How to join a pooled income trust in NYC, step by step (MAP-751W)

For 2026, the Medicaid income level for people 65+, blind, or disabled is $1,836 a month for one person and $2,489 for a couple. The resource limit is $33,038 for one and $44,796 for two. Income over the level is your surplus, or spend-down. Your Medicaid notice shows the amount.

Example: $2,356 a month in Social Security, minus the $20 disregard, is $2,336. That is $500 over $1,836, so the surplus is $500 a month.

Compare the two paths in spend-down vs pooled income trust.

1. Confirm your surplus amount on your latest Medicaid notice, or call the HRA Medicaid Helpline at 888-692-6116.
2. Choose a nonprofit pooled trust. Ask each trust about its enrollment fee, monthly fee, how it pays bills, and what happens to money left in the account. Only nonprofit trusts qualify.
3. Sign the joinder agreement. This is the trust's enrollment contract. If someone signs for you under a power of attorney, keep a copy of the POA.
4. Line up proof of disability. If Social Security found you disabled, use that letter. If not, you need a disability review. HRA says people 65 or older in a pooled trust use form MAP-3177 to request a disability determination. MAP-751W also lists LDSS-486T, LDSS-1151, MAP-751e, and OCA-960 as ways to request a review.
5. Make your first deposit of the surplus amount into the trust. Keep the receipt.
6. Fill out MAP-751W. Check "Pooled Trust – Budgeting for New Trust Submission." Attach the joinder agreement, the POA if any, the proof of deposit, and the disability papers.
7. Send it to HRA. The HRA Health Assistance page says MAP-751W can be faxed to 917-639-0837. Keep the fax confirmation.
8. Watch for a notice. HRA says it will send an eligibility notice about the change. Check that the spend-down is gone or lower.
9. Deposit every month. If you miss deposits, you may owe a spend-down again. If your income goes up, for example with a January Social Security raise, raise your deposit and send a new MAP-751W marked "Budget for Increased Deposits."

The idea is the same, but you send the papers to your county Department of Social Services, not HRA. Ask the county which form it wants. The Department of Health's list of county offices has each address and phone number (link in the sources below).

• Pooled trust joinder agreement
• Power of attorney, if used
• Proof of the first deposit
• Social Security disability letter, or a disability review request (MAP-3177 if you are 65+)
• Your Medicaid case number and CIN on every page

HRA does not publish a set processing time for pooled trust budgeting. Keep copies of everything. If you hear nothing in about a month, call the Medicaid Helpline at 888-692-6116. If you get a notice you disagree with, you have 60 days from the notice date to ask for a fair hearing. See our fair hearing prep checklist.

• Depositing less than the surplus amount.
• Forgetting the disability papers. A pooled trust only works for people found disabled.
• Not updating the deposit when income changes.
• Paying your own bills from the trust. The trust pays them for you, following its rules.