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New York State's Assisted Living Program pays the cost of services in licensed assisted living residences throughout the state for qualified individuals. Participants must require a high level of care, typically equivalent to the level of care in a nursing home. Although 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 clear 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.
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.
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.
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 2017.
Income Limits - Monthly income for an individual in 2017 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 2017 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, if 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. The home will not likely be considered exempt. However, with married couples, a healthy spouse could remain in the home and it would still be exempt until 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. These experts can creatively structure a family's financial assets, including exploring ways to make the home exempt, to ensure Medicaid eligibility. Learn more about this option.
The Assisted Living Program pays the basic cost for the individual to reside in an approved assisted living residence. Often, though, assisted living residences offer services beyond the "basics." These are not paid for by ALP. Included services are:
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 already 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.
Because the Assisted Living Program has limited enrollment, it is not unusual to be placed on a waiting list. Persons in this situation can still receive some financial assistance from NY Medicaid that can be used to offset personal care service costs in assisted living residences, but not room and board costs. Families can receive free assistance finding affordable assisted living here.