New York Medicaid for seniors and long-term care

Last verified: June 2026

$31,175

Resource limit (single)

CDPAP

Hire your own aide

MLTC

Required for dual eligibles

No Miller Trust

Income goes direct to facility

Long-term care Medicaid rules are complex — consult an elder law attorney

Asset and income rules for nursing home and MLTC Medicaid differ significantly from standard MAGI-based Medicaid. For situation-specific guidance, consult an elder law attorney or contact your local Department of Social Services. NYC residents contact HRA at (718) 557-1399.

CDPAP transition completed in 2025 — all recipients now use PPL as fiscal intermediary

As of the state's CDPAP transition (completed by early 2025), Public Partnership LLC (PPL) is the sole statewide fiscal intermediary for CDPAP. If you are currently in CDPAP, you must work with PPL for payroll processing. Per NY DOH: "Your CDPAP eligibility and services are NOT changing." Contact PPL at pplfirst.com or call your MLTC plan for transition help.

New York's long-term care Medicaid landscape

New York has one of the largest dual-eligible (Medicare and Medicaid) populations in the country, per KFF data. Most New Yorkers who need long-term services and supports receive them through the Managed Long-Term Care (MLTC) program — a system of managed care plans under contract with NY DOH that coordinate home care, nursing home placement, adult day services, and other supports.

Enrollment in MLTC is required for most dual eligibles who need more than 120 days of community-based long-term care. The MLTC plan becomes the primary coordinator for Medicaid-covered long-term services; Medicare continues to cover acute medical care. Contact NY Medicaid Choice (1-800-505-5678) to enroll in or change an MLTC plan.

As of September 1, 2025, NY DOH implemented new Minimum Needs Requirements for MLTC enrollment (MLTC Policy 25.04). Applicants must be assessed as needing at least limited assistance with more than two Activities of Daily Living — or, for individuals with dementia or Alzheimer's, supervision with more than one ADL. This requirement does not apply retroactively to current MLTC enrollees.

CDPAP: New York lets you hire and direct your own home care worker

The Consumer Directed Personal Assistance Program (CDPAP) is one of the most notable features of New York's Medicaid long-term care system. CDPAP allows Medicaid-eligible individuals who need home care to hire, train, and direct their own personal assistant. That personal assistant can be a friend, neighbor, or almost any family member — the only exclusions are the enrollee's spouse and the parent of a CDPAP consumer under age 21.

This is unusual nationally. Most state Medicaid home care programs hire workers through licensed home care agencies, removing the consumer from hiring decisions. New York's CDPAP shifts that control to the individual. The consumer (or their designated representative) recruits, hires, trains, supervises, and can terminate their personal assistant. Per NY DOH, the personal assistant can provide any service normally delivered by a personal care aide, home health aide, or nurse — including medication administration, wound care, and G-tube feeding.

Payroll for CDPAP personal assistants is handled by the statewide fiscal intermediary, Public Partnership LLC (PPL), since the 2025 transition from multiple fiscal intermediaries. The consumer remains the legal employer; PPL handles tax withholding and wage processing.

To apply for CDPAP, contact your MLTC plan or local DSS/HRA. An assessment determines the number of authorized hours. Note the Minimum Needs Requirements described above — these apply to new CDPAP applicants age 21 or older assessed on or after September 1, 2025.

What MLTC plans cover

Personal care services and home health aide services
CDPAP — consumer-directed home care with the worker of your choice
Adult day health care programs
Nursing home services (when community care is no longer appropriate)
Respiratory therapy, physical therapy, and occupational therapy at home
Medical equipment and supplies for home use
Caregiver respite services
Transportation to medical appointments

MLTC plans also coordinate Medicare benefits for dual eligibles, meaning one plan handles both Medicare and Medicaid long-term care coordination for enrolled members.

Nursing facility coverage and income/asset rules

New York Medicaid covers indefinite nursing home care for eligible residents once Medicare's 100-day benefit is exhausted. The income standard for nursing home Medicaid is the Medicaid Income Level — $1,732/month for a single person as of January 2025 (per NY DOH GIS 25 MA/01). Income above that limit must be applied toward the nursing home cost (the "patient pay amount"), with Medicaid covering the remainder.

Resource limits for institutionalized individuals are $31,175. The community spouse (if applicable) can retain up to $157,920 in countable resources and $3,948/month in income, per the spousal impoverishment standards in GIS 25 MA/01.

New York does not use Miller Trusts (Qualified Income Trusts) for nursing home applicants with income over the limit. Instead, excess income is applied directly to the facility cost. If your income exceeds the Medicaid Income Level, you do not use a trust — you pay the difference to the facility and Medicaid pays the balance.

PACE: an alternative to nursing home placement

The Program of All-Inclusive Care for the Elderly (PACE) is available in select New York counties. PACE integrates all Medicare and Medicaid services — including primary care, specialty care, and long-term supports — through a single program operated by a PACE organization. Enrollment is open at age 55 (not 65). PACE enrollees cannot simultaneously receive MLTC services; PACE replaces both Medicare and Medicaid separately.

PACE programs in New York include sites in New York City, Rochester, Buffalo, and other areas. Find locations at the National PACE Association (npaonline.org) or ask your MLTC plan.

New York operates Medicaid estate recovery

New York's Medicaid Estate Recovery Program (MERP) can seek repayment of Medicaid costs from the estate of a deceased enrollee age 55 or older who received nursing facility care, MLTC services, or certain other long-term care benefits. Recovery applies to the probate estate and, under New York law, may extend to assets that pass outside probate. Certain exceptions apply — a surviving spouse, a child under 21, or a blind or disabled child prevents recovery while that person is alive. For specific advice on estate planning and Medicaid, consult a licensed elder law attorney in New York.

Spousal impoverishment protections at a glance

Federal law (42 U.S.C. § 1396r-5) protects the community spouse when the other spouse enters a nursing facility. New York applies these protections per NY DOH GIS 25 MA/01.

Protection	2025 amount	Notes
Community Spouse Resource Allowance (CSRA)	Up to $157,920	Federal maximum; updated annually by CMS
Minimum Monthly Maintenance Needs Allowance (MMMNA)	$3,948/month	Per NY DOH GIS 25 MA/01; allocated from institutionalized spouse's income
Institutionalized spouse resource limit	$31,175	Per NY DOH GIS 25 MA/01; countable assets only

Source: NY DOH GIS 25 MA/01 (effective January 1, 2025). Request a formal asset assessment from your local DSS or HRA at time of application.

New York does not use Miller Trusts for nursing home income

Some states (including Texas) require a Qualified Income Trust (Miller Trust) when a nursing home applicant's monthly income exceeds the state's income cap. New York does not use this approach. Instead, a resident whose income exceeds the Medicaid Income Level ($1,732/month for a single person as of January 2025) applies the excess income directly toward the nursing home cost — called the "patient pay amount." Medicaid covers the balance.

This means no trust needs to be established in New York, and no attorney is needed solely for the income-cap workaround. Planning needs for NY LTC Medicaid instead focus on resource spend-down and look-back compliance.

What New York long-term care Medicaid covers

Nursing home care (indefinite, once Medicare's 100-day benefit is exhausted)
CDPAP — consumer-directed personal assistance with a worker you hire and direct
Home health aide and personal care services through MLTC plans
Adult day health care programs
Respiratory, physical, and occupational therapy at home
Medical equipment and supplies for home use
Caregiver respite services
Transportation to medical appointments
PACE — all-inclusive care integrating Medicare and Medicaid (select counties)

New York operates Medicaid estate recovery (MERP)

New York's MERP can seek recovery from the estate of a Medicaid recipient age 55 or older who received nursing facility, MLTC, or certain other LTC benefits. Recovery may extend beyond the probate estate under New York law. A surviving spouse, child under 21, or blind or disabled child prevents recovery while alive. Consult a licensed elder law attorney in New York before making asset transfers. See the national estate recovery guide for how MERP works.