New York Medicaid for Seniors & Long-Term Care

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 — a friend, neighbor, or almost any family member, with the only exclusions being 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, who 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 is handled by the statewide fiscal intermediary, Public Partnership LLC (PPL); the consumer remains the legal employer while PPL handles tax withholding and wage processing. To apply, contact your MLTC plan or local DSS/HRA.

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 — $1,836/month for a single person as of 2026. Income above that limit must be applied toward the nursing home cost (the "patient pay amount," minus a $50/month personal needs allowance), with Medicaid covering the remainder.

New York does not use Miller Trusts (Qualified Income Trusts) for nursing home applicants with income over the limit, unlike some states (including Texas) that require one when income exceeds the state's cap. Instead, a resident whose income exceeds the Medicaid Income Level applies the excess income directly toward the nursing home cost. 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 long-term care Medicaid instead focus on resource spend-down and look-back compliance.

The Program of All-Inclusive Care for the Elderly (PACE) is available in select New York counties, integrating 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.

Federal law (42 U.S.C. § 1396r-5) protects the community spouse when the other spouse enters a nursing facility. As of 2026, the community spouse can retain up to $162,660 in countable resources (CSRA, federal maximum) and $4,066.50/month in income (called the Community Spouse Monthly Income Allowance, or CSMIA, in New York). The institutionalized spouse's resource limit is $33,038. Request a formal asset assessment from your local DSS or HRA at time of application.

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. A surviving spouse, a child under 21, or a blind or disabled child prevents recovery while that person is alive. For specific advice, consult a licensed elder law attorney in New York.

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