Medicaid Financial Eligibility Rules for Nursing Home Care in New York State should be updated as follows:
RESOURCE LEVEL FOR THE MEDICAID APPLICANT FOR 2026:
The resource level for the Medicaid applicant is $33,038. GIS 26 MA/05 Attachment, which is dated 2/13/2026.
This is an update from the 2026 resource level which had previously been announced. The resource level was changed after the federal poverty levels were revised.
Posted 02/18/2026.
GIS 26 MA/03, which is dated 01/23/2026, discusses Medicaid renewal (recertification).
It advises that when a Medicaid case is up for renewal with a budget “From” date of 01/01/2026 or later: it should be re-budgeted using the person’s 2026 Social Security benefit amount and the person’s 2026 Medicare Part B premium.
However, if this calculation results in the person going from no spenddown to having a spenddown, or if it results in the person’s spenddown increasing: the case should be budgeted using the person’s 2025 Social Security benefit amount and the person’s 2025 Medicare Part B premium. These cases should be tracked. After the 2026 Federal Poverty Level is published in the Federal Register, a new Medically Needy Income level will be announced based on the 2026 Federal Poverty level. After that time, these cases should be updated using the person’s 2026 Social Security benefit amount and the person’s 2026 Medicare Part B premium.
All redeterminations effective 01/01/2026 or later will need to be re-budgeted, retroactive to 01/01/2026, after the new Medically Needy Income level based on the 2026 Federal Poverty Level is published in the Federal Register.
Posted 01/24/2026
Medicaid Financial Eligibility Rules for Nursing Home Care in New York State should be updated as follows:
INCOME LEVEL FOR 2026 – MONTH ONE – PERSON IN A NURSING HOME WHO DOES NOT HAVE A COMMUNITY SPOUSE
The Medically Needy Income Level for a household of one is $1,800 per month for now. GIS 26 MA/03 Attachment. In the first Non-MAGI Population page of the Attachment, look for the Monthly amount of Medicaid Income at 138% FPL for a household size of one in the chart at the top. In the second Non-MAGI Population page of the Attachment, look for the SSI-Related amount for a household of one.
INCOME LEVEL FOR 2026 – MONTH ONE – PERSON IN A NURSING HOME WHO DOES HAVE A COMMUNITY SPOUSE
The Medically Needy Income Level for a household of one is $1,800 per month for now. GIS 26 MA/03 Attachment. In the first Non-MAGI Population page of the Attachment, look for the Monthly amount of Medicaid Income at 138% FPL for a household size of one in the chart at the top. In the second Non-MAGI Population chart of the Attachment, look for the SSI-Related amount for a household of one.
INCOME LEVEL FOR 2026 – AFTER MONTH ONE – PERSON IN A NURSING HOME WHO DOES NOT HAVE A COMMUNITY SPOUSE
The person in the nursing home is allowed to keep a Personal Needs Allowance of $50 per month if they do not have a community spouse. In the first Non-MAGI Population page of the attachment to GIS 26 MA/03, look for the Institutionalized Spouse’s income in the Spousal Impoverishment chart.
INCOME LEVEL FOR 2026 – AFTER MONTH ONE – PERSON IN A NURSING HOME WHO DOES HAVE A COMMUNITY SPOUSE
The person in the nursing home is allowed to keep a Personal Needs Allowance of $50 per month if they have a community spouse. In the first Non-MAGI Population page of the attachment to GIS 26 MA/03, look for the Institutionalized Spouse’s income in the Spousal Impoverishment chart.
INCOME LEVEL FOR 2026 – COMMUNITY SPOUSE
The community spouse is allowed to keep a Minimum Monthly Maintenance Needs Allowance of $4,066.50 per month. GIS 26 MA/03 and its attachment. In the first Non-MAGI Population page of the attachment to GIS 26 MA/03, look for the Community Spouse’s income in the Spousal Impoverishment chart.
CHANGE IS COMING: GIS 26 MA/03 is dated 01/23/2026. The Medically Needy income level is based on a percentage of the Federal Poverty Level. When the 2026 Federal Poverty Level is published in the Federal Register, the Medically Needy Income Level will be updated. This is the level which is used for Month One for a person in a nursing home who does not have a community spouse, and for Month One for a person in a nursing home who does have a community spouse.
Posted 01/24/2026
Medicaid Financial Eligibility Rules for Nursing Home Care in New York State should be updated as follows:
HOME EQUITY LIMIT FOR 2026
The home equity limit for Medicaid coverage of nursing facility services is $1,130,000. GIS 26 MA/03, which is dated 01/23/2026.
For an explanation of how this rule works, see pages 13-14 of Medicaid Financial Eligibility Rules for Nursing Home Care in New York State.
Posted 01/24/2026
Medicaid Financial Eligibility Rules for Nursing Home Care in New York State should be updated as follows:
RESOURCE LEVEL FOR THE MEDICAID APPLICANT FOR 2026:
The resource level for the Medicaid applicant remains at $32,396 for now. GIS 26 MA/03 and its Attachment. In the first Non-MAGI Population page of the Attachment, look for Resources for a Household Size of one in the chart at the top. Also look for the Institutionalized Spouse’s resources in the Spousal Impoverishment chart on the same page. In the second Non-MAGI Population page of the Attachment, look for the SSI-Related amount for Resources.
RESOURCE LEVEL FOR THE COMMUNITY SPOUSE FOR 2026:
The minimum resource level for the community spouse is $74,820 and the maximum is $162,660. GIS 26 MA/03 and its Attachment. In the first Non-MAGI Population page of the Attachment, look for the Community Spouse resources in the Spousal Impoverishment chart. For an explanation of how this rule works, see page 9 of Medicaid Financial Eligibility Rules for Nursing Home Care in New York State.
CHANGE IS COMING: GIS 26 MA/03 is dated 01/23/2026. The Medically Needy resource level is based on a percentage of the Medically Needy income level, and the Medically Needy income level is based on a percentage of the Federal Poverty Level. When the 2026 Federal Poverty Level is published in the Federal Register, the Medically Needy resource level will be updated.
Posted 01/24/2026
GIS 25 MA/16, dated 12/23/2025, discusses the Public Assistance Reporting Information System (PARIS). Paris is used to identify people who are reported to be receiving public benefits in more than one state. If there is a match, the person must be given 30 days to provide a copy of one of the documents listed in the GIS’s attachment. The attachment specifies that the document must be dated within six months.
If the person does not respond, or if the person confirms that they left the state, their Medicaid eligibility must be terminated.
The GIS spells out special rules for people who receive Supplemental Security Income (SSI) benefits.
The documents listed in the attachment are:
There are different requirements for children.
Posted 01/02/2026
Previously, as a condition of receiving Medicaid, Applicants had been required to take all necessary actions to obtain other benefits to which they were entitled. GIS 25 MA/15, dated 12/23/2025, advises us that this rule has been eliminated.
Social Security Benefits: A Medicaid Applicant/Recipient is no longer required to apply for Social Security Retirement benefits, Social Security Survivor benefits, or Social Security Disability benefits. The GIS refers to these as “RSDI.”
Unemployment Benefits: A Medicaid Applicant/Recipient is no longer required to apply for Unemployment Insurance Benefits.
Veterans’ Benefits: A Medicaid Applicant/Recipient is no longer required to apply for veterans’ benefits. However, if someone is identified as a veteran, the local social service district is still responsible for advising the person that the State Division of Veteran’s Administration and local veterans’ service agencies can provide assistance and benefits to veterans under State and Federal law. Furthermore, if a veteran or the widow of a deceased veteran is institutionalized, the local social service district must still refer the person to the federal Veterans’ Administration for determination of whether the person is eligible for a $90 reduced (limited) pension benefit; this benefit continues to be subject to an income disregard.
Retirement Funds: A Medicaid Applicant/Recipient who is eligible to receive periodic payments from a retirement fund is no longer required to apply for the maximum periodic payment amount as a condition of Medicaid eligibility. Furthermore, failure to receive the maximum payment amount is no longer subject to treatment as an uncompensated transfer of assets. The GIS describes retirement funds as, “annuities or work-related plans for providing income when employment ends (e.g. pension, disability or other retirement plans administered by an employer or union). Other examples are funds held in an individual retirement account (IRA) and plans for self-employed individuals, sometimes referred to as Keogh plans.”
The GIS advises us that treatment of retirement funds for income or resource counting rules must be determined based on whether or not the retirement fund is in payout status. A retirement fund is in payout status when the person is receiving regularly scheduled periodic payments.
If a retirement fund is in payout status, it is subject to income rules. The payments are counted as monthly unearned income, regardless of the actual frequency of payments. The principal balance of the retirement fund is not a countable resource.
If a retirement fund is not in payout status, the principal balance of the retirement fund is a countable resource. The countable resource value is the amount that the person can currently withdraw. If there is a penalty for early withdrawal, the value of the resource is the amount available after the penalty deduction. Note that when calculating the value of the retirement fund, ordinary income taxes are not deducted.
If a person reports that there is a change to the periodic payment amount, local social service districts must recalculate income. If a person reports that there is a change to the payout status, local social service districts must change the treatment of the fund (from countable resource to countable income, or from countable income to countable resource). The recalculation is effective as of the month in which the change occurred. If the change is subject to the new eligibility requirement rule, the retroactive redetermination is limited to changes which occurred on or after 06/04/2025.
U.S. Savings Bonds: If a Medicaid Applicant/Recipient owns U.S. Savings Bonds: these bonds increase in value until they are cashed or reach final maturity. The bonds have a minimum retention period which is used for determining whether they are available, and what their value is. In the past, if the Medicaid Applicant/Recipient wanted Medicaid coverage for long-term care services, they were required to ask the U.S. Treasury to waive the minimum retention period. They are no longer required to ask the U.S. Treasury for this waiver.
Elective Share: A surviving spouse is no longer required to exercise the right of election against the deceased spouse’s estate, if the couple is not subject to a transfer of assets review.
Medicare: Medicaid Applicants must still apply for Medicare.
Health Insurance: Medicaid Applicants must still apply for available third-party health insurance. The rule regarding Medicaid payment of cost-effective health insurance premiums has not changed.
Posted 01/02/2026
The 2026 regional rates for calculating Medicaid penalty periods are found in GIS 25 MA/14, which is dated 12/22/2025. They are:
CENTRAL: $14,146
Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tioga, and Tompkins.
NORTHEASTERN: $14,783
Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, and Washington.
WESTERN: $13,765
Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, and Wyoming.
NORTH METROPOLITAN: $15,024
Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster, and Westchester.
NEW YORK CITY: $15,282
Bronx, Kings (Brooklyn), New York (Manhattan), Queens, and Richmond (Staten Island).
LONG ISLAND: $15,193
Nassau and Suffolk.
ROCHESTER: $15,675
Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne, and Yates.
Posted 12/23/2025
There is a new life expectancy table to use when determining if an annuity, promissory note, loan or mortgage is actuarially sound.
GIS 25 MA/09, dated 08/26/2025, states that the life expectancy table in its attachment is to be used rather than the table which was attached to 06 OMM/ADM-5.
Posted 08/31/2025
GIS 25_06, dated 07/14/25, has updated rules regarding Medicaid Recertification. Rules had been changed during the COVID-19 Public Health Emergency; now they are revised.
If a Medicaid Recertification was filed on or prior to 06/30/2025, the Social Services District was not allowed to decrease or terminate Medicaid coverage based on the Medicaid recipient’s resources. That rule applied to Recertifications, not applications.
This GIS tells us that Social Service Districts must apply the resource test for Recertifications received after 06/30/2025. Assets must be reviewed at renewal.
The GIS also tells us that the Asset Verification System (AVS) process will resume beginning with July renewals (cases with 09/30/2025 end dates). For renewals received after 06/30/2025, Social Service Districts must verify resources by submitting an AVS request. Social Service Districts also might need to submit AVS requests for non-applying spouses for cases which were authorized during the COVID-19 Public Health Emergency.
The GIS includes a timing reminder. A Medicaid recipient must be given 30 days to respond to renewal notices. If a Medicaid recipient’s eligibility is discontinued at the renewal process for failure to renew, but the applicant returns the completed renewal before the case expires, or within 90 days after the case is closed for failure to renew, the Social Service District must use the renewal to reopen the closed case. If it is within 30 days, the Social Service District must reactivate the case. If it is beyond 30 days, the Social Service District must reregister the case. If the Medicaid recipient is determined eligible, coverage may be authorized back to the effective date of discontinuance for the failure to renew.
The Attachment to the GIS reminds us that the changes discussed are for Recertifications only. For new applications, Medicaid applicants had already been required to provide information about resources, and use of the AVS system was already in place.
Posted 07/16/2025