For decades, New York was unique. It was the only state that provided generous Medicaid coverage for long-term home care without a financial “look-back” period. If you lived in New York City or Long Island and needed a home health aide, you could transfer your assets on Monday and qualify for care on Tuesday.
In 2026, that era is effectively over.
As an elder law attorney with over 30 years of experience, I, Russel Morgan, am constantly asked: “Is home care still covered?” The answer is yes, Medicaid still covers home health aides (including the popular CDPAP program). However, the barrier to entry has risen dramatically. The state has implemented two massive hurdles: a 30-month financial look-back and strict physical eligibility requirements (the 3-ADL rule).
At Morgan Legal Group, we have helped over 1,000 families navigate these shifting sands. This comprehensive 2026 guide will explain exactly what is covered, the new hurdles you must clear, and the legal strategies we use to help families protect their assets while getting the care they need.
The Cost of “Not” Qualifying: Why Medicaid is Essential
Why go through the trouble of applying for Medicaid? Because the alternative is bankruptcy.
In 2026, the private cost of home care in New York is staggering:
- Hourly Rate: $35 – $45 per hour for a Licensed Home Care Services Agency (LHCSA).
- 24/7 Care: If you need round-the-clock help (split shift or live-in), the cost exceeds $22,000 per month (over $260,000 per year).
Medicare pays $0 for this long-term custodial care. Unless you have millions in savings or a robust Long-Term Care Insurance policy, Community Medicaid is the only financial lifeline available.
Hurdle #1: The Financial Requirements (The 30-Month Look-Back)
For years, the “Look-Back” (a penalty for giving away money) only applied to nursing homes. Now, it applies to home care too.
The Rule in 2026
New York now imposes a 30-month (2.5 year) look-back period for all new Community Medicaid applications.
- How it works: When you apply for a home health aide, Medicaid will audit your financial transactions for the past 30 months.
- The Penalty: If they find “uncompensated transfers” (gifts to children, transferring a deed, large cash withdrawals), they will calculate a penalty period. During this period, you are ineligible for home care coverage.
- The Impact: You can no longer wait until a crisis strikes to protect your assets. If you transfer your home to a trust today because you had a stroke, you might be barred from receiving care for months or years.
The Asset & Income Limits (2026 Estimates)
To qualify, you must also be “poor” on paper. (Note: Figures are adjusted annually for inflation; these are based on 2025 trends).
- Asset Limit: You can keep roughly $31,175 in countable assets.
- Income Limit: You can keep roughly $1,732 per month in income.
The Solution: If you have more than this (as most homeowners do), you do not simply “spend it down.” We use Medicaid Asset Protection Trusts to protect the savings and Pooled Income Trusts to protect your monthly income. But these must be set up *before* you need care to beat the look-back.
Hurdle #2: The Physical Requirements (The “Not Sick Enough” Trap)
This is the change that catches most families off guard. Even if you are financially eligible, you must now be physically eligible under stricter standards.
The “New York Independent Assessor” (NYIA)
You no longer get approved by your local doctor or social worker. You must undergo an independent exam by a state-contracted nurse (NYIA). Their job is to be objective—and often, restrictive.
The 3-ADL Rule
In the past, needing help with *any* task (like cooking or cleaning) helped you qualify.
In 2026, you must prove you need “limited assistance” with at least THREE (3) Activities of Daily Living (ADLs).
- Qualifying ADLs: Bathing, dressing, toileting, transferring (walking), eating.
- Non-Qualifying IADLs: Shopping, cooking, cleaning, managing money.
- The Dementia Exception: If you have a diagnosis of dementia or Alzheimer’s, you only need help with TWO (2) ADLs.
The Danger: Many seniors are frail but can technically dress themselves. They need someone to cook and clean to stay safe. Under the new rules, they may be denied Medicaid home care. Proper preparation of medical records by an attorney is now essential to pass this exam.
What Home Care Services Does Medicaid Cover?
If you hurdle the financial and physical barriers, New York Medicaid offers the best coverage in the nation.
1. Consumer Directed Personal Assistance Program (CDPAP)
This is the most popular program. It allows the patient to hire their own caregivers—including adult children, friends, or neighbors (but not spouses).
- Medicaid pays the caregiver (through a fiscal intermediary).
- You control the schedule.
- It is a way to keep care “in the family” and pay family members for their time.
2. Personal Care Services (PCS)
This is the traditional agency model. Medicaid contracts with a Licensed Home Care Services Agency (LHCSA) to send aides to your home. You have less control over who shows up, but the agency handles the staffing.
3. Managed Long-Term Care (MLTC)
Once approved, you must enroll in an MLTC plan (like VNS, Fidelis, or Aetna). The MLTC plan determines how many *hours* of care you get per day.
Note: Fighting for hours is a legal battle in itself. MLTCs often try to minimize hours (e.g., offering 4 hours/day when you need 12). Our firm handles internal appeals and Fair Hearings to fight for the hours you deserve.
How to Navigate the 2026 Landscape: The Morgan Legal Group Strategy
Applying for Medicaid in 2026 is not a DIY project. The application involves 5 years of financial records, clinical assessments, and legal trusts. One mistake results in a denial or a penalty period.
Our strategy involves three steps:
- Asset Protection: We create the Medicaid Asset Protection Trust (MAPT) to shelter your home and savings, starting the 30-month clock as soon as possible.
- Income Protection: We set up a Pooled Income Trust so you can pay your bills while Medicaid pays your aides.
- Clinical Advocacy: We guide you through the NYIA assessment process, ensuring your doctor provides the specific documentation needed to meet the 3-ADL threshold.
Conclusion: Coverage Exists, But You Have to Fight for It
Is home care covered by Medicaid in New York in 2026? Yes. Is it easy to get? No. The state has made it harder to qualify financially and physically.
If you are over 65, do not wait for a fall or a diagnosis. The 30-month look-back clock is ticking. Schedule a consultation with Morgan Legal Group today. We serve clients across all five boroughs and Long Island. Let us help you secure the care you deserve without losing the assets you’ve built.
For the latest official updates on the NYIA assessment process and CDPAP, visit the New York State Department of Health NYIA Page.
