New York Nursing Home Medicaid pays for a nursing home once Medicare’s short rehabilitation benefit runs out — but only after the family clears an income test, an asset test and a level-of-care assessment. This New York nursing home medicaid guide gives the 2026 figures, what the spouse at home is allowed to keep, how the five-year look-back works, and where in New York the application actually goes.
Every dollar figure below comes from the state Medicaid agency, CMS or the statute cited, and each resets on its own calendar. Where New York has not published a current figure we say so instead of guessing.
In This New York Nursing Home Medicaid Guide:
New York Nursing Home Medicaid at a Glance (2026)
| Program | New York does not market nursing-home Medicaid under a separate brand name. State and county agencies simply call it Medicaid coverage of nursing home care, and in everyday practice you will hear “Institutional Medicaid,” “Chronic Care Medicaid,” or “Nursing Home Medicaid” used for the same thing. Official Department of Health material refers to the facility itself as a Residential Health Care Facility (RHCF). Treat all of these phrases as one program when you see them on county paperwork. |
| 2026 income limit (single applicant) | $1,836 |
| 2026 asset limit (single applicant) | $33,038 |
| Spouse at home may keep (assets) | $32,532 to $162,660 |
| Spouse at home income floor | $2,705 to $4,066.50 per month |
| Look-back period | 60 months |
| Penalty divisor | not published here yet — confirm with The application is filed with the Local Department of Social Services (LDSS) in the county where the person lives, not through NY State of Health. In New York City it goes to the Human Resources Administration (HRA), part of the Department of Social Services; the HRA Medicaid Helpline is 1-888-692-6116 and the DSS OneNumber is 718-557-1399. Statewide, the New York State Department of Health Medicaid Helpline is 1-800-541-2831. Many nursing homes have admissions or business-office staff who assemble and file the packet for families. |
| Home equity limit (no spouse at home) | $1,130,000 (confirm with The application is filed with the Local Department of Social Services (LDSS) in the county where the person lives, not through NY State of Health. In New York City it goes to the Human Resources Administration (HRA), part of the Department of Social Services; the HRA Medicaid Helpline is 1-888-692-6116 and the DSS OneNumber is 718-557-1399. Statewide, the New York State Department of Health Medicaid Helpline is 1-800-541-2831. Many nursing homes have admissions or business-office staff who assemble and file the packet for families.) |
| Over the income limit? | Medically-needy spend-down — no Miller trust |
New York Nursing Home Medicaid Income and Asset Limits
Two tests, both applied to the person entering the facility. The income test looks at gross monthly income from every source — Social Security, pensions, IRA withdrawals, annuities, rent. The asset test counts what can be turned into cash: bank accounts, investments, retirement accounts in most states, and any property other than the home.
New York is a medically-needy state. Being over the New York nursing home medicaid income figure does not end the application: the excess is spent down on the cost of care each month, and the nursing home bill itself usually absorbs it. No Miller trust is needed.
While the applicant is in the facility, the home is generally not counted as a resource if the applicant states an intent to return home, and it stays protected when a spouse or certain dependent relatives still live there. New York also disregards one automobile, an irrevocable pre-paid funeral agreement, burial plots or spaces for immediate family members, a limited burial fund, and household goods and personal effects.
Families should know a Medicaid lien or later estate recovery may still reach the house.
New York does not use qualified income trusts or Miller trusts. It is a medically needy state, so people over the income figure use a spend-down, known locally as the excess income or surplus income program.
For a nursing-home resident the local district instead calculates Net Available Monthly Income (NAMI), meaning nearly all monthly income is paid to the facility after deductions such as a personal needs allowance and health insurance premiums. Pooled income trusts, used for care at home, are not accepted for nursing home coverage.
What the Spouse at Home Keeps Under New York Nursing Home Medicaid
Federal spousal impoverishment rules stop New York nursing home medicaid from bankrupting the husband or wife who stays home. The at-home spouse keeps a protected share of the couple’s assets — between $32,532 and $162,660 in 2026 — and is guaranteed a monthly income floor of at least $2,705, rising to $4,066.50 when housing costs are high. The house is fully exempt while the spouse lives in it.
New York follows the federal spousal-impoverishment rules that let the at-home community spouse keep a share of the couple’s income and resources, and it adds a well-known state-specific option called spousal refusal under the Social Services Law. The community spouse may sign a written declaration refusing to make their own income and resources available, after which the institutionalized spouse is judged on their finances alone.
The county may then sue the refusing spouse for support, and that spouse must still disclose financial information or the case is denied.
The asset snapshot is taken on the first day of the continuous stay, not the application date. Families who spend down before asking for a resource assessment often spend money the spouse was entitled to keep.
The Look-Back Rule and Transfer Penalties
New York reviews every transfer made in the 60 months before the application. Money or property given away, or sold for less than it was worth, is added up and divided by the state’s penalty divisor — its average private-pay nursing home cost — to produce a period during which New York nursing home medicaid will not pay.
The divisor in New York is not published here yet — confirm with The application is filed with the Local Department of Social Services (LDSS) in the county where the person lives, not through NY State of Health. In New York City it goes to the Human Resources Administration (HRA), part of the Department of Social Services; the HRA Medicaid Helpline is 1-888-692-6116 and the DSS OneNumber is 718-557-1399. Statewide, the New York State Department of Health Medicaid Helpline is 1-800-541-2831.
Many nursing homes have admissions or business-office staff who assemble and file the packet for families..
60 months, federal standard. The IRS annual gift exclusion has no bearing here: a gift that is tax-free can still trigger a Medicaid penalty. Transfers to a spouse, to a disabled child, or of the home to a child who lived there and provided care for two years are the main exceptions.
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How to Apply for New York Nursing Home Medicaid
Where: The application is filed with the Local Department of Social Services (LDSS) in the county where the person lives, not through NY State of Health. In New York City it goes to the Human Resources Administration (HRA), part of the Department of Social Services; the HRA Medicaid Helpline is 1-888-692-6116 and the DSS OneNumber is 718-557-1399. Statewide, the New York State Department of Health Medicaid Helpline is 1-800-541-2831. Many nursing homes have admissions or business-office staff who assemble and file the packet for families. — start the application.
New York measures nursing-home-level need with the Hospital and Community Patient Review Instrument (H/C PRI), form DOH-694, paired with the SCREEN, form DOH-695. A registered nurse trained and certified by the Department of Health completes them: hospital discharge staff when the person is leaving a hospital, or a certified community PRI nurse when the person is coming from home.
The assessment records activities of daily living, mobility, continence, behavior, cognition, diagnoses, and specialized services, and screens for mental illness or developmental disability.
Bring five years of bank statements, deeds, vehicle titles, insurance policies, the Medicare and Social Security cards, and any trust or power of attorney documents. Missing paperwork is the most common reason a New York nursing home medicaid decision is delayed.
While the Application Is Pending
Nothing stops admission while the case is pending. The nursing home ordinarily admits the resident and bills Medicaid once the district approves, and the facility expects the resident’s own monthly income to be turned over toward the bill in the meantime. New York can cover unpaid medical bills for a period before the application month if the person would have qualified then.
Typical decision time in weeks is UNVERIFIED; districts commonly issue written requests for more documents, which extends the process.
After approval, nearly all of the resident’s income goes to the facility each month as the patient share, minus a small personal needs allowance, health insurance premiums and the spouse’s allowance.
Denials, Appeals and What Comes After
Most denials are about paperwork rather than wealth: missing bank statements, closed accounts, or unexplained withdrawals across the look-back period, gifts or transfers that trigger a transfer penalty, a community spouse who will not supply financial information, and a missing PRI or incomplete disability determination. Districts frequently deny for failure to furnish documentation, so file a complete packet.
To appeal, request a Fair Hearing from the New York State Office of Temporary and Disability Assistance at 1-800-342-3334 or at https://otda.ny.gov/hearings/request/.
One more thing families should know before they file: after the resident’s death, the state may seek repayment from the estate. That process — what it can reach and the exemptions — is covered in our guide to New York Medicaid estate recovery.
A Realistic New York Nursing Home Medicaid Timeline
Week one: the hospital or family calls the Medicaid office for the level-of-care assessment and starts gathering five years of statements. Weeks two to four: the assessment is done and the financial application is filed, usually with the facility’s admissions office helping. Weeks six to twelve: the caseworker verifies accounts and may ask for more documents; answer within the deadline on each request or the clock resets.
Approval, when it comes, is retroactive to the eligibility date, which is why filing early is the single most valuable thing a family can do.
Where to Get Help Free
Two free doors exist in every state: the New York SHIP counselor for the Medicare side and the state’s Aging and Disability Resource Center for the Medicaid side. Neither sells anything. For a New York nursing home medicaid question involving a house, a spouse at home or a recent gift, a local elder law attorney or legal aid office is the next call.
Key Takeaways: New York Nursing Home Medicaid
- Two tests, not one: New York nursing home medicaid checks income and assets separately, and passing one does not excuse the other.
- The spouse is protected: the at-home spouse keeps a share of assets and an income floor under New York nursing home medicaid before anything is spent down.
- The look-back is five years: any gift inside it is divided by the divisor and becomes months without New York nursing home medicaid coverage.
- The home usually does not count: while a spouse lives there, the house is exempt from the New York nursing home medicaid asset test.
- Apply as Medicaid pending: most facilities admit while New York nursing home medicaid is decided and the state pays back to the eligibility date.
- Assessment first: the level-of-care evaluation is what starts the New York nursing home medicaid clock, so request it on day one.
- Retirement accounts often count: IRAs and 401(k)s are countable in most states under New York nursing home medicaid unless in payout status.
- Income trust or spend-down: whether an over-income applicant needs a Miller trust is the first New York nursing home medicaid question to settle.
- The resource snapshot matters: New York nursing home medicaid measures the couple’s assets on the day the stay began, not the day you apply.
Official Sources
- New York does not market nursing-home Medicaid under a separate brand name. State and county agencies simply call it Medicaid coverage of nursing home care, and in everyday practice you will hear “Institutional Medicaid,” “Chronic Care Medicaid,” or “Nursing Home Medicaid” used for the same thing. Official Department of Health material refers to the facility itself as a Residential Health Care Facility (RHCF). Treat all of these phrases as one program when you see them on county paperwork. — New York Medicaid: https://www.health.ny.gov/health_care/medicaid/ is the New York State Department of Health’s main Medicaid page and the best single starting point, linking to how to apply, the forms above, and the Medicaid Reference Guide that county eligibility workers actually use. For the money side of nursing home care specifically, the department’s Net Available Monthly Income overview at https://www.health.ny.gov/facilities/nursing/select_nh/appendixe.htm explains what a resident pays the facility. Both are official state pages.
- The application is filed with the Local Department of Social Services (LDSS) in the county where the person lives, not through NY State of Health. In New York City it goes to the Human Resources Administration (HRA), part of the Department of Social Services; the HRA Medicaid Helpline is 1-888-692-6116 and the DSS OneNumber is 718-557-1399. Statewide, the New York State Department of Health Medicaid Helpline is 1-800-541-2831. Many nursing homes have admissions or business-office staff who assemble and file the packet for families.
- Medicaid.gov spousal impoverishment standards: medicaid.gov
- Medicare.gov Medicare Savings Programs: medicare.gov
This New York nursing home medicaid guide was checked against the state Medicaid agency, CMS and the statute cited above in September 2026. Figures reset on their own calendars (most on January 1); if a number here disagrees with a notice you received, the notice wins — and please tell us. This page is general information, not legal, financial or medical advice.