NY Assisted Living Program (ALP): Financial Help for Senior Living

Page Reviewed / Updated - Jan. 2016

Waiver Description

New York State's Assisted Living Program covers the cost of 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.

While 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. In the world of financial assistance for assisted living, this program is almost unique in that its hybrid structure of Medicaid and non-Medicaid funding allows it to pay for both assisted living care services and the room and board costs of some participants

 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

New York state residents of at least 21 years of age who meet both the rules for personal needs and financial limits will qualify for benefits from the ALP.

Functional Requirements

Applicants must be medically eligible for nursing home care. However, their functional ability cannot be so limiting 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. Below we present the New York state Medicaid entrance requirements for seniors in 2016.

Income Limits - Monthly income for an individual in 2016 is limited to $825 and for a couple $1,209. 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 - The value of the applicant's non-exempt assets in 2016 cannot exceed $14,850 for a single applicant and $21,750 for couples.

Medicaid does not include the value of the applicant's home when calculating assets, provided that the home is owner-occupied. In the case of the Assisted Living Program, if the applicant is single or widowed, they will live in the assisted living residence and therefore their home cannot be owner-occupied and as such, it would not be considered exempt. However, with married couples, a healthy spouse could remain in the home and it would still be exempt until such time as they moved from the home.

Couples in this situation or individuals over the asset limit may wish to investigate working with a Medicaid planning professional. In many cases, these experts are able to creatively structure a family's financial assets to ensure Medicaid eligibility.  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
  • Personal Emergency Response Services

 

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. Further, public officials have stated their commitment to adding 6000 new available slots in this program.  To learn more visit the program's official page.

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 be 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.