Podcast Transcription:
WRVO Producer Mark Lavonier:
This podcast is part of the series Estate Planning Pro Tips, hosted by attorney Tim Crisafulli of Crisafulli Estate Planning and Elder Law, P.C.—an estate planning, probate, and elder law firm serving clients throughout Central New York. A former schoolteacher, Tim explains complex legal subjects in an easy-to-understand way. The commentaries focus on essential aspects of estate planning, such as wills, trusts, asset protection, long-term care, and probate. And now here's Tim.
Tim Crisafulli:
Medicaid is a benefit program that can be quite confusing because it is so incredibly complex. Before addressing any particular aspect of Medicaid, it is important to clarify exactly which of its many programs is in play.
This podcast focuses on community Medicaid benefits: that is the program for people in need of long-term care who are at least sixty-five, blind, or disabled, and who need care with at least one activity of daily living. Activities of daily living include bathing, maintaining one’s own hygiene, dressing, walking, and eating. There are others. If someone needs help with multiple activities of daily living or if that individual has advanced dementia, then that person may be eligible for chronic Medicaid benefits—that’s more intense and often delivered in a skilled care nursing home.
By contrast, community Medicaid benefits are available for those who can get by with less medical support. Services are generally provided in the person’s home or in a type of assisted living facility that accepts Medicaid (not all do). Interestingly, it is even possible for community Medicaid recipients to hire caregivers of their own choosing—often an adult child, other relative, or friend. Those caregivers can then be paid by the Consumer Directed Personal Assistance Program (or CDPAP).
Of course, before any individual can receive community Medicaid benefits, that person must qualify financially. There are two components to financial qualification: resources and income. Though the number fluctuates with incremental annual increases, as of 2026, an individual must have no more than $33,038 in available resources. Fear not if you are over and need the community Medicaid benefit—there are strategies to preserve assets and still achieve that number on paper.
The second qualifying financial component—income—is the real focus of the moment. As of 2026, an individual can have no more than $1,836 in monthly income. I think of that as “mailbox money” or whatever shows up in the mail from all sources every month. That may be Social Security, a pension, rent payments received, required minimum distributions from an IRA, or any other recurring monthly payment. Although it adjusts annually, $1,836 does not go too far.
If an individual happens to have more than $1,836 of monthly income and still wants to qualify for community Medicaid, that person has two choices: either give up the excess of $1,836 and pay it to the county OR divert that excess income into a Pooled Income Trust.
A Pooled Income Trust is run by a charitable organization; there are dozens in New York State. Here’s how it works: each month, a community Medicaid recipient transfers all of the excess income beyond $1,836 to the pooled income trust. All of that person’s qualifying expenses—think rent, groceries, utilities—can then be paid by the trust. In this way, a person achieves the best of all worlds: the person’s excess income does not lead to community Medicaid disqualification, and the person still gets to use the excess income for their own needs.
There is one caveat: use it or lose it. Any pooled income trust balance that remains upon a person’s eventual passing does not return to that person’s beneficiaries. Rather, it is retained by the charity that operated the pooled income trust.
Community Medicaid is a great resource for people in need of help with some tasks of daily living. It can even provide a source of payment for hand-picked caregivers. But, excess income needs to be handled properly lest it simply be lost.
