Long-term care in New York can consume an estate that took a lifetime to build. Nursing home costs frequently exceed $200,000 a year, and families who have not planned often spend down their savings within a few years. A Medicaid Asset Protection Trust (MAPT) is the tool most New York families use to protect a home and savings while still qualifying for Medicaid long-term care benefits.
This page explains how a MAPT works under New York law, what it protects, what you give up and what you keep, the look-back periods that make timing critical, and the misunderstandings we correct most often.
What a Medicaid Asset Protection Trust is
A MAPT is an irrevocable trust that holds assets so they are not counted as resources when you apply for Medicaid long-term care benefits. Once assets have been properly transferred into the trust and the look-back period has run, they are treated as unavailable and are not part of the Medicaid spend-down.
You create the trust during your lifetime and choose the trustee, often an adult child or another trusted family member. You give up direct ownership and control of the assets you place in it. What you typically keep is the right to receive the income the trust assets generate, the right to live in your home if the home is in the trust, the right to change trustees, and the right to direct how the trust assets are distributed at your death. That combination lets you keep a meaningful connection to your property while still reaching Medicaid eligibility down the road.
Why the planning matters in New York
New York has some of the highest long-term care costs in the country. A private room in a skilled nursing facility in the New York metropolitan area can cost over $18,000 a month, and home health care and assisted living carry substantial price tags of their own.
Medicaid is the primary payor of long-term nursing home care for most New Yorkers, but qualifying means meeting strict income and asset limits. In 2026, an individual applying for institutional Medicaid in New York generally cannot have more than $33,038 in countable resources. A MAPT lets you reduce your countable assets lawfully while preserving wealth for your spouse, children or other beneficiaries.
The look-back period
For institutional (nursing home) Medicaid in New York the look-back period is 60 months, or five years. Assets transferred into a MAPT, or given away in any other form, within five years before a nursing home Medicaid application can trigger a penalty period during which you are ineligible for benefits.
New York enacted a 30-month look-back for community-based Medicaid, which includes home care, in 2020, but as of 2026 it has not been implemented. Historically there was no look-back at all for community Medicaid, so this is a significant change and it makes early planning more important than it used to be. The best time to fund a MAPT is well before you expect to need care; that is when you have the most flexibility and the most protection.
What usually goes into a New York MAPT
The primary residence is the most common and usually the most valuable asset placed in a MAPT. Vacation and second homes, rental and investment properties, brokerage and investment accounts, savings and certificates of deposit, stocks, bonds and mutual funds, and life insurance policies with cash value are also routinely transferred.
Retirement accounts such as IRAs and 401(k)s are usually not transferred into a MAPT, because moving them would trigger adverse income tax consequences. Those accounts are handled with other strategies as part of the same plan.
What a MAPT does for you
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It preserves the home
For most families the home carries both the greatest financial value and the deepest emotional ties. A home held in a MAPT is protected from Medicaid estate recovery after death and can pass to your children or other beneficiaries.
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It keeps the property tax exemptions
A properly drafted New York MAPT lets you keep the STAR exemption, the senior citizen exemption and veterans exemptions on your primary residence. You also continue to qualify for the capital gains exclusion on the sale of a primary residence.
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It avoids probate
Assets in the trust pass directly to the beneficiaries you named, without a Surrogate’s Court probate proceeding, which saves time and expense and keeps the estate private.
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It can preserve the step-up in basis
Because you retain certain powers over the trust, its assets typically receive a step-up in cost basis at your death. That tax benefit matters most for a home or investments that have appreciated over decades, and we explain how the drafting controls it on our page on step-up in basis and irrevocable trusts.
Common misconceptions
Clients often arrive with a picture of the MAPT that is not quite right. These are the four we correct most often.
| What people assume | What is actually true |
|---|---|
| “I can change my mind anytime.” | A MAPT is irrevocable. Certain modifications may be possible, but you cannot simply dissolve the trust and take the assets back. |
| “I will lose control of everything.” | You give up legal ownership, but a properly drafted trust lets you keep meaningful rights, including the right to change beneficiaries and to live in your home. |
| “It is too late to plan.” | Even when a health crisis is imminent, crisis planning strategies can still preserve significant assets. Earlier planning produces better results, but late planning is not useless. |
| “All trusts protect assets from Medicaid.” | Revocable living trusts do not protect assets from Medicaid. Only a properly drafted irrevocable trust does. |
What the planning involves
Medicaid law is one of the most technical areas of practice, and New York adds its own rules and procedures administered by the local Departments of Social Services and the State Department of Health. A drafting error or a mishandled transfer can produce a penalty period, a denied application or an unintended tax bill.
The work begins with deciding whether a MAPT is the right strategy for you at all. If it is, we draft the trust around your goals, coordinate the deeds and account transfers that actually fund it, and integrate it with the rest of your plan, including your will, power of attorney and health care proxy. When the time comes we assist with the Medicaid application itself and address any issues the agency raises, and where care is already needed we do crisis planning to preserve what can still be preserved.
Talk to us about protecting your assets
The decisions you make now will shape what your family keeps. Call us at 212-233-1233 or email [email protected]. We will review your assets, discuss your goals and tell you whether a Medicaid Asset Protection Trust makes sense for your situation.
