If your income is over the Medicaid limit, New York gives you two ways to keep Medicaid: pay the surplus to Medicaid each month, or put the same money into a pooled income trust that pays your bills. Both are legal and Medicaid handles both every day. They are not equal for your wallet.
Choice 1: pay the surplus to Medicaid
- How it worksEach month you send the surplus to Medicaid, or you show medical bills that add up to it. New York calls this the excess income or spend-down program.
- What it costsNo fees. But the money is gone: it pays Medicaid, not your rent.
- What to watchMedicaid covers only the months you paid. Nothing to sign beyond Medicaid's own forms, and no disability finding needed.
Choice 2: a pooled income trust
- How it worksThe same surplus goes into your own account at the trust each month. Medicaid approves the paperwork and counts you as under the limit. The trust pays your rent, utilities, phone and other bills from the account, and loads a Visa card for everyday needs.
- What it costs10% of each deposit, at least $35 and at most $300 a month; $150 a year from the second year; usually $300 once to join, waived when you switch from another trust.
- What to watchYou must deposit every month. No cash out. Money left at the end stays with the trust or the state. It is for people found disabled, which needing home care usually meets.
The same $244, both ways
- Pay Medicaid: leaves your pocket each month
- $244
- Pay Medicaid: leaves your pocket each year
- $2,928
- Trust: monthly fee (the $35 minimum)
- $35
- Trust: pays your own bills each month
- $209
In the first year the trust pays $2,508 of your bills and costs $420 in fees. From the second year the $150 annual fee also comes out of the account. The $244 is the surplus of one person with $2,100 a month in 2026; Medicaid sets your exact amount. Estimate yours ›
Which one is better for you?
With a very small surplus, paying Medicaid directly can make more sense, because our fee is never less than $35. With a surplus of a few hundred dollars or more, the trust usually wins: most of the money pays your own bills instead of leaving. We tell you honestly which is better on the first call.
We work out your number on the first call. A person picks up.
Common questions
Is a pooled income trust legal, and does Medicaid accept it?
Yes. Pooled income trusts are written into federal law (since 1993) and New York State law, which let a nonprofit run one trust for many people who are disabled. When you join, Medicaid's own reviewers check your trust paperwork and approve it before your budget changes. Nothing about it is hidden. The state explains the rules on its trusts information page at health.ny.gov.
Can I switch from one to the other later?
Yes. If you pay Medicaid now, you can join the trust later. If you are in the trust and want to leave, call us; remember that money left in the account cannot be paid back to you.
Do I have to be disabled to use the trust?
Yes. The law allows a pooled trust for people who are disabled under Social Security or New York State rules. Needing care at home usually meets that. Paying Medicaid directly has no such requirement.