Manhattan Medicaid Planning Attorney

When a parent or spouse in Manhattan may need nursing-home care, families usually ask the same question first: how do we pay for care without using up everything the at-home spouse or the next generation is counting on? Schwartsman Law Group helps Manhattan families plan for New York Medicaid long-term care using the rules in effect today. That includes the 60-month look-back for nursing-home coverage, the 2026 protections for the at-home spouse, and Medicaid asset protection trusts. We meet clients at our office at 590 Madison Avenue. Call (212) 518-3868 or schedule a Free Consultation.

This page is about Manhattan. For an overview of our Medicaid practice across New York, see our Medicaid planning services. For the wider estate planning and probate work we do in the borough, see our Manhattan trusts and estates attorney page.

What Medicaid planning involves

Medicaid planning means organizing assets, income, and legal documents before an application for long-term care coverage. It is not about hiding anything. New York reviews earlier transfers, and when a transfer happened can matter as much as what was transferred. Good planning works within those rules.

For Manhattan clients, the work usually includes:

• Reviewing assets and any transfers already made in the last five years
• Deciding whether a Medicaid asset protection trust (MAPT) fits the family's timeline
• Protecting the at-home spouse when the other spouse needs nursing-home care
• Putting a current power of attorney and health care proxy in place
• Coordinating the plan with a will, revocable trust, or planning for a family member with a disability

The 60-month look-back for nursing-home Medicaid

When someone applies for Medicaid to cover nursing-home care, New York looks back 60 months to review transfers of assets. This rule is in effect. It appears in New York Social Services Law § 366(5)(e) and in the federal Medicaid statute, 42 U.S.C. § 1396p(c)(1)(B), which sets a 60-month look-back for transfers made on or after February 8, 2006, including payments from a trust.

In practice, gifts to children, transfers into certain trusts, and other transfers made within that five-year window can affect eligibility. A transfer made more than 60 months before the relevant date falls outside the window. That is why families who plan years ahead usually have more choices than families who start during a hospital stay or a nursing-home admission.

Home care: the 30-month community look-back is not in effect

You may have read that New York adopted a 30-month look-back for community-based long-term care, such as home care. Here is where it stands. New York asked federal regulators to approve a 30-month look-back for applicants who are not in a nursing home, and the state law provision is written as subject to federal approval. The state's own proposal page says implementation was delayed, and we have not found an official New York Department of Health notice saying the 30-month rule is in operation.

So the 30-month community look-back should be treated as not in effect. These rules can change, and we check the current status when we review your situation rather than relying on older articles.

Medicaid asset protection trusts

A Medicaid asset protection trust is an irrevocable trust used in long-term care planning. Because transfers into the trust are transfers of assets, the 60-month look-back applies to them. Timing is the central planning question: a trust funded well before care is needed works very differently from one funded at the last minute.

Two New York rules matter when a trust is set up:

• Execution. Under EPTL 7-1.17, a lifetime trust must be in writing and executed and acknowledged by the creator and at least one trustee (unless the creator is the sole trustee), or executed in front of two witnesses. Amendments follow the same formalities.
• Funding. Under EPTL 7-1.18, a trust is valid only to the extent assets are actually transferred to it. A line in the trust document saying assets are "transferred" is not enough. Accounts must be retitled and deeds recorded.

If real property is moved into a trust by deed, New York State and New York City transfer tax exemptions may apply, such as Tax Law § 1405(b)(4) and (b)(6) and NYC Administrative Code § 11-2106(b)(8) for transfers without consideration or that are a mere change of identity. Even when an exemption applies, transfer tax filings are still generally expected with the deed. We handle that paperwork as part of the transfer.

For a longer explanation of how these trusts work, see our guide to Medicaid asset protection trusts in New York.

2026 protections for the at-home spouse

When one spouse needs nursing-home care and the other stays at home, New York's spousal impoverishment rules under Social Services Law § 366-c let the at-home (community) spouse keep a resource allowance and a minimum monthly income. The New York State Department of Health published these figures, effective January 1, 2026 (GIS 26 MA/03):

2026 New York Medicaid spousal figure	Amount
Maximum Community Spouse Resource Allowance (CSRA)	$162,660.00
Minimum Community Spouse Resource Allowance	$74,820.00
Minimum Monthly Maintenance Needs Allowance (MMMNA)	$4,066.50

These figures change from year to year. In planning, we look at how the couple's assets and income compare with these allowances and what steps make sense for the at-home spouse before an application is filed.

Powers of attorney, health care proxies, and avoiding guardianship

Medicaid planning often has to happen when the person who needs care can no longer sign documents. Current incapacity documents help keep planning possible.

• Statutory power of attorney. New York's current form rules under General Obligations Law § 5-1501B took effect October 25, 2023. The power of attorney must be printed in at least 12-point type, signed and dated, acknowledged before a notary, and signed by two witnesses (the notary may serve as one). Agents sign and acknowledge too.
• Health care proxy. Under Public Health Law § 2981, a health care proxy is signed in front of two adult witnesses, and the named agent cannot serve as a witness. The statute also allows remote audio-video witnessing.

Without these documents, a family may need to ask a court to appoint a guardian under Mental Hygiene Law Article 81. The court must find the appointment necessary, based on clear and convincing evidence, and must consider available resources. Mental Hygiene Law § 81.03(e) expressly lists powers of attorney, health care proxies, and trusts as available resources. Documents signed in advance can reduce the need for a guardianship.

Planning for a family member with a disability

Some Manhattan families are planning for an adult child or other relative with a disability at the same time as they plan for a parent's care. New York Social Services Law § 366(2)(b)(2)(iii) recognizes two kinds of trusts for this purpose. One is a first-party trust for a person under 65, set up by the individual, a parent, grandparent, guardian, or court, with a payback provision. The other is a pooled trust run by a nonprofit organization. We can discuss whether either fits with the rest of your plan.

How Medicaid planning connects to your estate plan

A Medicaid plan should line up with your will and any revocable trust. In New York, a will is still signed the traditional way under EPTL 3-2.1: signed at the end, with two witnesses, in one ceremony. Electronic wills have been enacted but do not take effect until December 12, 2027.

When a Manhattan resident dies, any probate proceeding generally takes place in New York County Surrogate's Court at 31 Chambers Street, the court for the county of domicile. Planning ahead can make that process simpler for your family. We do not promise any particular court timeline, because every estate is different.

Meeting with us in Manhattan

Our Manhattan office is at 590 Madison Avenue. Our attorneys are licensed in New York, and our practice focuses on New York law. To make the first meeting productive, it helps to bring:

• Recent statements for bank, brokerage, and retirement accounts
• Deeds or other ownership documents for any real estate
• Any existing will, trust, power of attorney, or health care proxy
• A list of significant gifts or transfers made in the last five years
• Information about current health and care needs, if known

Every family's situation is different, and the right plan depends on timing, assets, health, and goals. Call (212) 518-3868 or request a Free Consultation to talk through your options with our Manhattan team.