THE SHORT ANSWER

New York calculates a Medicaid transfer penalty by dividing the value of an uncompensated transfer by a regional rate — the average monthly private-pay nursing home cost in that region. For 2026, the rates range from $13,765 in the Western region to $15,675 in the Rochester region. The rate that applies depends on where the nursing home is located.

These seven numbers are some of the most useful — and hardest to find — in New York long-term care. They come straight from the state Department of Health.

2026 regional rates

Region 2026 monthly rate Counties
Western $13,765 Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, Wyoming
Rochester $15,675 Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne, Yates
Central $14,146 Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tioga, Tompkins
Northeastern $14,783 Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, Washington
Northern Metropolitan $15,024 Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster, Westchester
New York City $15,282 Bronx, Kings, New York, Queens, Richmond
Long Island $15,193 Nassau, Suffolk

Source: NYS Department of Health, GIS 25 MA/14, effective January 1, 2026.

How the rate is used

When someone applies for nursing home Medicaid, the county reviews the previous 60 months (five years) for gifts and below-value sales. The total of any non-exempt transfers is divided by the regional rate. The result is the number of months Medicaid won't pay.

Hypothetical example: $50,000 transferred, Western region: $50,000 ÷ $13,765 ≈ 3.6 months. The same $50,000 in the Rochester region would be about 3.2 months.

Partial months count. The penalty generally starts once the person is in a nursing home, has applied, and is otherwise eligible. The look-back, explained.

The Western region over time

Year Western region rate
2022 $11,884
2025 $12,842
2026 $13,765

Because the rate is the state's measure of average private-pay nursing home cost, it's also the most reliable public number for what nursing homes cost in each region. Nursing home costs in Western New York.

Questions families ask

Which region is Buffalo in?

The Western region, along with Allegany, Cattaraugus, Chautauqua, Genesee, Niagara, Orleans, and Wyoming counties. Its 2026 rate is $13,765.

Which year's rate applies?

Generally the rate in effect on the date of the Medicaid application, or the date an increase in coverage is requested, for the region where the facility is located.

Do these rates apply to home care Medicaid?

They're used for nursing home transfer penalties. New York's home care look-back hasn't taken effect as of 2026.

Keep exploring

A clearer plan starts here.

Get the free Family Care Planning Checklist: questions to ask, details to gather, and a place to organize your next steps.

Download checklist

Free PDF. No signup required. Email and text updates are optional. See all free downloads

Sources & dates