2026 Medicaid Regional Rates
The following rates are to be used for calculating penalty periods for uncompensated transfers by institutionalized individuals applying for Medicaid coverage on or after January 1, 2026:
| Regional Rates | January 1, 2026 |
| New York City | $15,282 |
| Long Island | $15,193 |
| Northern Metropolitan | $15,024 |
| Northeastern | $14,783 |
| Central | $14,146 |
| Rochester | $15,675 |
| Western | $13,765 |
The NY State Department of Health issued these rates, used to determine penalty periods for institutionalized individuals who apply for Medicaid on or after January 1, 2026.
Note: These rates have increased in all regions. This will result in shorter waiting (penalty) periods for Medicaid eligibility.
The following is an example of how to use these rates: if a NYC nursing home applicant (and his/her spouse) gifted $152,820 in January 2026, he or she will be ineligible for Medicaid benefits for 10 months ($152,820/$15,282) from February, 2026 through November 30, 2026; if a Long Island nursing home applicant gifted $91,158 in January, 2026, he or she will be ineligible for 6 months ($91,158/$15,193) from February 1, 2026 through July 31, 2026. The foregoing assumes that the recipient is not an exempt individual, such as a spouse or disabled child.
Note: For nursing home applications, the penalty period will not commence until the applicant is in a nursing home, has assets of no more than the allowable resource limit (plus other exempt assets) and has applied for Medicaid nursing home benefits. There are no transfer penalties for community-based applicants at the present time.
Note: Medicaid districts will use the rate for the region in which the facility is located.
– New Changes to Medicaid Eligibility Rules –
Elimination of the Requirement to Apply for Other Benefits as a Condition of Medicaid Eligibility
On December 23, 2025, the New York State Department of Health, Office of Health Insurance Programs (OHIP) issued GIS MA 25/15 (“GIS”), implementing federal rulemaking that eliminates the requirement that Medicaid applicants and recipients apply for, pursue, or maximize certain other benefits as a condition of Medicaid eligibility. As a result, local departments of social services (“LDSS”) may no longer cite failure to apply for or maximize these benefits as a reason for denial or discontinuance of Medicaid. The directive applies to applications, renewals, and ongoing cases and is binding on LDSS offices statewide and is effective immediately.
Benefit Categories Affected — and the Ramifications of Each Change
1. Social Security Benefits (RSDI)
Change:
LDSS may no longer require Medicaid applicants or recipients who appear eligible for Social Security Retirement, Survivors, or Disability Insurance (“RSDI”) to apply for such benefits as a condition of Medicaid eligibility. Failure to apply for RSDI may no longer be cited as a reason for denial or discontinuance.
Practical Impact:
Applicants may now obtain Medicaid eligibility without being forced to navigate the Social Security application process, which can be lengthy, complex, and difficult for individuals with cognitive or physical impairments. Advocates should challenge any LDSS request that conditions eligibility on applying for Social Security benefits.
2. Unemployment Insurance Benefits
Change:
The requirement that applicants or recipients apply for Unemployment Insurance Benefits as a condition of Medicaid eligibility is eliminated. GIS 16 MA/12 (“Applying for Entitlement Benefits”), which previously clarified the obligation to apply for entitlement benefits such as RSDI and Unemployment Insurance Benefits, is rescinded effective with the release of the GIS.
Practical Impact:
LDSS may no longer condition Medicaid eligibility on unemployment filings. This change is particularly relevant for individuals who are transitioning from employment to retirement, disability, or long-term care and removes a barrier that previously delayed Medicaid approvals.
3. Veterans’ Benefits
Change: Medicaid applicants and recipients are no longer required to apply for veterans’ cash benefits as a condition of Medicaid eligibility. Policy guidance contained in 93 ADM-21, which required individuals who identified as veterans to apply for veterans’ benefits as a condition of Medicaid eligibility, is rescinded for Medicaid purposes.
Requirements That Remain in Effect:
- While the obligation to apply for veterans’ benefits has been eliminated, several important requirements remain unchanged.
- LDSS must continue to advise individuals who identify as veterans that assistance may be available through state and local veterans’ service agencies and must retain documentation of such referrals.
- In addition, LDSS must continue to refer certain institutionalized veterans and institutionalized widowed spouses of deceased veterans to the federal Veterans Administration for a determination of eligibility for the $90 reduced (limited) pension benefit.
- Public Assistance program requirements administered by the Office of Temporary and Disability Assistance (“OTDA”) are unaffected unless OTDA directs otherwise.
Practical Impact:
Although Medicaid applicant/recipients are not required to apply for veterans’ benefits to qualify for eligibility, LDSS must continue to advise certain veterans that VA assistance may be available to them.
4. Maximum Periodic Payments From Retirement Funds
This section of the GIS has significant implications for chronic-care and long-term care planning.
A. Elimination of Mandatory Maximization
Change:
LDSS may no longer require applicants or recipients who are eligible to receive periodic payments from a retirement account to apply for the maximum periodic payment available as a condition of Medicaid eligibility.
GIS 98 MA/24 is rescinded to the extent that it required Medicaid applicants or recipients to receive the maximum periodic payment available from a retirement fund.
Consequences:
- Failure to maximize retirement payments may not be cited as a basis for denial or discontinuance.
- Applicants and recipients may not be compelled to increase retirement distributions solely to increase their net available monthly income (NAMI) contribution.
- Failure to receive maximized payments is not treated as an uncompensated transfer for purposes of determining eligibility for nursing home Medicaid.
B. Income vs. Resource Treatment — Clarified
The GIS reaffirms that treatment turns on payout status:
- In payout status → payments are countable unearned income; principal is not a resource. Per the GIS, ‘a retirement fund is in payout status when the individual is receiving regularly scheduled periodic payments’.
- Not in payout status → account balance is a countable resource, valued at the amount currently withdrawable (net of early-withdrawal penalties; ordinary income taxes are not deductible).
Reporting and Retroactivity:
- If a recipient reports a change in payout status or periodic payment amount, LDSS must recalculate eligibility based on the reported change. The change is effective the month in which the change occurred.
- If a change is reported after it has occurred, LDSS may be required to redetermine eligibility retroactively. The GIS limits retroactivity to changes occurring on or after June 4, 2025.
- The transfer-of-assets rules applicable to annuities under 06 OMM/ADM-5, implementing the Deficit Reduction Act of 2005, remain unchanged.
Practical Impact:
This change significantly curtails prior district practices that forced income acceleration and expands planning flexibility with respect to retirement assets.
5. U.S. Savings Bonds
Change:
Applicants seeking Medicaid coverage for long-term care services are no longer required to request a waiver of the U.S. Treasury’s minimum retention period for U.S. Savings Bonds as a condition of Medicaid eligibility. GIS 08 MA/006 (“Treatment of U.S. Savings Bonds During the Retention Period”) is rescinded effective with the release of the GIS.
Practical Impact:
This change removes another technical eligibility barrier that delayed Medicaid approvals and simplifies the treatment of savings bonds.
6. Elective Share Rights (EPTL § 5-1.1-A)
Change:
For married couples not subject to a transfer-of-assets review, LDSS may no longer require a surviving spouse to exercise the right of election against a deceased spouse’s estate under New York’s EPTL § 5-1.1-A as a condition of Medicaid eligibility.
Practical Impact:
This change could eliminate Court proceedings undertaken solely to satisfy Medicaid eligibility policy and has significant implications for post-death Medicaid planning.
What the GIS Explicitly Does Not Change:
- The requirement to apply for Medicare as a condition of Medicaid eligibility remains in full effect.
- Requirements relating to third-party health insurance and Medicaid payment of cost-effective premiums remain unchanged.
- Asset transfer rules under the Deficit Reduction Act continue to apply.
Conclusion
GIS MA 25/15 marks a major procedural reform in New York Medicaid eligibility administration. By eliminating the ability of LDSS to cite failure to apply for or maximize other benefits as a basis for Medicaid denial or discontinuance, the GIS reduces administrative barriers, accelerates eligibility determinations, and expands Medicaid planning options.
The attorneys at Meltzer, Lippe, Goldstein & Breitstone, LLP are dedicated to helping individuals and their families navigate the complexities of Medicaid planning, eligibility, and the application process for both home care and nursing home benefits with clarity, care and experience.