Often, no. "Crisis planning" exists precisely for this moment. Even after a loved one has entered care, strategies like exempt transfers, spousal refusal, and the caretaker-child exemption may still protect a meaningful portion of assets. What's possible depends on your specific facts — which is exactly what a free consultation sorts out. We won't promise an outcome, but we will tell you honestly what options remain.

The fear behind this question is usually bigger than the reality. A primary home is frequently exempt while a person is receiving care, and several transfer strategies — a life estate, a Medicaid Asset Protection Trust, or the caretaker-child exemption — can protect it. Medicaid may seek recovery from an estate later, but planning is what addresses that. The home is rarely as exposed as families fear, and there's usually something that can be done.

New York allows a healthy "community" spouse to formally refuse to make their income and assets available for the ill spouse's care, which can help the ill spouse qualify for Medicaid. It's a legitimate, established tool. The honest trade-off: Medicaid may later seek reimbursement from the refusing spouse. We walk every couple through that risk before using it — it's a decision, not a loophole.

They're two different programs. Community Medicaid pays for care at home — home health aides and personal care. Chronic Care Medicaid pays for a nursing home. They have different income rules, and importantly different look-back rules: nursing-home Medicaid has a five-year look-back, while the home-care look-back has been changing in New York. Knowing which one you need shapes the entire plan.

No — this is the single most common myth. Qualifying for Medicaid does not require draining every dollar. There are asset limits and a spousal resource allowance, and with planning a significant portion of what a family owns can often be preserved. The current figures are in the table above; confirm them with us, since they change yearly.

It's a trust you set up before care is needed. You move assets in now; once the look-back period passes, they no longer count against you for Medicaid. You keep the income those assets produce and a life estate in your home — which preserves your STAR and property-tax exemptions and the step-up in basis for your heirs — and you can change the trustee or beneficiaries later. It's the cleanest tool for families planning ahead.

Building with AI? Our public MCP server is available at jessicawilsonlaw.com/free-tools — AI-augmented attorneys and agent builders can connect directly.

Elder Law encompasses a broad range of legal issues affecting seniors as they age. As an elder law attorney, I help seniors not only focus on distributing assets on their deaths, but also plan for living independently and joyfully in the decades after retirement.

An elder law attorney is no more expensive than any estate planning attorney. An elder law attorney focuses on preserving seniors' assets while they are living so that they can lead healthy, happy independent lives. An elder law attorney can help develop an aging plan that includes long term care options while still preserving assets for future generations. An elder lawyer also assists seniors and their families qualify for Medicaid long-term care at home or in a hospital.

Medicaid long-term care is a joint state and federal program providing needed nursing home and home care services to citizens over age sixty-five, blind, or disabled and who are below certain income and asset thresholds. Contrary to popular opinion, Medicaid recipients receive the same homecare and nursing home care as private pay individuals. That's right — the same exact care. Medicaid is by far the largest provider of such services in the country.

The term "Medicaid long-term care" covers a range of different care:

• Chronic Medicaid, for inpatient nursing home care (also called "institutional"). This is an entitlement that is provided to anyone who is eligible, and only for care given in nursing homes.
• Community Medicaid, utilizing home health care services. Also called Medicaid waivers / home and community based services (HCBS). HCBS provides in-home care, adult day care, and assisted living.

To be eligible for Medicaid long-term care, an individual must:

• Be 65 years of age or older, permanently disabled, or blind
• Have no more than $33,038 in non-qualified assets
• Meet income restrictions

New York has a relatively generous Medicaid program which in 2026 allows a recipient to have up to $33,038 in countable resources and, under some circumstances, the residence.

Countable assets include:

• Cash
• Real estate, such as a vacation home or commercial building
• Bank accounts (checking, savings)
• Stocks, bonds, and other investments

Some assets are considered exempt, including:

• Primary residence (under some circumstances)
• Retirement accounts if the RMD is being taken
• Personal belongings
• A vehicle
• Non-refundable pre-paid funeral plans
• Burial funds (up to $1,500)
• Life insurance with a cash surrender value less than $1,500
• If married, the community spouse can retain between $74,820 and $162,660.

New Yorkers who do not meet the asset limits for Medicaid eligibility have some options available.

1. Transfer assets to a spouse. Spouses with over the community spouse resource allowance ($162,660 in 2026) can sign a "spousal refusal." Be aware that Medicaid can go after the spouse's estate when they sign a spousal refusal, but with proper planning this can be avoided.
2. Transfer assets to children. This can be problematic because the applicant loses control over the assets and runs the risk of children losing it to divorce or creditors. Moreover, if the applicant needs nursing home care before the 5-year look-back period, children may not return the assets.
3. Make exempt transfers. Medicaid has different exempt transfer rules depending on the type of asset. A home can be transferred to:
   • A spouse
   • A child under 21, or a certified blind / disabled child of any age (this can include a child over age 65)
   • A sibling with an equity interest in the home who has lived there for at least one year immediately prior to the applicant's most recent institutionalization
   • A caretaker adult child — a child who has resided in the home for at least 2 years immediately prior to the most recent institutionalization and who provided care that allowed the applicant to stay at home instead of in a nursing home. Care is presumed unless it can be proven otherwise.
4. Other assets can be transferred without a penalty to:
   • A blind or disabled child
   • A trust for the sole benefit of a disabled person under the age of 65 (Medicaid can seek reimbursement against the estate of the disabled beneficiary)
   • A trust for the sole benefit of a spouse
5. Draft a Medicaid Asset Protection Trust (MAPT). Assets placed in an irrevocable trust are not countable resources for Medicaid purposes after the look-back period. The grantor (and spouse) retains the right to income but cannot touch the principal. If a home is placed in the trust, the grantor retains the right to live there for life and continue to receive property tax exemptions. A family member or friend is chosen to act as the trustee. Most importantly, the grantor retains the right to change beneficiaries at any time and replace the trustee.

A Pooled Income Trust is how New Yorkers can obtain home care services while also preserving their monthly income for payment of household bills.

Pooled Income Trusts are established and managed by non-profit organizations for the benefit of disabled beneficiaries. Since a Community Medicaid recipient can only keep $1,836 per month, any income above this amount is sent to the Pooled Income Trust. The Medicaid recipient submits bills to the Pooled Income Trust for household expenses paid out for his or her benefit, and the trust uses the income deposited to pay those bills.

Medicaid long-term care income guidelines vary depending on whether the recipient needs home care (Community Medicaid) or nursing home (Chronic Medicaid).

In 2026, the Community Medicaid monthly income limit for a single applicant is $1,836. Income above this amount can be sheltered through a Pooled Income Trust. For Chronic Medicaid (nursing home), nearly all income must be turned over to the facility, with only a $50 personal-needs allowance retained by the recipient. A married applicant's spouse who remains in the community may keep more — the spousal income allowance (MMMNA) is up to $4,066.50 per month.

A pooled income trust can pay for:

• Prescriptions not covered by insurance
• Medical supplies not supplied by Medicaid
• Doctor visits not covered by Medicaid
• In-home care not covered by Medicaid
• Home modifications such as wheelchair ramps, stair lifts, bathroom remodeling, and other improvements for independence and safety
• Utilities
• Rent / mortgage
• Property taxes
• Credit card bills

Many people believe that if they start getting rid of assets immediately, they'll be "impoverished" enough to qualify for Medicaid. For instance, someone might sell property, such as a house, for less than market value to qualify. Unfortunately, that's not the way it works — and you could create even more trouble if you do it without help.

When you apply for Chronic (nursing home) Medicaid, the agency looks back at five years of financial records. Any uncompensated transfers (gifts, below-market sales, transfers into a non-protective trust) during that window can trigger a penalty period during which Medicaid will not pay for care.

The look-back for Community (home care) Medicaid is statutorily set to 30 months but has been repeatedly delayed. As of June 2026, the community look-back is not currently being enforced — but that can change. Plan as if it could activate.