Navigating Medicaid for Assisted Living in New York

March 15, 2024

This guide offers an extensive look at leveraging Medicaid to pay for assisted living in New York through eligibility rules, covered services, application tips,and associated costs.

Medicaid Eligibility Rules for Assisted Living

Medicaid can provide essential funding for assisted living in New York, but qualifying for coverage involves navigating a complex application process. This guide offers an in-depth look at using Medicaid to pay for assisted living in New York, including eligibility rules, covered services, and tips for applying.

To receive Medicaid assistance for assisted living in New York, applicants must meet financial and functional requirements. Income, asset, and disability criteria determine qualification on a case-by-case basis.

Income Cap

Medicaid applicants must fall below New York's income limits, which equate to the federal poverty level plus a nominal sum. Income from all sources, including Social Security, pensions, and investments, factor into eligibility.
In 2023, the monthly income limit for a single person is $904. For couples, the limit is $1,226 per month.
Some assisted living communities have special waivers to accept applicants with income up to $2,504 monthly. This varies by facility.

Resource Test

Excluding the applicant's home, New York Medicaid permits the following asset limits:
Individuals: up to $16,800
Couples: up to $25,200
Resources counted toward the cap include cash, bank accounts, stocks, and bonds. If assets exceed the threshold, applicants can "spend down" savings on medical care and adaptations to meet eligibility.

Disability Requirement

Applicants for Medicaid assisted living coverage cannot reside in facilities like residential care. Instead, they must qualify for andenroll in the Assisted Living Program (ALP) or other New York waiver program by meeting an equivalent level of care as that provided in nursing homes.

New York Medicaid's Assisted Living Program

New York's Assisted Living Program (ALP) is an important source of Medicaid assistance for assisted living services. The ALP Medicaid waiver helps chronically ill, physically disabled, or cognitively impaired adults live in assisted living rather than nursing facilities.

Services Covered By the Assisted Living Program

The ALP covers specific [[long term care]] services, including:

Personal care - assistance with dressing, bathing, grooming, mobility, toileting, and eating
Home health aide services
Housekeeping and laundry
Social work and counseling
Nursing
Physical, occupational, and speech therapy
Socialization opportunities
24/7 on-site monitoring to ensure safety and respond to emergencies

ALP Medicaid waivers do not cover room and board charges at assisted living communities. Applicants must have adequate long-term income, resources, pensions, or disability benefits to cover housing and food costs.

Eligibility and Application Process

To qualify for the ALP Medicaid waiver, applicants must:

Require help with several activities of daily living (dressing, bathing, etc.)
Meet New York Medicaid financial requirements
Be age 18+
Obtain a physician's order verifying that assisted living provides a suitable alternative to nursing facility placement
Apply through local social services districts and undergo assessment determining clinical eligibility

If approved, enrollees can use ALP Medicaid benefits to cover assisted living services in state-approved facilities.

Selecting a Medicaid Assisted Living Facility

Finding a suitable Medicaid-accepting assisted living community involves:

Research and Visits

The New York State Department of Health provides a complete list of ALP contracted, Medicaid approved assisted living residences.
Tour facilities you’re interested in to evaluate services, amenities, staff competency, and overall fit. Prepare questions in advance to ask staff and residents.
Which services does Medicaid cover here?
What out-of-pocket fees remain for me?
How quickly do staff respond when I need assistance?

Location

Consider convenience factors like proximity to:

Public transportation
Community resources
Nearby family and friends

A facility’s connectivity can help you access outside healthcare, social services, entertainment venues and maintain quality of life despite physical limitations.

Staffing Credentials

Check that an assisted living residence employs:

24/7 registered nurse oversight
Certified nursing assistants with adequate training in areas like dementia care
Stringent background check and skills verification protocols

These indicators help ensure staff can safely meet residents' needs.

Medicaid Assisted Living Applications - Top Tips

Completing New York State's complex Medicaid application presents a major barrier to accessing assisted living funding. These top tips help simplify the process:

Get expert help - Consult a [[Medicaid planning attorney]] or senior care advisor to guide your application. An expert can indentify eligibility pathways, maximize qualifying assets, and avoid rejection.
Apply ASAP - Processing times for Medicaid assisted living applications often exceed 90 days. Avoid rushed decisions or benefit delays by applying early in your care planning process.
Collect paperwork - Pull together essential documents like financial statements, physicians' evaluations, ID, and proof of residence. Thorough records streamline verification and boost approval odds.
Appeal denials - Over 30% of initial applications get rejected. Applicants can request reasonable accommodations or file appeals bringing new evidence to bolster their case. With persistence, approval is possible.

Costs and Considerations

Medicaid provides invaluable help covering assisted living service costs. However, beneficiaries still have financial responsibilities to factor into their care plans.

While Medicaid handles most care fees, enrollees must contribute their recurring income (like Social Security) to facilities for room and board charges.
Assisted living residents generally pay for supplemental amenities and services not included in their care plans out-of-pocket. Common add-ons like chiropractic care, massage therapy, restaurant-style dining, expanded entertainment options and specialized programming come with separate charges.
Medicaid assistance comes with strings attached and not all facilities accept it. Shop carefully to understand how Medicaid coverage coordinates with services offered and associated fees incurred at potential assisted living residences.

Even with Medicaid aid, assisted living remains beyond some New Yorkers’ financial means, highlighting the need to integrate public assistance into early retirement, estate, and care planning.

FAQs

Can Medicaid fully cover assisted living?

No, Medicaid cannot cover entire assisted living costs in New York. While ALP waivers pay for care services, enrollees must supply income to handle room and board charges. Additional amenities and services often involve supplementary fees too.

Is veteran's aid available?

Yes, veterans and surviving spouses meeting income thresholds can use VA pension benefits to cover assisted living costs either fully or partially based on level of disability.

Are there other funding options besides Medicaid?

Yes, options like long term care insurance, personal resources, and in some cases Medicare Advantage plans can provide alternative funding for assisted living services.

CONCLUSION

As more Americans grapple with chronic age-related health issues, Medicaid plays an indispensable and expanding role funding long term care. Qualifying for Medicaid help through programs like New York’s ALP waiver allows older adults to access assisted living supports that let them enjoy community and autonomy despite disability.

Figuring out New York’s stringent Medicaid eligibility tests, locating ALP contracted facilities, and expertly navigating the application process offers the best chance to secure coverage for assisted living’s significant costs. Partnership with senior care advisors simplifies the journey.