Long-Term Care Planning in New York: Costs, Medicaid & Your Options (2026 Guide)

New York has among the highest long-term care costs in the nation — nursing home care averages $15,528 per month, approximately 62% above the national average of $9,581, while assisted living averages $7,110 per month, approximately 15% above the national average of $6,200. Home care averages $6,673 per month, in line with the national rate. In New York, Medicaid for persons 65+ is called NON-MAGI Medicaid, administered by the New York Department of Health (DOH) in conjunction with local Departments of Social Services (DSS). The income limit is $1,836/month for individuals, with a $50/month Personal Needs Allowance. Uniquely, New York has a high asset limit of $33,038 for individuals. New York uses Pooled Income Trusts and a Medically Needy / Spenddown program for applicants over the income limit — not Miller Trusts. This guide covers what care costs in New York, how to qualify for Medicaid, and what options exist for veterans and family caregivers in New York City, Long Island, Westchester, Buffalo, Rochester, Albany, Syracuse, and across the Empire State.

New York's Aging Population: The Numbers Behind the Need

New York is home to more than 4.5 million residents aged 60 or older — the third-largest senior population in the nation. Seniors are concentrated across New York City (all five boroughs — Manhattan, Brooklyn, Queens, The Bronx, and Staten Island), Long Island (Nassau and Suffolk counties), Westchester County, Buffalo (Erie County), Rochester (Monroe County), Albany (Albany County — the state capital), and Syracuse (Onondaga County).

New York's geography ranges from dense urban centers with abundant provider options to vast rural Upstate regions where access to care is significantly more limited. The New York City metro area has the highest concentration of nursing homes, assisted living facilities, and home care agencies in the state, while rural areas across the Adirondacks, Catskills, and Southern Tier face provider shortages.

Unpaid Caregivers in New York: Scale and Impact

An estimated 2.5 million unpaid family caregivers in New York provide care to aging relatives and adults with disabilities — one of the largest caregiver populations in the country. According to AARP research, family caregivers nationwide spend an average of $7,242 per year in out-of-pocket costs related to caregiving.

New York offers strong support for family caregivers through the Consumer Directed Personal Assistance Program (CDPAP), which allows Medicaid recipients to hire the personal care assistant of their choosing — including select relatives such as one's adult child. CDPAP is available through the MLTC Program Waiver and Community First Choice Option (CFCO). Note: spouses cannot be hired through CDPAP.

What Long-Term Care Costs in New York

New York's care costs vary by type of care:

• Assisted Living: $7,110 per month — approximately 15% above the national average of $6,200
• Nursing Home (semi-private room): $15,528 per month — approximately 62% above the national average of $9,581
• Home Care (home health aide): $6,673 per month — in line with the national average of $6,673
• Adult Day Care: $3,120 per month — approximately 52% above the national average of $2,058

At these rates, a three-year nursing home stay in New York costs approximately $559,000 — while home care totals roughly $240,000 over the same period. Assisted living, at $7,110/month, totals approximately $256,000 over three years. For a detailed breakdown of care costs by type and how New York compares to other states, visit our New York Care Costs page.

How to Qualify for New York Medicaid: Eligibility Rules for 2026

New York Medicaid is administered by the New York Department of Health (DOH) in conjunction with local Departments of Social Services (DSS). Medicaid for seniors 65+ is called NON-MAGI Medicaid. In addition to nursing home care, NY Medicaid pays for non-medical services and supports to help frail seniors remain living at home or in the community. Consulting with a New York elder law attorney or Certified Medicaid Planner early can help families avoid costly mistakes. Eligibility rules vary by program type:

• Nursing Home Medicaid (Institutional): Income limit of $1,836/month. All of a recipient's monthly income, with the exception of a $50/month Personal Needs Allowance, Medicare premiums, and possibly a Needs Allowance for a non-applicant spouse, must go towards nursing home costs (Patient Liability). Asset limit of $33,038 (single) or $44,796 (married couple both applying). When only one spouse applies, the non-applicant spouse may retain up to $162,660 in assets. This is an entitlement — anyone who qualifies receives benefits.
• Medicaid Waivers / Home and Community Based Services (HCBS): Income limit of $1,836/month. Asset limit of $33,038 (single) or $44,796 (couple, both applying). This is not an entitlement — the number of participant slots is limited and waiting lists may exist.
• Regular Medicaid / Disabled, Aged 65+ or Blind (DAB): Income limit of $1,836/month (single) or $2,489/month (couple). Asset limit of $33,038 (single) or $44,796 (couple). This is an entitlement. Another pathway: persons determined eligible for SSI are automatically approved for Regular Medicaid in New York.

New York applies a 60-month (5-year) look-back period for Nursing Home Medicaid only. The look-back period does NOT currently apply to Regular Medicaid or HCBS (Community Medicaid). However, the state plans to implement a 30-month look-back period for Community Medicaid — the implementation date is currently unknown. The federal $19,000 Gift Tax exclusion (2026) does NOT apply to Medicaid's look-back rules. For the full New York Medicaid eligibility breakdown, see our New York Medicaid Guide.

Spousal Protections, CSMIA, and Spousal Refusal

When one spouse applies for Nursing Home Medicaid or an HCBS Waiver in New York, the non-applicant spouse's income is disregarded. The Community Spouse Resource Allowance (CSRA) allows the non-applicant spouse to retain 50% of the couple's assets, up to $162,660 (2026). If 50% is under $74,820, the non-applicant can keep 100% of assets up to $74,820.

New York uses the Community Spouse Monthly Income Allowance (CSMIA) of $4,066.50 per month (2026) — the federal maximum. If the non-applicant spouse's income is below this level, income can be transferred from the applicant spouse. If the non-applicant spouse's income exceeds $4,066.50/month, Medicaid requests 25% of the "excess" income go towards the applicant's care costs. In this situation, an applicant can institute Spousal Refusal — a legal strategy unique to New York that allows the community spouse to refuse to make their income or assets available for the applicant's care. For Regular Medicaid, both spouses' income is counted and there is no CSMIA or CSRA.

New York Medicaid Programs: MLTC, CDPAP & Community Options

New York offers a robust array of Medicaid-funded long-term care programs:

• Managed Long Term Care (MLTC) Program Waiver: For seniors who require a Nursing Facility Level of Care but prefer community living. Supports include personal care assistance, adult day care, meal delivery, and home modifications. CDPAP allows hiring the personal care assistant of one's choosing, including select relatives such as one's adult child. Waiting lists may exist.
• Community First Choice Option (CFCO): Provides long-term HCBS under the state Medicaid plan, including assistance with daily living activities, home health aides, and assistive technology. The consumer-directed option (CDPAP) is available.
• Assisted Living Program (ALP): Pays for services in adult care facilities for seniors who require a Nursing Home Level of Care. Services may include skilled nursing, personal care, personal emergency response systems, and housecleaning.
• Nursing Home Transition and Diversion (NHTD) Waiver: Helps nursing home residents transition back to community living by providing security deposits, utility set-up fees, essential home furnishings, assistive technology, home modifications, personal care assistance, and homemaker services.
• State Plan Personal Care Services (PCS) Program: For New Yorkers who are elderly or disabled with a medical need for assistance with daily living activities.
• Program of All-Inclusive Care for the Elderly (PACE): Combines Medicaid and Medicare benefits into a single program. Additional benefits such as dental and eye care may be available.
• Money Follows the Person (Open Doors): A federal program that helps institutionalized Medicaid-eligible persons transition back home or into the community.

Qualifying When Over the Limits: Pooled Income Trusts and Spenddown

New York does not use Qualified Income Trusts (Miller Trusts). Instead, the state offers two pathways for persons over the income limit:

• Medically Needy / Excess Income Program (Spenddown / Surplus Income Program): The medically needy income level is $1,836/month (single) and $2,489/month (couple) eff. 1/1/26. The spenddown amount is the difference between income and the medically needy level. Medical expenses (supplies, prescriptions, doctor visits) can be used to meet the spenddown. The medically needy asset limit is $33,038 (individual) and $44,796 (couple).
• Pooled Income Trusts: Persons who are disabled and have income over Medicaid's limit can deposit "excess" income into a Pooled Income Trust — a type of Supplemental Needs Trust. This can eliminate the need for income spenddown. Trust funds can only be used for limited purposes such as paying the recipient's bills.
• Asset Spend-Down: Spend excess assets on non-countable items — past-due medical bills (within 6 years), in-home care, home modifications (wheelchair ramps, stair lifts, wheelchair-accessible bathrooms), prepaying funeral/burial expenses, and paying off debt. Keep documentation as proof Medicaid's look-back rule was not violated.
• Medicaid Planning: Work with a Medicaid Planning Professional to employ legal strategies for eligibility and protect your home from Medicaid's Estate Recovery Program.

Asset Rules: What Counts and What Doesn't

Countable assets in New York include cash, stocks, bonds, investments, cryptocurrency, vacation homes, and bank accounts (checking, savings, money market). In New York, IRAs and 401Ks in payout status are exempt — meaning one's required minimum distribution (RMD) is being withdrawn, and the remaining balance does not count as an asset. Non-countable (exempt) assets include one's primary home, personal belongings, household items, a vehicle, burial funds up to $1,500 or a life insurance policy with cash value up to $1,500, and non-refundable pre-paid funeral agreements.

New York's asset limit is $33,038 for an individual and $44,796 for a married couple (both applying) — significantly higher than the $2,000 limit used in most states. All assets of a married couple are considered jointly owned regardless of the Medicaid program. The CSRA allows the non-applicant spouse to retain 50% of assets up to $162,660 (minimum $74,820). There is no CSRA for Regular Medicaid. In New York, VA Aid & Attendance does not count as income. Nationally, Holocaust restitution payments are not counted as income.

Veterans and Long-Term Care in New York

New York has one of the largest veteran populations in the country, with extensive VA infrastructure including the VA NY Harbor Healthcare System (Manhattan, Brooklyn, St. Albans), the VA Western New York Healthcare System (Buffalo, Batavia), the Stratton VA Medical Center (Albany), Syracuse VA Medical Center, and numerous community-based outpatient clinics. The state also operates five New York State Veterans' Homes in Oxford, Montrose, St. Albans, Batavia, and Stony Brook.

New York does not count VA Aid & Attendance as income for Medicaid eligibility purposes. Veterans should factor this advantage into their long-term care planning strategy. For a comprehensive overview of veteran long-term care benefits, see our Veterans Long-Term Care Guide.

Planning Ahead: How to Pay for Nursing Home Care in New York

Understanding how to pay for nursing home care in New York — or any long-term care setting — requires evaluating multiple funding sources. With nursing home costs at $15,528/month (62% above the national average), a 60-month look-back for nursing home Medicaid, and a $33,038 asset limit, advance planning is essential. New York long-term care insurance policies, personal savings, veterans benefits, and Medicaid each play a role. Key steps include:

• Understanding your current financial position relative to New York's NON-MAGI Medicaid eligibility thresholds
• Knowing that New York's $33,038 individual asset limit is significantly higher than the $2,000 standard used in most states
• Taking advantage of CDPAP to hire select relatives (including adult children) as paid personal care assistants
• Leveraging New York's CSMIA ($4,066.50 — the federal maximum) and the CSRA ($162,660, minimum $74,820) to protect the non-applicant spouse
• Understanding Spousal Refusal — a legal strategy available in New York that allows the community spouse to refuse to make assets/income available for the applicant's care
• Recognizing that IRAs/401Ks in payout status (RMD being withdrawn) are exempt assets in New York
• Knowing that the look-back period currently applies only to Nursing Home Medicaid — not Community Medicaid / HCBS — though a 30-month look-back for Community Medicaid is planned
• Considering Pooled Income Trusts for disabled individuals over the income limit
• Consulting with a New York elder law attorney or Certified Medicaid Planner to protect assets and avoid look-back penalties

Estate Recovery: Protecting Your Home in New York

New York operates a Medicaid Estate Recovery Program (MERP), which allows the state to seek reimbursement from a deceased Medicaid beneficiary's estate for long-term care costs paid by Medicaid. This can include the family home if proper protections are not in place. The primary home is automatically exempt if the applicant's spouse, child under 21, or permanently blind or disabled child (of any age) lives in it.

If no qualifying family member lives in the home, there is a home equity interest limit of $1,097,000 (in 2026). If neither the applicant nor qualifying family live in the home, the applicant must demonstrate Intent to Return. There is no home equity interest limit for Regular Medicaid. The home is NOT exempt from estate recovery — families should consult a New York elder law attorney to explore legal protections.

Regional Cost Variations Across New York

Long-term care costs in New York vary dramatically by region. New York City and the surrounding metro area (Westchester, Long Island) have the highest costs in the state — and among the highest in the nation — due to high demand, real estate costs, and labor market pressures. Buffalo, Rochester, Syracuse, and Albany represent more moderate cost markets. Rural Upstate New York (Adirondacks, Catskills, Southern Tier, Finger Lakes) generally has lower costs but significantly fewer providers, particularly for home care and specialized memory care services.

Application Timeline and Process

New York Medicaid applications for persons 65+ can be submitted through several channels:

• Apply in person at a Local Department of Social Services (LDSS) office
• Call a local LDSS office to apply by phone
• Download the Medicaid Application for Non-MAGI Eligibility Group and Supplement A form
• Call the Medicaid Helpline at 1-800-541-2831 for program questions or application assistance
• Contact a local Area Agency on Aging office or a Facilitated Enroller for the Aged, Blind and Disabled

There is no online application option for New Yorkers 65+ years old. Applicants should be certain all eligibility requirements are met prior to applying. Medicaid Planning can be invaluable for those over the income and/or asset limits. Processing times vary but typically take 45–90 days.

Federal Policy Update: One Big Beautiful Bill Act (OBBBA)

The One Big Beautiful Bill Act (OBBBA) includes approximately $1 trillion in Medicaid cuts over 10 years. While Nursing Home Medicaid is largely protected from future funding reductions, Home and Community Based Services (HCBS) — including New York's MLTC, CDPAP, CFCO, NHTD Waiver, and PACE — are likely targets for cuts. This law is still facing legal challenges. Additionally, New York's planned 30-month look-back for Community Medicaid adds further urgency to planning ahead. Families relying on or planning to use HCBS should monitor developments and consider applying early.

Last updated: September 2026. Data sources: New York Department of Health, CareScout 2025 care cost survey (updated March 2026). All Medicaid figures reflect 2026 eligibility thresholds. This guide is for informational purposes only and does not constitute legal or financial advice.