cover care costs unless the applicant spouse claims Spousal refusal. Both spouses’ incomes are considered for Regular Medicaid, and no CSMIA applies.

Medicaid Asset Limit In New York

The Medicaid asset limits in New York are outlined below:

Medicaid has a resource allowance of $31,185 for individuals applying, and $42,312 for a couple where both are applying. 

There is a further allowance in the case of one spouse applying for Medicaid, with a maximum of $3,853 for the Monthly Maintenance Needs Allowance. This protects the non-applicant spouse from spousal impoverishment. 

Common exempt assets in New York not counted towards Medicaid eligibility for long-term care in New York include the individual's primary residence, household items, personal belongings, and a vehicle. However, while a home is exempt, it can be subject to Medicaid estate recovery after the recipient's death to reimburse care costs.

When one spouse applies for Nursing Home Medicaid or HCBS Waiver, all of the couple's assets are considered jointly owned. However, Medicaid allows the non-applicant spouse (known as the community spouse) to keep a portion of the couple's assets through the Community Spouse Resource Allowance (CSRA). 

In 2025, this amount is up to 50% of the couple's total assets, up to $154,140. If they both have under $74,820, the non-applicant spouse can keep up to 100% of that amount. These rules are critical to understand when engaging in Medicaid estate planning in New York, especially to protect the financial security of the non-applicant spouse.

Medicaid Asset Transfer Rules in New York

New York has a 5-year look-back period (60 months) for institutional Medicaid to review asset transfers. Any assets given away or sold for less than fair market value during this time may result in a penalty period. The New York nursing home Medicaid look-back period applies to both the applicant and their spouse.

The U.S. federal gift tax exemption does not apply to Medicaid. Even gifts under that threshold may violate Medicaid’s transfer rules if made during the look-back period.

How to Qualify for Medicaid When Exceeding the Income or Asset Limits in New York

Seniors in New York who don’t initially meet Medicaid’s financial eligibility limits may still qualify through alternative pathways. With the proper New York Medicaid planning, many applicants can meet the requirements and gain access to long-term care benefits.

1. Medically Needy Pathway: New York offers an Excess Income Program for individuals who exceed Medicaid bank account limits in New York. Known as a spend-down program, this option allows applicants to subtract medical costs, like prescriptions, supplies, and doctor visits, from their income. 

2. Pooled Income Trusts: Disabled individuals in New York can use Pooled Income Trusts to qualify for Medicaid if their income exceeds the limit. By depositing surplus income into a trust (a form of Supplemental Needs Trust), the excess is excluded from Medicaid calculations. These funds can be used for approved personal expenses like housing or utility bills. 

3. Asset Spend Down: Applicants with assets above Medicaid’s limit can become eligible by spending down their excess in acceptable ways. New York state Medicaid spend-down rules allow paying for past medical bills, in-home care, necessary home modifications (like ramps or stair lifts), using the service of a Medicaid planner like Senior Planning Services, and paying off debts. This legal strategy of NY Medicaid spend-down allows applicants to reduce their countable assets below Medicaid’s limit.

4. Medicaid Planning: For those above the income or asset limits, still unable to afford care, New York long-term care Medicaid planning offers legal strategies to qualify. Working with a Certified Medicaid Planner, families can structure finances to meet eligibility criteria and receive New York Medicaid asset protection, such as safeguarding the family home from future estate recovery claims.

How To Apply for Medicaid in New York

Seniors in New York can apply for Medicaid at their Local Department of Social Services (LDSS) office or by calling the office and applying by phone. Applying online is not currently available for individuals aged 65 and above.

1. Choose a Medicaid Service: Available Medicaid services for long-term care include Institutional/Nursing Home Medicaid, Home and Community-Based Services, and regular Medicaid.

2. Gather the Necessary Documents: View the Medicaid Document Checklist for a comprehensive list of all the documents needed for applying. Some of the documentation required for Medicaid in New York state include:

   • Identification
   • Proof of citizenship
   • Marital Status
   • Income
   • Assets
   • Medical needs

3. Complete the Application: Fill out the necessary application forms at the Local Department of Social Services.

4. Apply: Submit the application along with all the necessary documents.

Choosing Nursing Homes

Once approved for Medicaid nursing home eligibility in New York, Medicaid will pay 100% of the costs for a nursing home, including room, meals, and medical care. However, according to Patient Liability, most of the applicant's income must go to the nursing home, and then Medicaid covers the rest. This excludes the costs of personal allowances, money for a spouse, or unpaid medical bills. If there is no remaining income after subtracting these allowances, Medicaid will pay the full cost.

When it comes to which nursing homes accept Medicaid, it is important to confirm availability. Although many nursing homes will accept Medicaid, there are a limited number of slots.

During the process of finding the right nursing home, consider the medical team and whether they are adequately equipped to assist, the social activities available, the location, and the quality of service and care. 

Assisted Living in New York

Finding an assisted living facility in New York can be challenging since there is no database for which facilities accept Medicaid as a form of payment. Additionally, some facilities may not list Medicaid as a payment option, although they will accept it. 

That said, most assisted living residents are apprehensive about accepting individuals paying through Medicaid because it pays less than private-pay residents, and limited Medicaid-funded beds are available.

How much does Medicaid pay for assisted living in New York? Medicaid covers the cost of care services. This does not include room or board, and residents are usually expected to pay for rent.

Get Approved for Medicaid in New York

Navigating Medicaid eligibility in New York for seniors can feel overwhelming. At Senior Planning, we specialize in helping New York residents understand the state-specific eligibility rules and complete the necessary application forms, ensuring you or your loved one can access the care they need.

Our team is here to guide you with expert, personalized support. From nursing home care to assisted living options, we will help you through every step of the process. Contact Senior Planning today for a free consultation and get the assistance you need.