To qualify for Community Medicaid in New York in 2026, you need to be a state resident who is 65 or older, blind, or disabled, with monthly income no higher than $1,836 and countable resources no higher than $33,038 if you’re applying on your own. You also have to show a medical need for long-term care, currently defined as needing help with at least three activities of daily living. Meeting the medical test but not the financial one doesn’t automatically end things: a pooled income trust can bring excess income under the limit.
2026 Income and Asset Limits
Community Medicaid uses non-MAGI budgeting rules, which cover applicants who are 65 or older, blind, or disabled. The income ceiling is tied to 138 percent of the federal poverty level, so it moves every year.
- Individual applicant: monthly income up to $1,836 and countable resources up to $33,038.
- Married couple, both applying: combined monthly income up to $2,489 and countable resources up to $44,796.
A $20 monthly disregard comes off unearned income first, such as Social Security. If your unearned income is under $20, the remainder of the disregard applies to earned income. Countable resources include bank accounts, investments, and most other financial assets. Your primary home, one car, personal belongings, and certain other property are generally exempt.
If Only One Spouse Needs Care
When one spouse applies and the other does not, spousal impoverishment rules protect the healthy spouse. For 2026:
- Community Spouse Resource Allowance: the healthy spouse keeps between $74,820 and $162,660 of the couple’s combined countable assets. At application, total resources are calculated and the community spouse keeps half, subject to that floor and ceiling. Anything above the ceiling still counts toward the applicant.
- Minimum Monthly Maintenance Needs Allowance: if the healthy spouse’s own monthly income is below $4,066.50, part of the applicant’s income can be redirected to bring the spouse up to that floor.
These protections apply whether care is delivered at home or in a facility.
The Medical Test: Help With Three ADLs
Financial numbers are only half of eligibility. You also have to demonstrate a clinical need for long-term care, evaluated through the Uniform Assessment System (UAS-NY). A nurse or social worker conducts the assessment, usually in your home.1New York State Department of Health. Understanding the UAS-NY Community Assessment
The assessment looks at how well you handle activities of daily living: bathing, dressing, eating, toileting, transferring between surfaces, and moving around your home. It also weighs cognitive function, behavioral health, and other clinical factors. Since September 2025, community-based home care services require a demonstrated need for help with at least three ADLs. Meeting only one or two is no longer enough.
Residency and Immigration Status
You must be living in New York and intend to stay, but there’s no minimum time you have to have been here. U.S. citizens and nationals qualify without restriction. Lawful permanent residents and other qualified immigrants are also eligible for full Medicaid in New York, including during the federal five-year bar; the state uses its own funds to cover care during that window.2New York State Department of Health. Citizenship and Alien Status Requirements for the Medicaid Program Undocumented immigrants and temporary visa holders do not qualify for Community Medicaid, though they can receive coverage for emergency medical conditions.
What If Your Income Is Over the Limit
Income above $1,836 a month doesn’t automatically disqualify you. You can deposit the excess into a pooled income trust, and the money in the trust is not counted for Medicaid purposes. The trust pays your bills directly out of those deposits each month.3New York State Department of Health. Explanation of the Effect of Trusts on Medicaid Eligibility
To be valid, a pooled trust has to be run by a nonprofit, the account has to be set up by the beneficiary or a parent, grandparent, legal guardian, or court, and whatever remains at the beneficiary’s death that the nonprofit does not retain must reimburse Medicaid. Setup fees vary from nothing to several hundred dollars, with monthly administrative fees on top.
Excess resources are a different problem. Countable assets above $33,038 have to be spent down or restructured before the application will succeed, and how that’s done depends on the pending look-back rule described next.
The 30-Month Look-Back: Pending but Not Yet Active
New York has historically not applied any look-back period to asset transfers for Community Medicaid. Someone could gift assets and apply for home care shortly afterward without penalty. That will change once the state implements a 30-month look-back authorized by the legislature in 2020 for transfers on or after October 1, 2020.4Department of Health. 30-Month Lookback for Community Based Long Term Care Services
As of early 2026, the rule still isn’t being enforced. It requires federal approval and implementing procedures the Department of Health hasn’t finished, and the effective date has been postponed repeatedly. Implementation is not expected before late 2026 or 2027 at the earliest. Applications filed before the rule takes effect are not subject to transfer penalties.
Once it does go live, home care applications will be reviewed for asset transfers made in the 30 months before filing. Transfers in that window can trigger a penalty period during which community-based long-term care services are denied. The penalty is calculated by dividing the transferred amount by a regional rate. For 2026, those rates range from $13,765 in Western New York to $15,675 in the Rochester region, with New York City at $15,282. Anyone weighing large gifts or transfers now should assume the rule will eventually apply; when it takes effect, there won’t be a grace period.
How to Apply
Where you file depends on your budgeting category. Applicants who are 65 or older, blind, or disabled apply through their local Department of Social Services, or in New York City through the Human Resources Administration. Younger applicants who don’t fall into those categories generally use the NY State of Health marketplace.5New York State Department of Health. How Do I Apply for Medicaid
Because most Community Medicaid applicants are aged or disabled, the local DSS office is usually the correct door. Plan to bring:
- Proof of identity, such as a birth certificate, passport, or driver’s license.
- Proof of New York residency, such as utility bills or a lease.
- Income documentation, including Social Security award letters, pension statements, and tax returns.
- Asset documentation, including bank statements, brokerage statements, life insurance policies, and property deeds.
- Medical evidence supporting the need for long-term care.
Federal rules set processing times. Non-MAGI applications that involve a disability determination must be decided within 90 days. Applications that don’t involve a disability determination have a 45-day window. Incomplete paperwork is the most common reason files stall, so submit the full package the first time.
Keeping Coverage: Annual Recertification
Eligibility has to be renewed at least once every 12 months. New York first tries to confirm your continued eligibility automatically, using federal tax records and Social Security data. If that check succeeds, you’re renewed without paperwork.6Centers for Medicare and Medicaid Services. Overview: Medicaid and CHIP Eligibility Renewals
If the automatic check can’t confirm eligibility, a renewal packet arrives in the mail. You sign it, add any requested documents, and return it by the printed deadline by mail, fax, in person at DSS, or through the NYDocSubmit app. New York City residents can also submit through Access HRA.7NY State of Health. How to Renew Your Health Insurance Missing the deadline can end coverage even when you still qualify. Treat the packet as urgent when it shows up.
If You Are Denied
A denial notice has to be in writing and has to explain the reason. You can request a fair hearing before an administrative judge at the Office of Temporary and Disability Assistance, where you can present evidence and challenge the agency’s decision.8Office of Temporary and Disability Assistance. Fair Hearings
The deadline is 60 days from the date on the denial notice. Requests can be filed online, by phone, by mail, or by fax. If you request the hearing before your current benefits expire, coverage generally continues while you wait for a decision. If the hearing goes against you, you have four months to challenge the result by filing suit in state court.