How to Claim Medicaid in New York State: Income Limits and Filing

To apply for Medicaid in New York, most adults under 65 use the NY State of Health marketplace online, while people who are 65 or older, certified blind or disabled, or seeking nursing home coverage submit Form DOH-4220 to their local Department of Social Services. A single adult generally qualifies in 2026 with annual household income at or below $22,025, and the state must decide on your application within 45 days in most cases.¹

Which Application Channel Applies to You

New York splits Medicaid applicants into two groups, and the group you fall into decides where you apply and what rules the state uses to evaluate you.

The first group uses Modified Adjusted Gross Income, or MAGI. It covers most adults ages 19 through 64 who are not on Medicare, along with children, pregnant women, and parents or caretaker relatives. MAGI eligibility looks only at household income. There is no asset or resource test. If you are a healthy adult without Medicare, this is you, and you apply through NY State of Health at nystateofhealth.ny.gov.²

The second group is called Non-MAGI. It covers people who are 65 or older, certified blind, or certified disabled, and anyone applying for nursing home care or receiving Supplemental Security Income. Non-MAGI eligibility looks at both income and countable resources. Non-MAGI applicants file on paper, using Form DOH-4220, sent to the local Department of Social Services in the county where they live.³

2026 Income and Resource Limits

Both MAGI and Non-MAGI adults qualify at household incomes up to 138 percent of the Federal Poverty Level. For 2026, the annual limits are:

1 person: $22,025
2 people: $29,863
3 people: $37,702
4 people: $45,540

These figures come from the 2026 Federal Poverty Guidelines published by the U.S. Department of Health and Human Services.⁴⁵

Non-MAGI applicants face a separate resource test on top of the income limit. In 2026, a single person can hold up to $33,038 in countable resources, and a couple can hold up to $44,796. Retirement accounts are disregarded. Countable resources typically include bank accounts, cash, and certain property; your primary home while you live in it and one vehicle are not counted.⁶

If You’re Slightly Over Income: The Spend-Down

Income a little above the limit isn’t the end of the road. New York’s Excess Income Program, sometimes called the spend-down, lets you subtract qualifying medical expenses from your income until you reach the Medicaid threshold. Once your medical bills for the month equal or exceed your excess income amount, Medicaid covers your remaining care for the rest of that month.⁷

Doctor and dental visits, prescription drugs, lab tests, medical equipment, insurance copayments and deductibles, and transportation to medical appointments all count toward the spend-down. Providers do not need to participate in Medicaid for their bills to count. Once you have hit your excess income amount for the month, though, Medicaid will only pay for services from providers enrolled in the New York Medicaid program.⁷

Documents to Gather Before You Apply

Having your paperwork ready before you start prevents avoidable delays. You’ll need documents in several categories:

Identity and age: a valid New York driver’s license, state photo ID, or U.S. passport.
Citizenship or immigration status: a U.S. birth certificate, certificate of naturalization, U.S. passport, or permanent resident card.
Residency: a recent utility bill, lease, rent receipt, or piece of official mail with your current New York address.
Income if employed: your most recent four consecutive pay stubs showing gross income, pay period, and hours worked.
Income if on benefits: award letters or benefit statements from Social Security, disability, unemployment, or veterans’ benefits.
Resources (Non-MAGI only): bank statements for all accounts covering the most recent several months, plus documentation of any other countable assets.

If you’re applying for nursing home or long-term care coverage, plan on much more paperwork. The state reviews asset transfers going back five years, so pull together bank statements, property deeds, and records of any gifts or transfers during that period.

Filing the Application

MAGI Applicants: NY State of Health

If you fall in the MAGI group, apply online at nystateofhealth.ny.gov. You can upload supporting documents through the portal, and the NY State of Health mobile app lets you submit paperwork from your phone.²⁸

Non-MAGI Applicants: Form DOH-4220

If you’re 65 or older, blind, disabled, or seeking nursing home coverage, use Form DOH-4220, the Access NY Health Care application. List every person in your household on the form, including anyone not seeking coverage. Make sure your gross monthly income entries match your pay stubs exactly. If you want Medicaid to cover unpaid medical bills from the previous 90 days, check the box requesting retroactive coverage.³⁹

Submit the completed DOH-4220 to the local Department of Social Services in your county. If you live in one of the five boroughs of New York City, contact the Human Resources Administration at 212-331-4640. You can mail the form by certified mail to get proof of delivery, or drop it off in person. Confirm your county’s mailing address before sending, since addresses vary.³

When You’ll Hear Back

New York regulations require the state to decide on your application within 45 days of the date you applied. If your eligibility depends on a disability determination, the deadline extends to 90 days. If the state cannot reach a decision within that 90-day window, it must send you a written explanation for the delay.¹

You’ll receive a written Notice of Decision saying whether your application was approved, denied, or needs more information. If approved, you’ll receive a Common Benefit Identification Card (also called an EBT card) in the mail, which serves as your proof of Medicaid coverage at any participating provider.¹⁰

If Your Application Is Denied

A denial isn’t final. You have the right to request a fair hearing, an administrative review where you can present evidence and argue that the denial was wrong. You generally have 60 days from the date on the denial notice to request one, through the New York State Office of Temporary and Disability Assistance online, by phone, or by mail. Miss the deadline and you may forfeit your right to appeal, so move quickly. At the hearing, an administrative law judge reviews the evidence independently, and you can bring documents, witnesses, and a representative or attorney.

After Approval: Managed Care and Yearly Renewal

Most Medicaid recipients in New York are required to enroll in a Medicaid Managed Care plan rather than receiving services through traditional fee-for-service Medicaid.¹¹ After approval, you’ll typically be asked to choose a plan; if you don’t, the state may assign you to one.

Coverage doesn’t run forever on its own. The state must review your eligibility at least once every 12 months. It will first try to verify your continued eligibility using data already available, such as tax records and wage databases. If it can, coverage renews automatically and you’re notified. If it can’t, you’ll receive a prepopulated renewal form in the mail, which you must confirm or correct and return within at least 30 days by online, phone, mail, or in-person channels. Not responding can cost you coverage even if you still qualify, so watch your mail carefully around your annual renewal date.¹²

Extra Rules for Nursing Home Applicants

If you’re applying for Medicaid to cover nursing home care, the financial review is much stricter. New York enforces a 60-month (five-year) look-back period. The Department of Social Services will review any asset transfers you made during the five years before your application. If you gave away money or property, or sold it for less than fair market value, during that window, the state may impose a penalty period during which you are ineligible for nursing home Medicaid.

The penalty period is calculated by dividing the total value of disqualifying transfers by the average monthly cost of nursing home care in your region of New York. The result is the number of months you must wait before Medicaid will cover your nursing home stay. The penalty doesn’t begin until you’re otherwise eligible for Medicaid and actually in a nursing home, so poorly timed transfers can leave you without coverage exactly when you need it.

Some transfers are exempt from the look-back penalty, including transfers to a spouse, to a child under 21 or a child who is disabled at any age, to a sibling who co-owns and has lived in your home for at least a year, or to an adult child who lived in your home and provided your care for at least two years before your application.

If one spouse enters a nursing home and the other stays at home, spousal impoverishment rules protect the at-home spouse. In 2026, the at-home spouse can keep the greater of $74,820 or their share of the couple’s combined assets, up to $162,660. This is called the Community Spouse Resource Allowance.⁶ The at-home spouse also receives a Monthly Maintenance Needs Allowance for living expenses, with a 2026 base of $3,303.75 per month, which can go higher if shelter costs are high.¹³

1
Cornell Law Institute. New York Codes, Rules and Regulations Title 18 360-2.4 – Decision
2
Department of Health. How to Apply for NY Medicaid
3
New York State Department of Health. Form DOH-4220 – Access NY Health Care Medicaid Application
4
ASPE. 2026 Poverty Guidelines – 48 Contiguous States
5
NY State of Health. 2025 Income Levels for Medicaid, Child Health Plus, Essential Plan
6
New York State Department of Health. GIS 26 MA/05 Attachment I – 2026 Medicaid Income and Resource Levels
7
Department of Health. Medicaid Excess Income Program
8
NY State of Health. Support and Resources
9
NYC Human Resources Administration. Medicaid – OCHIA
10
HRA – NYC.gov. Electronic Benefit Transfer Cards
11
Department of Health. Overview of Medicaid Managed Care
12
Medicaid.gov. Overview – Medicaid and CHIP Eligibility Renewals
13
Centers for Medicare and Medicaid Services. 2026 SSI and Spousal Impoverishment Standards