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Medicaid Waivers and Assisted Living

New York's Assisted Living Program (ALP) and Managed Long Term Care (MLTC) system, and what each actually pays for inside a licensed community.

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Short answer

New York runs several separate community-based Medicaid programs rather than one combined waiver: the Assisted Living Program (ALP) pays for care services inside specific licensed Adult Homes and Enriched Housing Programs, Managed Long Term Care (MLTC) coordinates home care and related services through managed care plans, and the Nursing Home Transition and Diversion (NHTD) waiver funds in-home services for those diverting from or transitioning out of a nursing facility.

What ALP actually pays for

ALP, regulated under 18 NYCRR Part 494, covers personal care, housekeeping, supervision, home health aides, nursing, therapy, medical supplies and RN case management delivered inside the ACF. It does not function as a cash voucher, and it does not fully cover room and board -- confirm the specific split with any community that participates.

Which program pays for in-home-only services

The NHTD waiver and MLTC both fund services delivered at home, not inside a licensed community. Neither covers rent or a mortgage payment.

How families pay for care. New York's Assisted Living Program, NHTD waiver and Managed Long Term Care each pay for different community-based settings. Read the full explanation →

Questions families ask

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.

How much money can my spouse keep if I go on Medicaid for nursing home care in New York in 2026?

For 2026, the community spouse may generally keep the greater of the state minimum Community Spouse Resource Allowance ($74,820) or half of the couple's countable resources, up to the federal maximum of $162,660. The community spouse is also entitled to a Minimum Monthly Maintenance Needs Allowance of $4,066.50 per month from the institutionalized spouse's income. These figures come from NYSDOH's GIS 26 MA/03 guidance, effective January 1, 2026.

How much spending money is a Medicaid nursing home resident allowed to keep each month in New York?

New York's Nursing Home Resident Personal Needs Allowance is $50 per month - the amount a Medicaid-funded nursing home resident is permitted to keep from their own income for personal expenses, with the rest going toward the cost of their care. According to the NY State Office for the Aging (NYSOFA), this figure has been unchanged since the 1980s, and NYSOFA notes that 33 other states currently pay a higher PNA, ranging from $52 to $200.

What is the MLTC special income standard for Long Island and why does it matter for Medicaid home care?

The special income standard for housing expenses, available to certain individuals enrolled in a Managed Long Term Care plan, varies by NYSDOH region - for the Long Island region specifically, it is $1,701.00. This regional figure is higher than most upstate regions (for comparison, the Central New York region's is $426 and the Western region's is $341), reflecting Long Island's higher housing costs, and remains in effect until updated federal poverty levels are published.

How much does assisted living cost in New York State?

According to CareScout's 2025 Cost of Care Survey, the median cost of an assisted living community (private one-bedroom) in New York State is $225 per day, or about $7,110 per month and $85,320 per year. This is a statewide median - CareScout's published state-level data tables do not break out a separate Long Island or metro New York figure.

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