Last updated: May 20, 2026 | By Inna Fershteyn, Esq. | Reading time: ~9 minutes
The Medicaid 5-year lookback in New York reviews every asset transfer you made in the 60 months before applying for nursing home Medicaid. The state calculates a penalty period by dividing the total amount transferred by the regional monthly Medicaid rate for the area where the nursing facility is located. Transfers to a spouse, to a disabled or blind child, to a caregiver child who lived with you for at least two years, and into a properly funded Medicaid Asset Protection Trust are exempt. This article explains how the calculation works, who qualifies for exceptions, and what families can do at least five years before they need care.
Key facts at a glance (2026)
- Lookback period: 60 months (5 years) for Institutional / Nursing Home Medicaid in New York.
- Community Medicaid lookback: A 30-month lookback was authorized in 2020 but has not been implemented as of May 2026.
- Single asset limit (2026): $33,038.
- Married couple, both applying (2026): $44,796 combined.
- Community Spouse Resource Allowance (2026): Up to $162,660 for the non-applicant spouse.
- Regional penalty divisor range (2026): $13,765/month (Western NY) to $15,675/month (Rochester region).
Institutional vs. Community Medicaid: Which Lookback Applies?
New York runs two long-term care Medicaid programs, and only one of them currently has an active lookback.
Institutional (Nursing Home) Medicaid pays for care in a Medicaid-certified nursing facility. It has a 60-month lookback that applies to every applicant.
Community Medicaid covers home health aides, personal care services, adult day care, and the Consumer Directed Personal Assistance Program (CDPAP). New York State authorized a 30-month lookback for Community Medicaid in the April 2020 budget, but implementation has been delayed multiple times. As of May 2026, no Community Medicaid lookback is being enforced.
Source: New York State Department of Health, 30-Month Lookback for Community Based Long Term Care Services (MRT2).
The article below focuses on the Institutional / Nursing Home lookback because that is the rule actively affecting families today.
Nursing Home Medicaid Eligibility Requirements in 2026
To qualify for Nursing Home Medicaid, the applicant must have countable assets and monthly income below the state limits.
Countable assets include cash, checking and savings accounts, money market accounts, certificates of deposit, stocks, bonds, cryptocurrency, investment accounts, and vacation homes.
Exempt assets include the applicant’s primary residence (within the home equity limit), personal belongings, household furnishings, clothing, one vehicle, prepaid funeral arrangements, and IRAs or 401(k)s that are in regular payout status under New York rules.
2026 Asset Limits in New York
| Household situation | 2026 asset limit |
|---|---|
| Single applicant | $33,038 |
| Married couple, both spouses applying | $44,796 combined |
| Married, only one spouse applying — applicant | $33,038 |
| Married, only one spouse applying — community spouse (CSRA) | Up to $162,660 (minimum $74,820) |
Source: New York State Department of Health, 2026 Medicaid resource and income levels (effective January 1, 2026). See NY DOH Medicaid.
2026 Monthly Income Limits
Nearly every source of income counts toward the limit, including wages, alimony, pensions, Social Security retirement and disability, annuity payments, and IRA distributions. Holocaust restitution payments and VA Aid and Attendance benefits are not counted.
| Household situation | 2026 monthly income limit |
|---|---|
| Single applicant | $1,836 / month |
| Married couple, both applying | $2,489 / month combined |
| Married, only applicant spouse counted | $1,836 / month |
Source: NY DOH, 2026 Medicaid Income and Resource Limits, effective January 1, 2026.
If income exceeds the limit, the applicant may still qualify through a Pooled Income Trust or a Medically Needy spend-down. A Brooklyn Medicaid attorney can advise on which option fits the family’s situation.
What Counts as a “Transfer” Under the New York Medicaid Lookback?
Under the lookback, a transfer is any gift or sale of an asset for less than fair market value during the 60 months before the Medicaid application. This includes:
- Cash gifts to children, grandchildren, or anyone else (other than an exempt recipient).
- Selling a home, car, or other property to a relative below market price.
- Funding certain irrevocable trusts.
- Forgiving loans owed to the applicant.
- Sales at fair market value where documentation is missing or insufficient.
Medicaid can treat a sale as a disqualifying transfer even when the price was fair, if the applicant cannot prove it. Proper sale documentation, including signed contracts, appraisals, and bank records, is essential. For more detail, see the article How Gifts Can Delay Medicaid Eligibility in New York.
Example: a below-market home sale
A homeowner sells a $200,000 house to her cousin for $170,000. Even though it is a real sale, the $30,000 below-market gap can be treated as a disqualifying transfer under the 5-year lookback because the cousin is not an exempt family member and the discount was not supported by an independent appraisal.
How the Penalty Period Is Calculated
The penalty period equals the total dollar amount of disqualifying transfers divided by the regional monthly Medicaid rate, also called the regional penalty divisor. The divisor reflects the average private-pay cost of a nursing home in the region where the facility is located, and the New York State Department of Health publishes new figures every January.
2026 Regional Penalty Divisors
| NY Medicaid region | 2026 monthly divisor |
|---|---|
| New York City (5 boroughs) | $15,282 / month |
| Long Island | $15,193 / month |
| Northern Metropolitan | $15,024 / month |
| Northeastern | $14,783 / month |
| Rochester | $15,675 / month |
| Central | $14,146 / month |
| Western | $13,765 / month |
Source: New York State Department of Health, GIS 25 MA/14 — 2026 Medicaid Regional Rates for Calculating Transfer Penalty Periods, effective January 1, 2026.
Worked example 1: Brooklyn (NYC region)
A Brooklyn applicant gifted $100,000 to her son four years before applying for nursing home Medicaid. Because the gift falls inside the 60-month lookback, Medicaid divides it by the 2026 NYC divisor of $15,282. The penalty period is approximately 6.54 months. During those 6.54 months, the family must pay the nursing home out of pocket before Medicaid begins covering the cost.
Worked example 2: Long Island
A Nassau County applicant transferred $200,000 to his daughter three years before applying. The 2026 Long Island divisor is $15,193, so the penalty period is approximately 13.16 months. The same $200,000 gift would produce a different penalty in a different region: about 13.09 months in NYC, or about 14.53 months in Western New York. The region used is the one where the nursing facility is located, not where the applicant lived previously.
What happens during the penalty period
During the penalty period, Medicaid will not pay for nursing home care. The applicant or the family pays privately, often at a rate of $15,000 to $20,000 per month in the New York City area. If the applicant is in a nursing home and receives Supplemental Security Income (SSI) during the penalty period, the SSI payment is reduced to $30 per month for the duration of institutionalization, and other state assistance can be reduced as well.
Transfers That Are Exempt From the Lookback
Federal and New York rules exempt several categories of transfers. A transfer that fits one of the categories below will not trigger a penalty period.
- Transfers to a spouse. Transfers between spouses are not counted. The community spouse is also protected by the Community Spouse Resource Allowance, which permits the non-applicant spouse to keep up to $162,660 in 2026 (minimum $74,820).
- Transfers to a disabled or blind child. Any direct transfer to a child of any age who is disabled or blind under Social Security rules is exempt.
- The caregiver-child exception. A transfer of the home to an adult child who lived with the applicant for at least two years immediately before nursing home admission and provided care that delayed the move is exempt.
- Transfers to children under 21. Transfers to a son or daughter under age 21 are exempt.
- The sibling exception. A home can be transferred to a sibling who has an equity interest in the home and who lived there for at least one year before the applicant entered the nursing facility.
- Transfers into a properly funded Medicaid Asset Protection Trust. Assets placed in a MAPT before the 60-month window do not count as disqualifying transfers, and assets inside the trust do not count toward the applicant’s asset limit.
Medicaid Asset Protection Trusts (MAPTs) and the Lookback
A Medicaid Asset Protection Trust (MAPT) is an irrevocable trust that holds assets for the benefit of the applicant’s family. The grantor transfers ownership of selected assets, typically a home and a portion of liquid savings, to a trustee. The trustee distributes income from the trust under the grantor’s lifetime instructions and passes the assets to the named beneficiaries after death.
Because the assets are no longer owned by the applicant, they do not count toward the $33,038 asset limit. The transfer into the trust does count as a Medicaid transfer, however, which is why the trust must be funded at least 60 months before the application. A MAPT funded inside the lookback window will trigger a penalty period equal to the value placed in trust divided by the regional divisor.
A MAPT is one of several planning tools. Promissory notes, caregiver agreements, life-estate deeds, and spousal refusal each have a role depending on the family’s circumstances and timeline.
Five Common Mistakes Families Make in the 60-Month Window
Most penalty periods are caused by ordinary family decisions that were not framed as Medicaid planning. The patterns below are the ones our firm sees most often.
- Gifting to grandchildren for college or a down payment without documentation. Birthday checks, tuition help, and gifts for a first home are common, but every transfer of $1,000 or more should be documented and reviewed against the applicant’s timeline.
- Selling a home or car to a family member below market value. Even small below-market discounts can be treated as disqualifying transfers without an independent appraisal and signed sale documents.
- Paying a family caregiver without a Personal Care Agreement. Payments to an adult child or relative caregiver look like gifts to Medicaid unless there is a written caregiver agreement that predates the payments and reflects fair market rates.
- Funding a revocable living trust and assuming it protects assets. Revocable trusts do not shield assets for Medicaid purposes. Only an irrevocable trust funded outside the lookback window protects the assets it holds.
- Waiting until a hospital discharge to start planning. Crisis planning is possible but more expensive and less effective than planning at least five years out. The most powerful tools, including a properly funded MAPT, require time.
What to Do 60 Months Before You Might Need Care
Five years out is the moment when families have the widest set of options. A clear plan with an estate planning and elder law attorney usually involves:
- A full inventory of countable and exempt assets, with valuations.
- A review of titled property, beneficiary designations, and any prior gifts.
- A written plan for which assets to leave in the applicant’s name, which to fund into a MAPT, and which to title jointly with a spouse or community spouse.
- Personal Care Agreements for any family member who is providing care.
- Updated wills, durable power of attorney, and health care proxy to support the plan.
For families starting the planning conversation, the firm’s Medicaid Planning overview explains how the pieces fit together.
Frequently Asked Questions
Can paying family caregivers violate Medicaid rules?
Yes. Without a written Personal Care Agreement signed before payments begin, Medicaid will treat payments to a family caregiver as gifts and apply a penalty period. A Personal Care Agreement sets out duties, hourly rate, schedule, and payment terms, and the rate must be in line with what a non-relative caregiver would charge in the same area.
Can you qualify for Medicaid if you own a home?
Yes. The primary residence is generally exempt from the asset limit if the applicant intends to return home, or if a spouse, a child under 21, or a disabled or blind child lives there. The home equity limit in 2026 is $1,130,000 in New York. Estate recovery after death is a separate issue and can affect what the family inherits.
What is Medicaid estate recovery in New York?
Medicaid estate recovery is the state’s right to seek reimbursement, after death, from the estate of a Medicaid recipient who received long-term care benefits at age 55 or older or who was permanently institutionalized. Recovery can reach bank accounts and the home if it passes through probate. Planning ahead, often with an irrevocable trust, can keep the home out of the probate estate. The article on protecting your house from Medicaid goes into more detail.
Can Medicaid rules change in the future?
Yes. Medicaid rules change every year. Asset and income limits are updated each January, regional rates are reissued every January as well, and major policy changes such as the long-delayed Community Medicaid 30-month lookback can take effect on short notice. Families with active plans should revisit them at least once a year and any time there is a major life event.
Talk to a New York Medicaid Planning Attorney
Plan five years out, not five days out.
The Law Office of Inna Fershteyn and Associates, P.C. has been guiding families through Medicaid planning, irrevocable trusts, and estate administration since 2000. The firm serves clients across Brooklyn, Manhattan, Queens, Long Island, Westchester, and New Jersey, and works with English-speaking, Russian-speaking, and Ukrainian-speaking families.
Call: (718) 333-2395 • Email: Inna@FershteynLaw.com • Office: 1517 Voorhies Avenue, 4th Floor, Brooklyn, NY 11235
Inna is fluent in English, Russian, and Ukrainian — Наша команда говорит по-русски и по-украински.