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How Families Pay for Senior Care

Private pay, New York's Medicaid programs (MLTC, ALP, NHTD), VA Aid and Attendance, and long-term care insurance.

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How Long Island families actually pay for care

New York fully expanded Medicaid under the ACA in 2014, but that expansion (income-based, for adults under 65) is a completely separate eligibility pathway from long-term-care Medicaid for seniors, which is asset-tested. Do not conflate the two.

For community-based long-term care, most Nassau and Suffolk seniors on Medicaid go through Managed Long Term Care (MLTC) — mandatory in both counties since 2013 for Medicaid recipients who need more than 120 days of community-based long-term care and can remain safely at home. Within a licensed Adult Home or Enriched Housing Program, the Assisted Living Program (ALP) can cover personal care, nursing, therapy and case management for residents who are medically eligible for a nursing home but stay in a lower-cost, licensed setting instead. For residents who want to stay entirely at home, the Nursing Home Transition and Diversion (NHTD) Medicaid waiver funds home and community-based services for those assessed as needing nursing-home-level care.

For 2026, New York's nursing-facility Medicaid figures include a Community Spouse Resource Allowance of $74,820–$162,660, a Minimum Monthly Maintenance Needs Allowance of $4,066.50/month, and a nursing home resident Personal Needs Allowance of just $50/month — among the lowest in the country. VA Aid and Attendance, a federal (not state) benefit, adds up to $29,093/year for an eligible veteran or $18,697/year for a surviving spouse (rates effective through November 2026).

Questions families ask

Does Nassau County or Suffolk County have a bigger, more spread-out senior care market?

Suffolk County's senior care market is more geographically spread out, stretching from denser, transit-served western hamlets such as Huntington, Brentwood, Bay Shore, and Islip to more rural, exurban North and South Fork communities that have become popular retirement-relocation destinations. Nassau County's market is more geographically compact, concentrated along its village and LIRR corridor towns, including Garden City, Rockville Centre, Great Neck, Freeport, Long Beach, and Mineola.

What's the difference between standard assisted living and memory care in New York?

Standard assisted living in New York is licensed as an Assisted Living Residence (ALR) under 10 NYCRR Part 1001. Memory care is not a separate license; it's delivered through a Special Needs Assisted Living Residence (SNALR) certification, an additional certification an ALR can obtain to serve residents with dementia or cognitive impairments per an Individualized Service Plan, regulated under the same Part 1001 rules.

What's the difference between a nursing home and an assisted living residence in New York, regulation-wise?

Nursing homes are licensed under 10 NYCRR Part 415, Nursing Homes - Minimum Standards, a distinct regulatory chapter focused on skilled, medically intensive care. Assisted Living Residences are licensed under 10 NYCRR Part 1001, and can only exist as an additional certification on top of an already-licensed Adult Home or Enriched Housing Program, themselves licensed under 18 NYCRR Parts 487 and 488.

At what point does hourly in-home care cost more than assisted living in New York?

Using CareScout's 2025 New York State medians, in-home non-medical caregiving costs $35 per hour, or about $6,673 per month at 44 hours a week, compared to assisted living's median of $7,110 per month ($225 per day). At roughly 45 to 46 hours per week of paid in-home care, the monthly cost crosses over and exceeds the assisted living median; families needing care beyond that, including any overnight or 24/7 coverage, would generally spend more on home care than on a private one-bedroom assisted living apartment.

What's the difference between a CCRC or Life Plan Community and a standalone assisted living or nursing facility on Long Island?

A Continuing Care Retirement Community (CCRC), also called a Life Plan Community, offers a full continuum of care, independent living, assisted living, memory care, and skilled nursing, on one campus, so a resident can move between levels of care as needs change without relocating to a different facility or provider. Long Island examples include Jefferson's Ferry in South Setauket, which describes itself as Long Island's first Life Plan Community, and Peconic Landing in Greenport, which describes itself as New York's only equity-based CCRC; a standalone assisted living or nursing facility, by contrast, offers only one level of care and requires a resident to move elsewhere if their needs change.

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