Your mom moved from the hospital into a nursing home in Albany for rehab, and now the doctors say she won't be able to go home. The social worker mentions chronic care Medicaid, a Supplement A form and something called NAMI. You want to know what those mean and what your family needs to do.
This guide uses New York State Department of Health (DOH) guidance, its yearly income and resource notice, and Title 18 of the New York Codes, Rules and Regulations (NYCRR). We don't list dollar figures, because they change each year. Instead, we explain how each rule works and point to the official DOH figures. For decisions about property, trusts or gifts, talk with your local social services office or a New York elder law attorney.
Short-term stay or permanent placement?
New York treats a temporary nursing home stay differently from a permanent one. During a temporary stay, when a person is expected to return to the community, they keep net income up to the regular Medicaid income level instead of only a small personal needs allowance1. There's no set time limit for temporary status, but it's reviewed periodically based on medical evidence1.
When a stay becomes permanent, eligibility is determined under institutional rules, including a review of transfers in the look-back period, and income is figured using chronic care budgeting1. Medicare may cover a short rehab stay first after a qualifying hospital stay6. See when Medicare stops paying for a nursing home.
The resource level
For people who are aged, blind or disabled, New York uses a resource level for a single person that is set each year and is higher than the federal SSI resource level34. Counties publish the current figure each year. Niagara County's chronic care page, for example, lists the 2026 single-person resource limit and the community spouse amount3. DOH's GIS 26 MA/03 explains that some medically needy levels stay at prior-year amounts until new federal poverty levels are published4.
Some property is exempt, including household furniture and personal effects, an automobile, and one burial plot per household member5. Excess resources must be reduced before Medicaid can be authorized, though incurred medical bills can count toward reducing them7. See Medicaid spend-down.
Income and NAMI
New York doesn't use a hard income cap for chronic care Medicaid. Instead, income determines how much your parent contributes each month toward the cost of care1. This contribution is often called the NAMI, for net available monthly income. After eligibility is set, a resident of a nursing home keeps a small personal needs allowance set in regulation2. The county also deducts health insurance premiums and amounts set aside for a spouse or dependents at home2. What remains goes to the nursing home each month, and Medicaid pays the rest.
Niagara County notes that a person permanently placed in a skilled nursing facility keeps only the personal needs allowance from their income3. A small increase is allowed for some veterans with a reduced VA pension2.
The homestead
For people 65 or older, or certified blind or disabled, a homestead stays exempt unless the owner moves out without the intent to return and no spouse, child under 21, certified blind or disabled child, or other dependent relative lives there5. New York adopted this approach after a court decision required it to follow SSI policy: the home stays exempt as long as your parent indicates an intent to return, regardless of whether they are actually able to7.
A home equity limit still applies to Medicaid coverage of nursing facility services and community-based long-term care. DOH updates it each year in its income and resource notice4. Transferring the home to certain people can also lead to ineligibility for nursing facility services5. See can a nursing home take your house and Medicaid estate recovery.
When one spouse stays at home
New York follows federal spousal impoverishment rules for married people who are not eligible under the newer MAGI rules, when the nursing home spouse is expected to stay at least 30 consecutive days1. The spouse at home keeps a Community Spouse Resource Allowance between a state minimum and a federal maximum, both updated each year48. They may also receive part of the nursing home spouse's income if their own income is below the Minimum Monthly Maintenance Needs Allowance4.
Spousal impoverishment rules also apply when the nursing home spouse is enrolled in managed care1. Counties may tell you that you qualify for a higher resource amount in some spousal cases3, so ask.
The 60-month look-back
For coverage of nursing home care, New York reviews transfers made in the 60 months immediately before the month an institutionalized person applies1. Gifts and sales for less than fair market value can lead to a penalty period during which Medicaid won't pay for nursing home care9. See the Medicaid look-back period and caregiver agreements with family.
How to apply in New York
- Contact the county. Apply through your local department of social services. In New York City, contact the Human Resources Administration.
- Complete the right forms. Applicants file a Supplement A form, and people not already on Medicaid also complete an Access NY application3.
- Gather verification. Income statements, bank and investment records for the look-back period, deeds, life insurance and burial records.
- Coordinate with the nursing home. The facility notifies the county of a permanent placement on form LDSS-35591.
- Answer requests quickly. Missed deadlines can delay approval.
- Read the budget letter. It shows the monthly NAMI your parent pays the facility.
For general steps, see how to apply for Medicaid for an elderly parent.
An example of how it fits together
Walter, 86, is widowed and permanently placed in a nursing home in Buffalo. He has Social Security and a small pension, owns his house and has savings just under the county's resource level. His daughter files the Supplement A with records for the past five years.
Because Walter says he intends to go home, his house remains exempt, provided his equity is under the state limit54. He made no gifts during the 60-month look-back1. The county approves him and figures his NAMI: his income minus his health insurance premiums and the personal needs allowance2. He pays the NAMI to the nursing home each month.
This is an illustration, not advice. A spouse at home, a recent gift or savings over the limit would change the result.
Managed care and nursing home residents
Since New York moved nursing home benefits into Medicaid managed care, many permanent residents receive their nursing home coverage through a plan rather than directly through regular Medicaid1. Eligibility itself is still decided by the county, not the plan1. In practice, this means two separate steps: the county decides whether your parent qualifies and sets the monthly contribution, and the plan works with the facility on authorizing care.
If your parent already has a plan when they enter a nursing home, ask the plan's care manager and the facility's business office how the stay is being authorized. Keep copies of every notice from both the county and the plan. When something seems wrong, the notice tells you who made the decision and how to appeal it.
Documents to collect before you apply
Most delays come from missing paperwork. Gathering records early, while your parent is still in rehab, often saves weeks. Plan to collect:
- Proof of identity, age and New York residence. A birth certificate or passport, and something showing a New York address.
- All income records. Social Security award letters, pension statements and any annuity or rental income.
- Five years of financial statements. Bank, brokerage and retirement accounts, because the county reviews the full 60-month window1.
- Property records. Deeds, recent property tax bills and mortgage statements for any real estate.
- Insurance and burial records. Life insurance policies with cash values, health insurance cards and any prepaid funeral contracts.
- Legal documents. A power of attorney or guardianship papers if someone is signing for your parent.
If your parent can't sign, the person filing should have legal authority. See power of attorney for an elderly parent.
Planning carefully, not quickly
Families sometimes hear about trusts, annuities or transferring the house to a child who has been a caregiver. Some of these strategies are allowed under federal rules in narrow situations, and others trigger a penalty period9. Because New York reviews five full years of records for nursing home care1, a rushed decision can be expensive to undo.
Before you move money or property, get advice from a New York elder law attorney or your county office. Ask them to explain in writing how a step would be treated under the transfer rules. Spending savings on your parent's own care, debts, or exempt items such as household goods is generally not a transfer, but keep receipts for everything.
Common mistakes New York families make
- Confusing temporary and permanent budgeting. Income treatment changes when a stay becomes permanent1.
- Gifting before applying. Transfers in the 60-month window can cause a penalty period1.
- Not stating intent to return. That statement helps keep the homestead exempt7.
- Missing the NAMI payment. Unpaid NAMI is owed to the facility.
- Ignoring renewal notices. Medicaid must be renewed. Watch the mail.
If the county denies coverage or sets a NAMI you think is wrong, the notice explains how to request a fair hearing.
Getting help
Your county department of social services and the nursing home's business office can help with forms. The long-term care ombudsman can help if a facility pressures your parent to leave while an application is pending. See nursing home eviction. For costs in the state, see how to pay for assisted living in New York. For other large states, see Pennsylvania, California, Florida and Texas.
