Fratello Law

Does Medicaid Pay for Assisted Living?

New York’s Medicaid program is a government-funded benefits plan that pays for long-term care for eligible elderly or disabled individuals who require a certain level of medical and personal assistance. If you are a resident of New York and qualify for Medicaid, the program may pay for the care component of your stay in a licensed assisted living facility that qualifies as an Assisted Living Program.

Fratello Law helps individuals in New York understand what their Medicaid benefits may cover regarding personal care while living in assisted living. While a person may be eligible for Medicaid benefits, there are further requirements for an individual to also qualify for those benefits to pay for care in assisted living in New York.

When Will Your Medicaid Benefits Pay for Assisted Living in New York?

The Assisted Living Program provides supportive housing and home care services to individuals who are medically eligible for placement in a nursing facility, but whose needs can be met in a less restrictive and lower cost residential setting. An assisted living facility provides individuals with room, board, housekeeping, personal care, case management, home health services and supervision. Assisted living facilities are generally lower in cost and less medically intensive than nursing homes and are generally licensed by New York to accept Medicaid residents. Those assisted living facilities that are licensed to accept Medicaid residents are known as Assisted Living Programs.

New York residents who want Medicaid to cover their stay at an assisted living facility must qualify for the Assisted Living Program (often referred to as ALP). ALP has limited enrollment and is not available to everyone. Here is what you need to know.

Who Qualifies for ALP in New York?

Similar to Community Medicaid, the eligibility criteria for ALP placement is a two-pronged determination with financial and medical need components.  For financial eligibility, the current resource level for an individual is $30,182 and for a couple is $40,821.  The monthly income limit is $1,608 for an individual.  To meet the medical criteria for ALP, an individual must be medically eligible for placement in a nursing facility, but cannot require 24-hour nursing care, be bedridden, or be a danger to other assisted living facility residents.

It should be noted that most assisted living communities are not licensed to be ALPs, and they generally only take private pay residents. However, residents in assisted living facilities may qualify for Medicaid home health services. These services can be provided to them while they live in the assisted living facility.

How a Medicaid Attorney Can Help You Qualify for ALP

The cost of long-term care, whether it be in a nursing home, assisted living community or home health aid services, has skyrocketed over the years. If you feel assisted living may be something you could greatly benefit from but are unsure if it is in the cards due to the high cost, a Medicaid attorney may be able to help.

A New York attorney experienced in Medicaid planning can assist clients by helping them understand what benefits they may be eligible for, including ALP and other Medicaid covered services. The laws and requirements regarding Medicaid and your eligibility for ALP can become confusing and overwhelming. However, when you work with a knowledgeable attorney, you can be sure that your rights will be represented and protected as they help you apply for the long-term care you require.

Get Help From a Medicaid Attorney in New York Today

Fratello Law is a New York law firm with experience working with families and helping elderly individuals understand their eligibility for Medicaid, including the Assisted Living Program. We are a small firm with a big heart that focuses on building high-quality relationships with our clients to assist them as they seek the Medicaid benefits necessary to pay the high cost of long-term care.

For a no-cost initial consultation with one of our New York Medicaid attorneys, contact us here or call (631) 406-5580. We look forward to welcoming you to our client family.