By Long Island Senior Advisor Care Team · October 23, 2026
New York protects a healthy spouse when the other spouse enters a nursing home. Here is what your mother keeps in 2026, what happens to the house, and the two forms Long Island families almost never hear about.
The fear is that the nursing home takes everything. That is not how New York works.
A nursing home bed in New York is expensive enough to end a conversation. The 2025 CareScout Cost of Care Survey, published in March 2026, puts the New York State median at $15,528 a month for a semi-private room and $16,729 a month for a private one. Those are statewide medians. CareScout does not publish a Nassau, Suffolk or Long Island figure, and local pricing very likely runs above the state number rather than below it.
So when a Massapequa family sits down after a hospital stay and does the arithmetic on a couple who have been in the same house since 1974, the conclusion feels obvious: the money is gone, the house is gone, and your mother ends up with nothing. That conclusion is wrong, and it is wrong in a specific, written-down way.
New York, like every state, operates under federal spousal impoverishment rules. When one spouse enters a nursing home and applies for Medicaid, the other spouse — the community spouse — is entitled to keep a protected share of the couple's assets and a protected monthly income floor. These are not discretionary. They are published figures that a county caseworker applies.
What families lose is not usually the house. What families lose is the protection they never asked for, because nobody at the hospital mentioned that it existed.
What your mother is allowed to keep in 2026
The protected asset figure is called the Community Spouse Resource Allowance, or CSRA. For 2026, New York sets it at the greater of two amounts: $74,820, or one half of the couple's total combined countable resources up to a ceiling of $162,660.
Run that through three Long Island households and the shape becomes clear. A couple with $100,000 in countable savings: half is $50,000, which is below the floor, so the community spouse keeps the full $74,820. A couple with $240,000: half is $120,000, which sits between the floor and the ceiling, so she keeps $120,000. A couple with $600,000: half is $300,000, which exceeds the ceiling, so she keeps $162,660 and the rest is expected to go toward care before Medicaid pays.
The institutionalized spouse, meanwhile, is held to a very small individual resource allowance. The practical effect is that the couple's assets are divided on paper as of a snapshot date, and the snapshot date matters more than almost anything else in the process. It is set at the beginning of the continuous period of institutionalization, not on the day somebody finally gets around to filing.
Countable is doing real work in that sentence. Retirement accounts, the second car, a prepaid burial fund and the cash value of a life insurance policy are each treated under their own rule. This is the point in the process where a Long Island elder law attorney earns the fee, and where a family that guesses tends to guess expensively.
The house is a separate question, and usually a better answer
New York's 2026 home equity limit for Medicaid long-term care is $1,130,000. That figure applies to the primary residence, and a great many Nassau and Suffolk houses bought decades ago now sit well under it even after the last twenty years of appreciation.
More to the point, while your mother is living in the house as her principal residence, the house is not the asset the county is looking at. The question of what New York can eventually recover against the property is a different question, asked at a different time, under the Medicaid Estate Recovery Program — and federal law requires states to protect a surviving spouse while that spouse is alive. We walk through what estate recovery can and cannot reach in our guide to Medicaid estate recovery on Long Island.
What this means in practice is that the conversation families dread — selling the house to pay for a nursing home — is frequently not the conversation New York's rules actually require. It is the conversation that happens when nobody checks.
It also means the house should not be transferred to the children in a panic the week after a hospital discharge. Transfers have consequences inside the lookback window, and a transfer made to protect a house can be the thing that delays coverage for months.
Her income is protected too, and the $50 a month that is left of his
Assets are only half of it. New York also sets a Minimum Monthly Maintenance Needs Allowance — the MMNA — at $4,066.50 a month for 2026. If the community spouse's own income falls below that floor, income from the institutionalized spouse can be diverted to her to bring her up to it.
Whatever is left of his income after that diversion, after a health insurance premium deduction and after a small personal allowance, goes to the nursing home as his contribution toward care. That personal allowance is the figure that tends to stop people mid-sentence: New York's nursing home resident monthly income allowance is $50. It has been $50 since the 1980s and it is among the lowest in the country. Haircuts, a phone, clothing and anything else personal come out of that $50 or out of family money.
The contrast with staying home is stark. A community-based Medicaid applicant in 2026 has a monthly income allowance of $1,836, and a participant in the Nursing Home Transition and Diversion waiver keeps a personal needs allowance of $653 a month. The setting changes the arithmetic enormously, which is one reason the NHTD waiver and Managed Long Term Care deserve a look before a permanent nursing home placement is treated as settled.
One more wrinkle worth knowing before it surprises you: New York's own notice to couples states that Medicaid will request a contribution from a community spouse of 25 percent of the income she has above the MMNA plus any family member allowance. A request is not a seizure, and it is worth asking an attorney how it is handled in your county.
Two forms most Long Island families never hear about
New York publishes an Information Notice to Couples with an Institutionalized Spouse, and buried in it are two rights that materially change outcomes.
The first is the Request for Assessment — Spousal Impoverishment, form DOH-5298. Either spouse, or someone acting for them, may ask the local social services district to assess the couple's countable resources at the beginning of, or any time after the beginning of, a continuous period of institutionalization. This produces a written resource assessment rather than an informal guess. Note one detail: if the request is not filed together with a Medicaid application, the district may charge up to $25 for preparing and copying the assessment.
The second is the right to more than the standard allowance. New York's notice says a community spouse may be able to obtain additional resources to generate income, or additional income where exceptional circumstances cause significant financial distress, by requesting a Medicaid fair hearing or by commencing a Family Court proceeding against the institutionalized spouse. That sounds adversarial and reads oddly when the two people involved have been married fifty years. It is a procedural mechanism, not a dispute, and it exists because the standard figures do not fit every household.
The third thing worth naming is spousal refusal, a feature of New York law that most states do not have. A community spouse is required to cooperate by providing information about her resources — refusing to provide information is grounds for denying the application, because eligibility simply cannot be determined without it. But New York's notice also provides that the institutionalized spouse will not be found ineligible for the community spouse's refusal to make excess resources available where an assignment of support rights is executed, or where he is unable to execute one because of impairment. How that plays out in a specific case is an elder law question, not a do-it-yourself one, and it is the single most common reason Long Island families end up in an attorney's office.
Where the application actually goes, and why Suffolk is different from Nassau
Here the two counties diverge in a way that wastes real weeks when nobody checks. If the applicant is 65 or older or disabled, Suffolk County's Department of Social Services states plainly that you cannot apply through NY State of Health. A paper Medicaid application has to be completed and brought or mailed to the right office.
And Suffolk splits Medicaid into two districts. Medicaid WEST is the Smithtown DSS Center at 200 Wireless Blvd., Hauppauge, NY 11788, reachable at (631) 853-8408, with mailed applications going to Medicaid Eligibility, P.O. Box 18100, Hauppauge, NY 11788, (631) 854-9916. Medicaid EAST is the Riverhead DSS Center at 605 Old Country Road, Riverhead, NY 11901, (631) 852-3570. Both list public hours ending at 3:00 p.m., which is earlier than most people assume a county office closes.
Nassau County runs a single Department of Social Services at 60 Charles Lindbergh Boulevard, Uniondale, NY 11553, with general information at (516) 227-8519 and the same 8:00 a.m. to 3:00 p.m. window. The structural difference is worth internalizing: in Suffolk, filing in the wrong district is a real possibility; in Nassau it is not. We cover the wider pattern of county-by-county differences in which county line decides who you call.
For free help with the application itself, Suffolk's own page points to the Nassau-Suffolk Hospital Council at (631) 656-9783, which runs a Consumer Assistance program for the aged, blind and disabled. For everything upstream of the application — what the options even are — Nassau's Office for the Aging is (516) 227-8900 and Suffolk's Office for the Aging is (631) 853-8200. Each county runs its own, separately; there is no shared Long Island agency to call.
The lookback question, and the part that is genuinely unsettled
A five-year lookback applies to applications for nursing home and institutional care in New York. Transfers of assets made in that window are examined and can produce a penalty period during which Medicaid will not pay for care. This is the rule that makes last-minute gifts to adult children such a bad idea, and it is why the week after a hospital discharge is the worst possible week to move money.
What is not settled is the lookback for community-based long-term care — home care, personal care, MLTC enrollment. New York enacted a 30-month lookback for those services in its 2020 budget and has repeatedly postponed it. Legal aid tracking of the issue and elder law summaries published as recently as February 2026 both describe it as announced but without a firm implementation date, pending federal steps and state directives that had not been issued.
Two practical consequences. First, do not let anyone tell you the community lookback is in force without showing you a current directive, and do not plan as though it will never arrive either. Second, because this is exactly the kind of rule that changes between the day a family reads about it and the day they file, confirm the status with the county or an elder law attorney rather than with an article — including this one.
One thing that is firmly settled: MLTC enrollment has been mandatory in both Nassau and Suffolk since the transition that began in 2013, for Medicaid recipients aged 21 and over who need more than 120 days of community-based long-term care. If your parent is going home with services rather than into a bed, that is the system you are entering.
What to do in the next two weeks
Ask for the resource assessment in writing. Form DOH-5298 exists for exactly this, and filing it alongside the Medicaid application avoids the $25 charge. A written assessment is also the only version of the numbers you can later argue about.
Establish the snapshot date and write it down. The division of assets is measured from the beginning of the continuous period of institutionalization, so knowing that date — and being able to document it — sets the frame for everything that follows.
Do not move money, retitle accounts, or deed the house to anyone until somebody who practices elder law in New York has looked at the whole picture. Nearly every expensive mistake in this process is a well-intentioned transfer made in the first fortnight.
Then get a second read on the setting itself. A nursing home may be right, and it may also be that one of New York's community-based programs fits better at a fraction of the household cost. Our page on how families actually pay for care lays out the pathways side by side, and what to do when a spouse needs more care covers the non-financial half of this, which is usually the harder half.
A closing caveat, said plainly: we are not attorneys and this is not legal advice. Every figure above is a published 2026 New York State figure, and published figures change. Confirm them with your county Department of Social Services or an elder law attorney before you rely on them.
