How it works, in one example
- Your monthly income
- $2,100
- 2026 Medicaid limit for one person
- $1,856
- Goes into your trust account each month
- $244
- Each month the $244 goes into your own account, not to Medicaid.
- Medicaid counts you as under the limit, so your home care continues.
- We pay your rent, utilities and other bills from the account.
For a couple the limit is $2,509. Medicaid sets your exact amount; we work it out with you on the first call. Estimate yours ›
We work out your number on the first call. A person picks up.
How it works, in four steps
- Your income is a little over what Medicaid lets you keep.
- Each month you put the extra amount into your account in the trust.
- The trust pays your bills from that account, such as rent, utilities and phone.
- Medicaid covers your care.
The extra amount has three names that mean the same thing: surplus, excess income and spend-down. Here is how the surplus is set and why it can change.
Who can use one in New York?
In New York, the person must be found disabled by Social Security or by New York State, and must need Medicaid, often for care at home. Most people who need home care meet this, and many have not been officially found disabled before they apply. If that is you, we start that paperwork together with the trust application.
The income limit and the amount you would put in change every year, and every person's number is different. We work out yours on the first call from your own papers.
Why it is called "pooled"
A nonprofit runs the trust and keeps a separate account for every member. The accounts are managed together, which is why it is called pooled. Your money is tracked under your name and other members cannot use it.
What the trust pays for, and what it does not
The trust pays things that help you live: rent, utilities, phone, groceries, medical costs Medicaid does not cover, and many other bills. It pays the company you owe, never you directly.
Some things are not allowed, such as alcohol, tobacco, firearms, gifts and donations. If you are not sure about a bill, ask us before you count on it.
Two things to know before you join. The money cannot be sent back to you or to your bank account: the trust pays the companies you owe, and the Visa card cannot be used to take out cash. And when a member passes away, the money left in the account stays with the trust or goes to the state for Medicaid costs; it cannot be paid back to the family or the estate. We say this plainly on the first call, because it is the part people most need to understand.
What happens to money left in the account
The rules of the trust and of New York law decide this. Money left when a member passes away is kept by the trust or goes to the state for Medicaid costs. It cannot be paid back to the family, the estate or the member's bank account, so the account is meant to be used for the member's bills and needs each month, not saved up. The state explains the rules on its trusts information page. We explain exactly how it applies before you sign anything.
Is it your only choice?
No. You can also pay the surplus to Medicaid directly each month. A pooled income trust is an option, not a requirement. We are glad to talk through both.
Common questions
Is a pooled income trust legal in New York?
Yes. New York and federal law allow pooled trusts that are set up and managed by a nonprofit for people who are disabled. The New York State Department of Health describes the rules on its trusts information page.
Do I give up control of my money?
The money in your account stays in your name and is used for your benefit. The trust pays your bills to the companies you owe, and the trustee approves each payment, so you do not receive the money as cash.
Who qualifies for a pooled income trust in New York?
A New York resident who needs Medicaid and who is found disabled by Social Security or New York State. Many people who need home care qualify, and we can help start the disability paperwork with the trust application.
What is the difference between a surplus, a spend-down and excess income?
Nothing. They are three names for the part of your monthly income that is over the Medicaid limit.
How do I start?
Call 718-701-7777, Monday to Thursday, 9 AM to 5 PM, and Friday, 9 AM to 12 PM in winter and 1 PM in summer, Eastern. A person picks up, and it costs nothing. We explain how it works and the fees, and set up a second conversation to go through the application.
All the questions people ask us, answered.