New York Medicaid's 2026 Numbers, Explained for Rochester Families

The table

These are the figures the Department of Health sent to county social services offices in its General Information System messages 26 MA/03 and 26 MA/05, and the regional rates in 25 MA/14:

The income and resource levels moved up in February, once the 2026 federal poverty guidelines were published, so documents printed in January may show older amounts.

Income: the $1,836 line

The Medicaid income level for one person is $1,836 a month, which is 138% of the federal poverty level. Income above that does not end the conversation. For nursing home care, almost all income goes to the home anyway, and the question is simply whether savings are low enough. For care at home, a person over the line can “spend down” the excess on medical bills each month, or place it in a pooled supplemental needs trust run by a nonprofit, which many Rochester-area elder law attorneys use.

Resources: what counts and what does not

Countable resources include bank accounts, investments and the cash value of some life insurance. The home is generally exempt while the applicant or a spouse lives there, up to $1,130,000 of equity for long-term care. A car, personal belongings, a prepaid funeral and most retirement accounts in payout status are treated differently; the county caseworker applies the details.

Couples: the spouse at home

When one spouse enters a nursing home, the other keeps resources equal to the greater of $74,820 or half the couple's countable resources, up to $162,660, and can receive part of the nursing home spouse's income to bring their own up to $4,066.50 a month. Those protections make Medicaid realistic for many married couples who assume they have too much. New York also recognizes spousal refusal, a formal statement that the community spouse will not contribute, though the county may then pursue contribution.

Three Rochester households, three outcomes

A widowed mother in Irondequoit with $1,950 a month in Social Security and a pension and $28,000 in savings needs a nursing home after a stroke. Her savings are already under the $33,038 limit, so once she applies, Medicaid pays the nursing home and her income, minus a $50 personal needs allowance and her health insurance premiums, goes toward her care. Her family's main task is gathering five years of bank statements.

A married couple in Pittsford with $240,000 in savings faces the husband's nursing home admission. The wife at home can keep half, capped at $162,660, plus the house, and receive part of his income if hers is under $4,066.50 a month. The rest must be spent on care or exempt purchases before he qualifies. A single man in Medina who gave his son $40,000 three years ago and now needs a nursing home faces nearly three months of penalty at the Western region's $13,765 rate.

Common mistakes to avoid

The costliest mistake is moving money to children without advice in the year before a nursing home admission. The second is waiting until savings hit the limit before starting the application, which leaves weeks of private-pay bills while the county reviews five years of records. The third is assuming a spouse must spend everything; New York's spousal rules protect far more than most couples expect.

A fourth mistake is assuming the rules for care at home are the same as for a nursing home. They differ on the look-back, on income spend-down options and on the assessment process, which runs through the New York Independent Assessor before a Managed Long Term Care plan sets hours. When in doubt, call NY Connects or the county Office for the Aging before acting, and an elder law attorney before moving any significant amount of money.

The look-back and the Rochester rate

Nursing home Medicaid looks back 60 months for gifts and below-value transfers. Each transfer is divided by the regional rate to produce months of ineligibility: $15,675 in the Rochester region, which covers Monroe, Ontario, Wayne and Livingston, and $13,765 in the Western region, which includes Orleans. A $31,350 gift by a Penfield resident means two months without Medicaid nursing home coverage; the same gift by a Medina resident means a little over two and a quarter months.

For home care, a 30-month look-back passed in 2020 but its start has been delayed repeatedly; check the current rule with the county before relying on either answer.