Founding Attorney
For many seniors in New York, Medicaid is the only way to afford long-term care at home or in a nursing facility. But if your income seems too high, you might worry that you don’t qualify. The good news is that there are legal tools and planning strategies that can help you access Medicaid even if your monthly income is above the program’s limits.
Here, we’ll take a closer look at how Medicaid eligibility works and what options you may have if your income is over the threshold.
How Medicaid Income Limits Work in New York
Medicaid has strict income and asset limits. In 2025, the monthly income cap for a single individual applying for Community Medicaid in New York is $1,800. That includes nearly all sources of income, such as:
- Social Security benefits
- Pensions and retirement distributions
- Interest, dividends, and rental income
If your monthly income is above this level, you may assume you are automatically disqualified. However, the rules are more flexible than they appear, especially when you understand how the surplus income rules apply.
Legal Strategies for Income Above the Limit
If your income is too high to qualify outright, you may still be eligible through the Medicaid Excess Income Program. Also known as a “spend-down,” this program allows you to deduct certain medical expenses from your income each month to reach the allowable limit.
Here’s how it works:
- The state calculates how much of your income is above the Medicaid threshold.
- You must either spend that “surplus” on medical expenses or contribute it to a special trust.
- Once the spend-down is met, Medicaid covers the rest of your approved care for that month.
One of the most effective tools for seniors receiving home care under Medicaid is the pooled income trust. Instead of spending your surplus income on medical bills each month, you can deposit it into a trust run by a nonprofit organization. That trust can then use the funds to pay for your living expenses, such as:
- Rent or mortgage
- Utilities
- Groceries
- Transportation
This option allows you to maintain your standard of living while staying eligible for benefits.
Why Timing and Documentation Matter
Whether you’re using a pooled income trust or participating in the spend-down program, timing is everything. Medicaid is reviewed on a monthly basis, and a missed payment or an incomplete record can result in a denial of services.
To keep things on track, you need to:
- Submit the correct documents for your income and expenses
- Ensure your trust payments are made before the Medicaid cycle begins
- Respond quickly to requests for additional paperwork
Mistakes can be costly, especially when care is urgently needed. Planning ahead with proper legal guidance helps reduce stress and avoid interruptions in your care.
Common Mistakes to Avoid
Many people make costly errors because they assume they won’t qualify or try to handle everything alone. Here are a few pitfalls to watch out for:
- Not setting up a pooled trust when you’re eligible
- Using surplus income for non-approved expenses
- Filing with inaccurate income documentation
- Waiting too long to apply, especially after a diagnosis or health change
Even small missteps can lead to denial or delays in benefits.
How Sverdlov Law Can Help
At Sverdlov Law, we work with seniors and their families in New York to create Medicaid plans that work for their income, needs, and goals. Whether you’re just starting the process or trying to fix a denied application, we can guide you through the steps.
We help clients:
- Set up pooled income trusts
- Calculate and manage spend-down obligations
- Gather and prepare documentation
- Submit Medicaid applications and follow through with the review process
Every situation is different. We take the time to understand your finances, health care needs, and long-term goals so you can move forward with a clear plan.
Next Steps for Medicaid Planning
Having income above the Medicaid limit doesn’t mean you’re out of options. With the right plan, many seniors qualify for the care they need while preserving income for everyday living.
If you’re unsure about your eligibility or want help putting a strategy in place, contact Sverdlov Law today. We’ll work with you to make sure your application is on solid ground and help you make the most of the resources available to you.