New York Medicaid’s Sibling Transfer Exemption for the Home

In New York, a nursing-home Medicaid applicant may transfer their primary residence to a sibling without a transfer penalty if (1) the sibling already has an equity (ownership) interest in the home and (2) the sibling lived in the home for at least one year immediately before the applicant became institutionalized (entered a nursing facility or equivalent). This rule comes from federal law and is recognized in New York’s Medicaid guidance.

Why this exemption matters

Medicaid imposes a five-year (60-month) lookback for nursing-home care. Gifts during the lookback can trigger a penalty period—a temporary denial of Medicaid payment for long-term care. The sibling transfer exemption is one of a handful of safe transfers that do not trigger a penalty when the conditions are met.

The two legal requirements

1. Sibling had an “equity interest.”
   The sibling must already be a co-owner (e.g., on the deed) or otherwise hold a real ownership stake at the time of transfer. Being “on title” is the cleanest proof of equity interest.
2. Sibling lived in the home for ≥ 1 year before institutionalization.
   The sibling must have resided in the home continuously for at least one year immediately before the Medicaid applicant became institutionalized (entered a nursing facility or equivalent level of care).

Authority: 42 U.S.C. § 1396p(c)(2)(A) (home transfer exceptions); mirrored in New York Medicaid policy materials.

What counts as “institutionalized”?

Typically, entry into a nursing facility (or a hospital level of care equivalent to a nursing facility). New York follows the federal framework in defining when institutionalization triggers transfer-of-assets scrutiny.

Documentation checklist (to prepare before any deed work)

• Proof of equity interest: prior deed showing the sibling already on title (or other recorded ownership evidence).
• Proof of one-year residency: driver’s license, voter registration, tax returns, utility bills, bank/insurance statements addressed to the sibling at the property for the one-year lookback period.
• Timeline evidence of institutionalization: admission records or facility paperwork showing the institutionalization date.
• Property status: confirm it’s the applicant’s primary residence (homestead).

Practical example

Scenario: Joan enters a Queens nursing home on June 1, 2025. Her brother, Mark, has been on the deed since 2019 (equity interest) and lived in the home with Joan continuously from May 2024 through May 2025.
Result: Joan may transfer the home to Mark without a Medicaid transfer penalty under the sibling exemption.

Sibling exemption vs. caregiver-child exemption

• Sibling exemption: 1-year residency and pre-existing equity interest. ()
• Caregiver-child exemption: Adult child lived in the home 2 years and provided care that delayed institutionalization; equity interest not required. (A different, frequently used pathway.) ()

(If you need a primer on the caregiver-child rule, see our guide: NY Medicaid Caregiver Child Exemption.)

Common pitfalls we see

• Adding the sibling to title too late. Equity interest must exist before the transfer relying on the exemption.
• Gaps in residency proof. Keep a paper trail—12 months of consistent mail and records tied to the property.
• Mixing exemptions. The sibling exemption is not the caregiver-child exemption; each has its own requirements.
• Assuming all home care rules are identical. Transfer-of-assets rules are nuanced across settings and programs; verify current NY guidance for your specific benefit category.

Action steps if you think you qualify

1. Confirm the dates: one-year sibling residency immediately before institutionalization.
2. Confirm equity: ensure sibling already has a recorded ownership interest.
3. Assemble evidence: collect 12+ months of documents showing occupancy.
4. Coordinate the deed with counsel; align transfer timing with the Medicaid application strategy.
5. Document your file for fair-hearing readiness.

FAQs (New York–specific)

Is being “on the deed” the only way to show equity interest?
It’s the cleanest method and what agencies commonly expect. Other forms of real ownership can be argued, but proving them is harder in practice.

Does the one-year residency have to be continuous?
Yes—continuous for the year immediately before institutionalization. Gaps or moving out can break eligibility.

Can we use the sibling exemption for home-care Medicaid (not nursing-home)?
Transfer rules vary by program and evolve. New York’s policies for community Medicaid have been in flux; get current, program-specific guidance before relying on any exemption.

What if the sibling moved in 10 months ago?
Then the sibling exemption doesn’t apply (you’re short of 12 months). Consider other planning options (e.g., caregiver-child if facts fit, MAPT, or timing strategies).

Can a sibling buy a small share shortly before the transfer?
Creating an equity interest at the last minute raises scrutiny and may not satisfy the spirit (or documentation) of the rule. Get counsel to assess risk.

Legal Sources & Guidance

• Federal statute (home transfer exceptions): 42 U.S.C. § 1396p(c)(2)(A). ()
• NY regulations / policy materials: 18 NYCRR 360 and DOH administrative guidance & reference materials acknowledging sibling-with-equity and residency requirements.

Talk with a New York elder-law attorney

This article is general information, not legal advice. Medicaid planning is fact-intensive and time-sensitive. If you’re in Queens, Brooklyn, or anywhere in NYC, the Law Offices of Roman Aminov, P.C. can help you evaluate whether the sibling transfer exemption (or another option) fits your situation. Call us at 347-766-2685 for a free phone consultation