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Choosing Between Two Communities

The questions that break a tie once the tours all start blurring together.

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Short answer

When two communities both seem workable, compare the all-in cost at your parent's actual care level, the three-year rate increase history, overnight staffing (not daytime), both facilities' state inspection records, and whether either holds a Medicaid waiver provider agreement your family might eventually need.

This decision comes up often enough that we cover it in full, with a step-by-step comparison process, on its own page in our situations section rather than repeating it here.

See the full comparison walkthrough →

What to ask on a tour. Ask to see the state inspection report, the memory-care disclosure/certification if marketed, the all-in cost at your parent's care level, the three-year rate increase history, and the overnight staffing ratio. Read the full explanation →

Questions families ask

Do I have to enroll in an MLTC plan for home care in Nassau or Suffolk County?

Yes - Managed Long Term Care (MLTC) enrollment is mandatory in both Nassau and Suffolk counties for dual-eligible Medicaid recipients age 21 and older who need community-based long-term care services for more than 120 days. NYSDOH extended mandatory MLTC enrollment to Nassau, Suffolk, and Westchester counties beginning in the 2013 transition period, and that mandatory enrollment structure remains in effect. MLTC plans coordinate home care, adult day care, nursing home care, and related services through a single managed care plan rather than fee-for-service Medicaid.

What is the NHTD Medicaid waiver and could it help my parent stay out of a nursing home?

The Nursing Home Transition and Diversion (NHTD) Medicaid Waiver is a federal 1915(c) Home and Community-Based Services waiver administered by NYSDOH through Regional Resource Development Centers. It helps Medicaid-eligible people age 65 and older, and younger people with physical disabilities, who have been assessed as needing nursing-home-level care receive services in the community instead, either transitioning out of a nursing facility or diverting from being admitted to one in the first place.

What is New York's Assisted Living Program (ALP) and how is it different from private-pay assisted living?

The Assisted Living Program (ALP) is New York's Medicaid-funded alternative to nursing home placement, operating inside licensed Adult Homes or Enriched Housing Programs rather than as a separate building type. It serves people who are medically eligible for nursing home care but can safely be served in a less medically intensive, lower-cost setting, covering personal care, room and board, housekeeping, home health aides, nursing, therapy, medical equipment, adult day health care, and RN case management. ALP is regulated under 18 NYCRR Part 494.

My mom is 68 with a low income - does New York's ACA Medicaid expansion cover her nursing home or home care costs?

No. New York's 2014 ACA Medicaid expansion covers a different population: adults ages 19-64 without dependent children, up to 138% of the federal poverty level, with no asset test. Long-term care Medicaid for seniors is a completely separate eligibility pathway - it is asset and resource-tested, applies to people 65 and older or those needing institutional-level care, and is what actually covers nursing home care, MLTC, the ALP, and NHTD waiver services.

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