Assisted Living Program (ALP) from New York Medicaid

Page Reviewed / Updated - Mar. 2014

What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through "Medicaid Waivers" which are also called Home and Community Based Services (HCBS Waivers) or Waiver Funded Services.

Waiver Description

New York State's Assisted Living Program provides for services in licensed assisted living residences throughout the state for individuals who are medically qualified for nursing home care.  Though not without controversy, the program is generally considered a win-win as residents prefer the increased social and recreation activities offered in assisted living and the state saves money as the cost is significantly less expensive than nursing home care. 

The program is open to non-Medicaid eligible persons, the vast majority of participants, approaching 90%, are on Medicaid.  Each assisted living residence that participates in the ALP is certified initially and periodically by the New York State Department of Health.

 Did You Know? Over 90% of persons living in assisted living are happy with their level of independence and with the quantity and type of care they receive.

 

Eligibility Guidelines

In addition to requiring applicants to be residents of New York State and 21 years of age, ALP has both functional ability and financial restrictions.

Functional Requirements
Applicants must be medically eligible for nursing home care, however their functional ability cannot be so limited that they require nursing home care around the clock.  In addition, they must have a degree of self-mobility that will enable them to function in an assisted living environment.  Each applicant is assessed by medical professionals to determine need as well as by the specific assisted living residence to which they are seeking entrance to ensure social compatibility. 

Financial Requirements
While Medicaid eligibility is not a requirement for this program, the overwhelming majority of participants receive Medicaid assistance.  As such, follows is a review of New York's Medicaid eligibility requirements for seniors in 2014.

Income Limits - Monthly income for an individual in 2014 is limited to $809 and for a couple $1,192.  Persons with income in excess of these amounts may possibly still qualify either through the Medicaid Excess Income option or through the use of a qualifying income trust.

Asset Limits - Medicaid does not include the value of the applicant's home, primary vehicle and certain other personal effects when calculating assets.  These are called Exempt Assets.  The value of the applicant's Non Exempt Assets in 2014 cannot exceed $14,550 for a single applicant and $21,550 for couples.  Persons over the asset limit may qualify by working with Medicaid professionals to convert some Non Exempt Assets to Exempt Assets.  Learn more about this option.

 

Benefits and Services

The Assisted Living Program pays the basic cost for the individual to reside in an approved assisted living residence.  Be aware that often times assisted living residences will offer services beyond the "basics".  These are not paid for by ALP.   Included services are:

  • Personal Care
  • Room & Board
  • Housekeeping
  • Skilled Nursing (as required)
  • Physical and Occupational Therapy
  • Included Recreational Activities

 

How to Apply / Learn More

The Assisted Living Program is available throughout New York City and State.  It allows for a maximum of 4200 concurrent participants.  It is estimated that the 4200 "beds" are distributed at between 80 - 100 different residences in 38 counties.  A complete list is available here.   The program's official page is here.

The application process is specific to one's current situation.  Individuals on Medicaid can contact participating ALP residences in their preferred geographic area to determine if a position is available.   Persons hoping to qualify for Medicaid should contact their local Medicaid office or their local Area Agency on Aging.

Given the limited enrollment, it is not usually to be placed on a waiting list for participation in the Assisted Living Program.  Persons in this situation can still receive some financial assistance from Medicaid that can used to offset personal care service costs in assisted living residences.  However, this option does not contribute to room and board costs.  Families in this position can receive free assistance finding affordable assisted living here.