Waiver Description
New York State’s Assisted Living Program (ALP) 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, this program is generally considered a win-win. This is because residents prefer the increased social and recreational 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 — approximately 85% — 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 85% 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’s Assisted Living Program has eligibility criteria related to the candidate’s age, functional ability, and financial situation.
General Requirements
AgeApplicants must be at least 21 years of age. There is no maximum age limitation.
Functional AbilityApplicants 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 2022.
Income Limits
This program is unique in that the income limits are higher than for the regular state Medicaid program. Monthly income for an individual applying for the ALP is limited to $1,488, and for a couple, with both spouses as applicants, is limited to $2,976. Persons with income in excess of these amounts may possibly still qualify through the Medicaid Excess Income option, which is also called a Surplus Income program or “Spend-down” program. One may also hear it referred to as a
medically needy pathway.
Asset LimitsThe value of the applicant’s non-exempt assets cannot exceed $15,900 for a single applicant and $21,400 for couples, given both spouses are applying for benefits.
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 an applicant is single or widowed, he or she will live in the assisted living residence. Therefore, the home cannot be owner-occupied. The home will not likely be considered exempt, with the exception of the individual having intent to return to his or her home. However, with married couples, a healthy spouse could remain in the home and it would still be exempt until the non-applicant spouse moved from the home. NY also limits the monetary value of one’s home equity at $906,000.
Couples in which one spouse is healthy and one requires residential care or individuals who are 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.
Benefits and Services
The Assisted Living Program pays the basic cost for a program participant 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:
- Case Management
- Adult Day Health Care
- Personal Care
- Room & Board (note this is not paid for by Medicaid, but by other funding sources for persons eligible for Medicaid)
- Housekeeping
- Home Health Aides
- Medical Supplies / Equipment
- Skilled Nursing (as required)
- Physical, Speech, and Occupational Therapy
- Recreational Activities
- Personal Emergency Response Services
- Supervision
How to Apply / Learn More
The Assisted Living Program is available throughout New York City and State. It allows for a maximum of 4,200 concurrent participants. It is estimated that the 4,200 “beds” are distributed between 80-100 different residences in 38 counties. 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 Social Services office, their local Area Agency on Aging, or a Medicaid planning professional.
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.
