A pooled income trust pays your bills for you. Each month you deposit the income that sits above the Medicaid limit into your own account in the trust, and the nonprofit that runs it pays your landlord, utility company or phone provider directly. Because the money goes to vendors and not into your pocket, New York Medicaid does not count it as your income. That is how someone whose pension or Social Security is a little too high can still qualify for Medicaid home care.
How does a pooled trust pay bills in NYC?
The New York State Department of Health’s trusts page describes a pooled trust as one that is established and managed by a nonprofit, which keeps a separate account for each person but pools the accounts for investing. Your account is built from your own money. The trustee, not you, decides what gets paid and sends the payment.
The number that matters is the Medicaid income level. For 2026 the state’s income and resource chart for aged and disabled applicants lists $1,836 a month for one person and $2,489 for a couple. Income above that line is your surplus, also called a spend-down. Without a trust you pay the surplus toward medical bills every month. With a trust, the routine looks like this:
- You deposit the surplus in the month your income arrives. The state’s rule (GIS 19 MA/04) is that income is excluded only if it goes into your own trust during the month you receive it.
- You send bills or payment requests to the trust. Each trust has its own way of taking them, such as a portal, email or mail.
- The trust pays the vendor directly. The landlord, the electric company and so on get the payment, not you.
- Medicaid stays open. The state’s guidance tells local offices to review trust activity at each renewal to confirm the deposits were made.
What bills can a pooled trust pay?
The Department of Health does not publish a master list. What it does say is that money paid directly to someone for your benefit does not count as your income, and it gives examples: food, shelter, telephone bills, education and entertainment. A state letter on pooled trusts (GIS 08 MA/020) uses rent and household utilities as its worked example.
What the trust will actually pay beyond those examples depends on its own policies, so ask before you rely on it for anything unusual. The table shows how the state treats the common cases.
| Payment | How Medicaid treats it | Where it comes from |
|---|---|---|
| Rent paid by the trust straight to your landlord | Not counted as income | DOH trusts page; GIS 08 MA/020 example |
| Household utilities paid by the trust to the utility company | Not counted as income | GIS 08 MA/020 example |
| Phone bill, food, education, entertainment paid on your behalf | Not counted as income | DOH trusts page |
| Cash paid from the trust to you | Counted as income | DOH trusts page |
| Cash a relative hands you outside the trust | Counted as income and can raise your spend-down | NY Health Access (NYLAG) renewal guide |
The practical lesson: have the trust, or a relative, pay the bill itself. If your daughter wants to help with rent, she should pay the landlord, not hand you cash.
Who can use a pooled trust in New York?
You must be a “certified disabled” individual. The state accepts pooled trusts for people of any age, which is why they work for seniors, while the other main exception trust, the special needs trust, is limited to people under 65. In New York City, HRA says disability can be certified by the Social Security Administration or the New York State Commission for the Blind. If you are 65 or older and not already getting disability benefits, the state’s disability review team makes the call, and its adult disability packet includes an “Over 65 Pooled Trust” section.
| Feature | Pooled trust | Individual special needs trust |
|---|---|---|
| Who may benefit | Certified disabled person of any age | Certified disabled person under 65 |
| Who runs it | A nonprofit, with separate accounts that are invested together | Created for one person by that person, a parent, grandparent, legal guardian or a court |
| Funded with | The person’s own assets or income | The person’s own assets |
| At death | Funds the nonprofit does not retain go to the state, up to the Medicaid paid | The state receives what remains, up to the Medicaid paid |
How do you set up a pooled trust and get Medicaid to count it?
You need two things: membership in a trust, and Medicaid’s agreement to lower your budget. NY Health Access, the legal-resources program run by the New York Legal Assistance Group, lays out the usual order. Details vary by trust, since each sets its own fees and minimum deposits.
- Choose a nonprofit trust. Compare fees and minimum deposits. There are many in New York State.
- Join. Expect a joinder agreement signed before a notary, a Social Security award letter, and an initial deposit. If an agent under a power of attorney signs for you, state guidance says the office may not require gifting powers in that document for an exception trust. See our guide to power of attorney and guardianship.
- Tell Medicaid your monthly deposit. Local offices must obtain a written statement of the amount you will deposit each month, along with a copy of the trust.
- Prove disability. If you receive Social Security Disability or SSI because of disability, the award letter is enough. Otherwise ask for a disability determination. In NYC, NY Health Access reports the request form is MAP-3177.
- Deposit every month. Keep the trust’s verification of deposits for your renewal.
Timing is a real issue. NY Health Access notes that if the trust goes in with a new application, Medicaid has up to 90 days when a disability determination is needed, and 45 days otherwise. Many people apply first with a spend-down so home care can start, then submit the trust. If you already have Medicaid in NYC, HRA’s MAP-751w form has a Pooled Trust section. For the monthly pay-as-you-go alternative, see our Medicaid spend-down guide and our overview of pooled income trusts.
What can go wrong with a pooled trust?
- A missed deposit. The exclusion applies only to income placed in the trust in the month it is received. A month without a deposit leaves that month’s surplus exposed.
- Cash that reaches you. Money paid directly to you from the trust counts as income.
- Married couples in managed long-term care. The Department of Health says that if your eligibility is set under spousal impoverishment budgeting, any of your income placed in a trust counts. A 2014 state directive (GIS 14 MA/25) says that budgeting is not mandatory for MLTC enrollees, and NY Health Access explains that some married people choose to be budgeted as single so a pooled trust can work. This is worth discussing with a lawyer.
- Deposits after age 65. State guidance says additions made after 65 are subject to transfer rules if you later need nursing home Medicaid. Payments the trust makes for your benefit, such as rent, offset them, so keep the trust’s payment records.
- A pooled trust is not a savings account. The money is held under the trust’s rules, and at death the nonprofit and the state have claims, as described above.
Trust fees are not set by the state, and home care itself still has to be arranged. Our guides to what Medicaid covers for home care and what home care costs in New York help with that part.
Where to start if the paperwork feels like too much: advice from our nurse director
Anna Klyauzova, RN, MSN, MPA, Director of Patient Services at ProLife Home Care, on what she sees in practice:
Families often haven’t heard of the Medicare Savings Programs, Extra Help with prescription costs, SNAP, or HEAP for heating bills. Many never check Medicaid or home care eligibility because they assume their income is too high.
If you don’t know what you qualify for, start with what is on the table: insurance, income, benefits already received and the person’s care needs. You don’t have to fill out a dozen applications this week. First find out which programs fit. NYC Aging, NY Connects and Medicaid specialists are good places to ask, and hospital Medical Social Services can help in tricky situations. We help families understand their home care options in Brooklyn and Queens and send them to the right specialist for the rest, so nobody has to sort it out alone.
ProLife Home Care is a licensed home care agency in Brooklyn and Queens, licence #2572L001, New York State Department of Health. We are not a trust, a law firm or a Medicaid office, so we cannot set up your trust or file your Medicaid paperwork. We can talk through the home care side with you. Call (718) 232-2777 or use our contact page.
Program rules and dollar figures change. Everything above was checked against health.ny.gov, nyc.gov and the NY Health Access legal-resources site on 9 October 2026. A pooled trust is a legal and financial arrangement: the Department of Health itself tells people to consult a lawyer or financial advisor, and free help may be available through Legal Aid or Legal Services. Confirm your own situation with your Medicaid office or an elder law attorney.
Frequently asked questions
How does a pooled trust pay bills?
You deposit your surplus income into your trust account each month, and the nonprofit trustee pays approved bills directly to the vendor. The Department of Health says money paid directly to someone for your benefit is not counted as your income.
What bills can a pooled trust pay in NYC?
State guidance gives examples such as rent, household utilities, telephone bills, food, education and entertainment. The trust’s own policies decide the details, so ask the trust before assuming a particular bill is covered.
Can a pooled trust pay for private home care?
The state’s examples do not mention it, so there is no official answer to rely on. Because money paid to someone for your benefit is not counted as income, some members ask their trust to pay for care. Check with the trust first.
What happens if I miss a monthly deposit?
The income exclusion applies only to income placed in the trust in the same month it is received. If you skip a month, that month’s surplus is not excluded. Contact the trust and your Medicaid office right away.
What happens to the money left in the trust when I die?
The trust must state that funds the nonprofit does not keep go to the state, up to the amount of Medicaid paid for you. Ask the trust how much it retains.
Do I need a lawyer to join a pooled trust?
The state does not say a lawyer is required, but it tells people considering a trust to consult a lawyer or financial advisor. Some trusts and social workers help with the paperwork, and Legal Aid or Legal Services may help at no cost.
