Rochester Senior AdvisorHow much can the spouse at home keep when one spouse needs a nursing home?
In 2026 the community spouse in New York may keep resources equal to the greater of $74,820 or half the couple's countable resources, up to $162,660, and income up to a monthly maintenance needs allowance of $4,066.50.
| 2026 New York spousal standard | Amount |
|---|---|
| Community spouse resource allowance, minimum (state) | $74,820 |
| Community spouse resource allowance, maximum (federal) | $162,660 |
| Minimum monthly maintenance needs allowance | $4,066.50 |
| Nursing home personal needs allowance | $50 |
Source: NYSDOH GIS 26 MA/03, 2026 Medicaid Levels and Other Updates (January 23, 2026).
New York also allows a spouse to refuse to contribute to the other's care, a step known as spousal refusal, after which the county may seek contribution. It is a legitimate tool but needs professional advice.
What is the Medicaid look-back period in New York?
For nursing home Medicaid, New York reviews 60 months of financial transactions before the application; gifts or transfers for less than fair value in that window create a penalty period of ineligibility.
For community-based care such as home care, a 30-month look-back was written into the 2020 state budget, but its start has been postponed repeatedly and the Department of Health had not put it into effect as of our last check. Confirm the current rule with the county Department of Social Services before relying on it.
How is a transfer penalty calculated for a Rochester-area nursing home?
The county divides the value of the uncompensated transfer by Medicaid's regional monthly rate, which for 2026 is $15,675 in the Rochester region (Monroe, Ontario, Wayne, Livingston and five other counties) and $13,765 in the Western region, which includes Orleans County.
So a $47,025 gift made within the look-back by a Monroe County resident would mean about three months without Medicaid nursing home coverage. The penalty starts only once the person is otherwise eligible and in a nursing home, which is why timing matters.
Does New York Medicaid count the house?
A home is generally exempt while the applicant, a spouse or certain relatives live there, but for long-term care New York caps the exempt equity at $1,130,000 in 2026 unless a spouse or a minor or disabled child lives in the home.
After death, the state may seek recovery from the estate for Medicaid paid on behalf of a person 55 or older. Planning tools exist, and a Rochester elder law attorney can explain them; this site does not give legal advice.
How much of a nursing home resident's income goes to the home?
Once on Medicaid, a New York nursing home resident keeps a $50 monthly personal needs allowance plus health insurance premiums, and most of the rest of their income goes toward the cost of care.
If there is a spouse at home, part of the income can go to that spouse first, up to the maintenance allowance. The personal needs allowance pays for haircuts, clothing and small purchases, and the home must account for it if it holds the money.
At a glance
| New York's 2026 rules | What they do not mean | |
|---|---|---|
| Spouse at home | Keeps $74,820-$162,660 in resources | Must spend down to $33,038 |
| Look-back | 60 months for nursing homes | No review for community care forever |
| Penalty divisor | $15,675 a month in the Rochester region | The same rate statewide |
| Home | Exempt up to $1,130,000 equity in most cases | Always safe from estate recovery |
Sources include the N.Y. Social Services Law and Public Health Law, 18 NYCRR Parts 487-494, 10 NYCRR Parts 415 and 1001, Department of Health GIS messages, CMS, the VA and CareScout, as cited above; see our editorial standards.
