When your loved one needs care that can’t be provided at home, many families begin to look for an assisted living facility and are shocked by the cost. The majority of assisted living facilities only accept private payment.

Medicaid may be used in certain circumstances to cover some or all of the costs, but understanding what types of care and facilities are eligible with Medicaid in New York can be complicated. Consulting with a New York elder law attorney is important if you are starting on this journey for yourself or a loved one. Medicaid and assisted living costs in New York

New York Medicaid: How Assisted Living Is Defined

When considering care for a senior, it’s important to understand the difference between assisted living and a nursing home or rehabilitation/skilled nursing facility. Assisted living is for people who need a moderate level of assistance. The cost usually includes room and board at the facility along with some services such as nursing, medication administration, and a moderate level of personal care assistance such as help with showering or dressing. A nursing home is for acute, round-the-clock care. Seniors who get sick or experience an injury may be placed in a nursing home to recover. Or, as someone ages, they may have to move from assisted living to a nursing home to get a higher, more constant level of care.

New York State and the federal government work together to provide help paying for nursing homes for low-income people who qualify for Medicaid. New York does not guarantee this support to people who are in assisted living facilities or who are receiving in-home care. Assistance is available for Medicaid recipients, but there is a long waitlist.

The Assisted Living Wait List

The Medicaid Assisted Living Program in New York “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. The operator of the assisted living program is responsible for providing or arranging for resident services that must include room, board, housekeeping, supervision, personal care, case management, and home health services.”

Assisted Living facilities are divided into two categories: Assisted Living Facilities (ALF), which are usually private pay only, and Assisted Living Programs (ALP), which are facilities that are licensed by the state to accept Medicaid residents, although some ALPs may also be private pay.

If you are in New York and need Medicaid to pay for assisted living, you must qualify for an ALP. However, even if you qualify, there is a long waiting period for a facility—perhaps even longer than your loved one has left to live. The waitlist is prioritized to serve the sickest individuals first.

When You Can’t Wait for the Wait List

If your senior is on the wait list for an ALP and experiences a major injury, sickness, or other medical event that requires specialized care more urgently, you may be able to shorten the wait time since the list is designed to serve the most frail people first.

If your loved one urgently needs to be in a care facility, you may be able to bypass the lengthy waiting period for an ALP by placing them in a nursing home, which is typically where a higher level of care is needed, rather than in assisted living. A person must qualify for nursing home care to be admitted to such a facility. However, if they are recovering or rehabilitating from an injury or illness but have the potential to recover and live in assisted living, placing them in a nursing home can help you shortcut the waiting list. If a senior is already in a skilled nursing facility and is on Medicaid, you can move them to assisted living after only 60 days.

Medicaid Challenges

Medicaid may not pay for all of a person’s associated costs for an ALP. You need to talk with the facility to understand what you should expect to pay if your loved one moves there. Many families have to pay at least part of assisted living costs, even with assistance from Medicaid. The more care a person needs, the higher their monthly costs in assisted living.

Protecting your assets so they can’t be used by Medicaid to help pay for your care is an important part of estate planning. An experienced New York elder care lawyer can help you make the best decisions no matter where you are preparing to move—to an assisted living facility or skilled nursing home.