New York Medicaid Long-Term Care Eligibility for 2025

New York Long-Term Care Program Overview

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New York State provides extensive Medicaid programs for individuals needing long-term care. Medicaid offers assistance both for residential care in nursing homes or assisted living facilities and for in-home or community-based services.

Medicaid long-term care qualification standards differ significantly from other Medicaid programs. The Affordable Care Act’s MAGI (Modified Adjusted Gross Income) standard does not apply to these programs; instead, Non-MAGI standards are used for determining eligibility.

Services Offered in 2025

Eligibility requirements include the following:

  • Residency and Citizenship: Applicants must be New York residents and either U.S. citizens or lawful immigrants.
  • Age/Disability: Applicants must be 65 or older, disabled, or have a diagnosis of blindness.
  • Income Limits: Monthly income must not exceed $1,732 for an individual or $2,351 for a couple. A personal needs allowance of $50 per month is excluded from income calculations.
  • Asset Limits: Countable assets must not exceed $30,182 for an individual or $42,312 for a couple. A five-year look-back period applies to asset transfers.
Exempt Assets for 2025:
  • Primary home with an equity limit of $1,071,000 (if the applicant intends to return home or if a spouse or dependent resides there).
  • One car, regardless of equity value.
  • Personal belongings, household furnishings, and heirlooms.
  • Irrevocable funeral trusts or burial funds up to $1,500.
  • Life insurance policies with a face value of $1,500 or less.
Spousal Rules for 2025:

The community spouse may retain up to $154,140 in assets under the Community Spouse Resource Allowance (CSRA). Additionally, the community spouse can receive income from the institutionalized spouse to maintain a minimum income of $3,853.50 per month.

Key Medicaid Programs in 2025

  • Managed Long-Term Care (MLTC): Provides personal care, home health aides, and adult day care for individuals needing a Nursing Facility Level of Care.
  • Community First Choice Option (CFCO): Offers home and community-based services for eligible participants, including personal care and assistive technology.
  • Assisted Living Program (ALP): Covers services for seniors residing in adult care facilities who meet nursing home care requirements.
  • PACE: Integrates Medicaid and Medicare benefits into one program, including dental and vision services.

How to Apply for Medicaid in New York

Applications can be completed in person at a Local Department of Social Services (LDSS) office or via phone by contacting the Medicaid Helpline at 1-800-541-2831. Assistance with the application process can also be obtained through local Area Agencies on Aging or Medicaid planners to ensure proper eligibility.

Further Reading and Resources

Disclaimer: This content is for informational purposes only and does not constitute legal advice. Please consult a Medicaid planner or legal advisor for specific guidance.

New York Medicaid provides services under two primary categories:

  • Residential Care: Includes care in nursing homes or assisted living facilities, though most recipients utilize nursing homes.
  • Community-Based Services: Offers options such as personal care, home health care, Medicaid Managed Long-Term Care (MLTC), and adult day care programs, allowing participants to remain at home while receiving necessary care.

Both services are designed to assist with activities of daily living (ADLs), including bathing, dressing, and meal preparation. Evaluations are conducted by county-based offices to determine an individual’s level of need and eligibility.

General Eligibility Requirements for 2025

Eligibility requirements include the following:

  • Residency and Citizenship: Applicants must be New York residents and either U.S. citizens or lawful immigrants.
  • Age/Disability: Applicants must be 65 or older, disabled, or have a diagnosis of blindness.
  • Income Limits: Monthly income must not exceed $1,732 for an individual or $2,351 for a couple. A personal needs allowance of $50 per month is excluded from income calculations.
  • Asset Limits: Countable assets must not exceed $30,182 for an individual or $42,312 for a couple. A five-year look-back period applies to asset transfers.
Exempt Assets for 2025:
  • Primary home with an equity limit of $1,071,000 (if the applicant intends to return home or if a spouse or dependent resides there).
  • One car, regardless of equity value.
  • Personal belongings, household furnishings, and heirlooms.
  • Irrevocable funeral trusts or burial funds up to $1,500.
  • Life insurance policies with a face value of $1,500 or less.
Spousal Rules for 2025:

The community spouse may retain up to $154,140 in assets under the Community Spouse Resource Allowance (CSRA). Additionally, the community spouse can receive income from the institutionalized spouse to maintain a minimum income of $3,853.50 per month.

Key Medicaid Programs in 2025

  • Managed Long-Term Care (MLTC): Provides personal care, home health aides, and adult day care for individuals needing a Nursing Facility Level of Care.
  • Community First Choice Option (CFCO): Offers home and community-based services for eligible participants, including personal care and assistive technology.
  • Assisted Living Program (ALP): Covers services for seniors residing in adult care facilities who meet nursing home care requirements.
  • PACE: Integrates Medicaid and Medicare benefits into one program, including dental and vision services.

How to Apply for Medicaid in New York

Applications can be completed in person at a Local Department of Social Services (LDSS) office or via phone by contacting the Medicaid Helpline at 1-800-541-2831. Assistance with the application process can also be obtained through local Area Agencies on Aging or Medicaid planners to ensure proper eligibility.

Further Reading and Resources

Disclaimer: This content is for informational purposes only and does not constitute legal advice. Please consult a Medicaid planner or legal advisor for specific guidance.