THE SHORT ANSWER

A pooled income trust is run by a nonprofit and lets a person with a disability — including many older adults — deposit the part of their monthly income that's over the Medicaid limit. The trust then pays their bills, like rent and utilities, from that money. Medicaid doesn't count the deposited income, so the person can qualify for Medicaid home care without losing the money they need to live at home.

Many older New Yorkers have Social Security and a pension that together put them a little over the Medicaid income limit — $1,836 per month for a single person in 2026. They need help at home, but they also need their income to pay rent and the electric bill. A pooled income trust is how New York solves that.

How it works

  1. The person joins a pooled trust run by a nonprofit organization. The trust "pools" many members' accounts for management, but each member has their own sub-account.
  2. Each month, they deposit their excess income — the amount over the Medicaid limit — into the trust.
  3. The trust pays their bills from that money: rent or mortgage, utilities, phone, and other everyday expenses, paid directly to the vendors.
  4. Medicaid doesn't count the deposited income, so the person can qualify for Medicaid home care without a monthly spend-down.

Who can use one

The person must meet the definition of disability. That doesn't only mean a lifelong condition — many older adults who need help with daily living qualify. For people 65 and older, the county can make a disability determination as part of the Medicaid process.

Pooled trust vs. spend-down

Without a trust, income over the limit has to be "spent down" on medical bills each month before Medicaid pays — like a monthly deductible. For someone who needs that income for rent, a spend-down can make staying home impossible. A pooled trust keeps that money usable. Excess income and the spend-down.

What to watch for

  • Fees. Trusts charge enrollment and monthly fees. Ask for all fees in writing.
  • Payment timing. Bills are paid by the trust, not the person. Ask how quickly the trust pays.
  • What happens at death. Remaining funds usually stay with the nonprofit or repay Medicaid. Read the agreement.
  • Monthly discipline. Deposits must be made every month for the arrangement to work.

Is it for nursing homes?

Pooled income trusts are mainly a tool for staying at home. In a nursing home, the resident's income generally goes toward the cost of care after the allowances, so a pooled income trust usually doesn't change the outcome.

Questions families ask

Who can use a pooled income trust?

A person who meets the definition of disability. For people 65 and older, the county can make that determination as part of the Medicaid process.

Does a pooled trust work in a nursing home?

It's mainly used for Medicaid at home. In a nursing home, income over the allowances generally goes toward the cost of care.

Is there a cost?

Trusts usually charge an enrollment fee and a monthly fee. Compare a few; fees and service vary.

What happens to money left in the trust?

Rules vary by trust. Commonly, money remaining at death stays with the nonprofit or repays Medicaid. Read the joinder agreement carefully.

Keep exploring

More support. More life at home.

Explore Homeward by Cardinal for help coordinating everyday support and the next steps for aging at home.

Explore Homeward

Homeward is a separate paid service. Scope, availability, and pricing are confirmed before enrollment. It does not replace medical care. How Cardinal is paid.

Sources & dates