In New York, there are three primary categories of Medicaid:
- MAGI Medicaid – Generally for low-income adults under 65, children, and pregnant women.
- Community Medicaid – For individuals who live at home but need help with daily care.
- Institutional Medicaid – For individuals who require care in a nursing home or skilled nursing facility.
Since MAGI Medicaid is geared more toward individuals under 65, we’ll focus today on the two types that are most relevant for older adults: Community Medicaid and Institutional Medicaid.
Community Medicaid: Care at Home
Community Medicaid is a lifeline for seniors who wish to remain in their homes but need assistance with daily living. If your loved one needs help bathing, dressing, preparing meals, or managing medications, Community Medicaid can provide a home health aide to assist with these tasks.
Other services covered may include:
- Personal care aides (home attendants)
- Adult day care programs
- Housekeeping assistance
- Medical supplies and equipment
- Some therapies and nursing care
The goal of Community Medicaid is to keep people safely in their homes for as long as possible—and it’s an increasingly popular option for families trying to avoid nursing homes.
Who Qualifies for Community Medicaid?
To qualify for Community Medicaid, an individual must meet strict income and asset limits. As of 2025, the monthly income limit for an individual is approximately $1,800, and the asset limit is $32,396. (These numbers are subject to annual updates.)
Here’s the good news: With the help of an experienced elder law attorney, there are legal planning strategies that can protect your income and assets while still qualifying you for benefits. For example, you might use a pooled income trust to preserve your excess income or transfer assets into a Medicaid Asset Protection Trust (MAPT).
There is currently no “look-back period” for Community Medicaid, although this may change in the future. New York passed a law for a 30 month look back for Community Medicaid but at the time of publishing this article, it had not gone into effect. Currently by having no lookback, this makes planning easier and more flexible—but don’t delay. Medicaid rules are always evolving.
Institutional Medicaid: Nursing Home Coverage
When staying at home is no longer safe or sustainable, Institutional Medicaid can cover the cost of nursing home care—which can exceed $240,000 per year in New York.
This type of Medicaid kicks in only when someone is residing in a long-term care facility, such as a skilled nursing home, and it’s specifically designed to help cover those high costs.
What Makes Institutional Medicaid Different?
While the income and asset limits are similar to Community Medicaid, the major difference is this: Institutional Medicaid has a five-year “look-back period.”
That means the state will review any financial transfers made in the five years prior to the application. If you’ve given away money or transferred assets for less than fair market value, you may face a penalty period, during which you’re ineligible for Medicaid coverage.
This rule often catches families off guard. That’s why early planning is essential. Creating a Medicaid Asset Protection Trust well before nursing home care is needed can help shield assets and ensure eligibility when the time comes.
Why Understanding Medicaid Matters
Navigating Medicaid can feel like trying to find your way through a maze. The rules are complex, and even small mistakes can cause costly delays or denials. But understanding the two key types—Community and Institutional Medicaid—can empower you to make better decisions for yourself or your aging parents.
Both forms of Medicaid offer critical services, but they have different rules, benefits, and timelines. That’s why working with an elder law attorney is so important. We can guide you through the process, develop strategies to protect your hard-earned assets, and help you access the care you need—whether at home or in a facility.
Take the First Step Toward Long-Term Care Planning
Medicaid planning isn’t just about filling out forms—it’s about protecting your independence, your dignity, and your financial future. The earlier you start planning, the more options you’ll have.
If you’re caring for an aging parent, or starting to think about your own long-term care needs, now is the time to learn more. Contact our office today to schedule a consultation and explore your options.
Long-term care can be overwhelming—but you don’t have to figure it out alone.
Contact us today if you’re ready to take the next step in securing your family’s future. Be sure to mention this article during your consultation so we can focus on your specific concerns and guide you with personalized advice.
This article is a service of Miller & Miller Law Group. We do not just draft documents; we ensure you make informed and empowered decisions about life and death for yourself and the people you love.
