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What Happens When the Money Runs Out

Spend-down, Medicaid waiver transitions, and why you should ask a community about this before you move in.

Home›Costs & Paying›What Happens When the Money Runs Out
Short answer

If private funds run out, the options generally are a Medicaid HCBS waiver for care inside a licensed community, Medicaid nursing facility coverage, or moving to a community that holds a waiver provider agreement. Confirm your state's specific programs before relying on this.

Ask before you move in, not after

This is the single most consequential question families skip. A community that does not hold a Medicaid waiver provider agreement will ask your parent to leave when private funds are exhausted — often with short notice, at the point when moving is hardest.

Ask directly: do you hold a Medicaid waiver provider agreement, and how many current residents use it? A community can technically hold an agreement and still have no waiver capacity available.

How families pay for care. New York's Assisted Living Program, NHTD waiver and Managed Long Term Care each pay for different community-based settings. Read the full explanation →
The local long-term care ombudsman. Suffolk: Family Service League, 631-470-6755. Nassau: Family and Children's Association, 516-466-9718. Read the full explanation →

Questions families ask

How much money can my spouse keep if I go on Medicaid for nursing home care in New York in 2026?

For 2026, the community spouse may generally keep the greater of the state minimum Community Spouse Resource Allowance ($74,820) or half of the couple's countable resources, up to the federal maximum of $162,660. The community spouse is also entitled to a Minimum Monthly Maintenance Needs Allowance of $4,066.50 per month from the institutionalized spouse's income. These figures come from NYSDOH's GIS 26 MA/03 guidance, effective January 1, 2026.

How much spending money is a Medicaid nursing home resident allowed to keep each month in New York?

New York's Nursing Home Resident Personal Needs Allowance is $50 per month - the amount a Medicaid-funded nursing home resident is permitted to keep from their own income for personal expenses, with the rest going toward the cost of their care. According to the NY State Office for the Aging (NYSOFA), this figure has been unchanged since the 1980s, and NYSOFA notes that 33 other states currently pay a higher PNA, ranging from $52 to $200.

What is the MLTC special income standard for Long Island and why does it matter for Medicaid home care?

The special income standard for housing expenses, available to certain individuals enrolled in a Managed Long Term Care plan, varies by NYSDOH region - for the Long Island region specifically, it is $1,701.00. This regional figure is higher than most upstate regions (for comparison, the Central New York region's is $426 and the Western region's is $341), reflecting Long Island's higher housing costs, and remains in effect until updated federal poverty levels are published.

How much does assisted living cost in New York State?

According to CareScout's 2025 Cost of Care Survey, the median cost of an assisted living community (private one-bedroom) in New York State is $225 per day, or about $7,110 per month and $85,320 per year. This is a statewide median - CareScout's published state-level data tables do not break out a separate Long Island or metro New York figure.

What does a nursing home cost per day in New York?

CareScout's 2025 Cost of Care Survey puts the New York State median at $511 per day ($15,528/month, $186,333/year) for a semi-private room and $550 per day ($16,729/month, $200,750/year) for a private room, both based on 365 days of care. These are statewide figures; CareScout does not publish a separate Long Island-specific nursing home rate.

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