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Medicaid Waiver vs. Nursing Home Medicaid

Nursing home Medicaid is an entitlement in New York once eligible. MLTC, ALP and NHTD pay for different community-based settings and are not automatically available.

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Short answer

Nursing home Medicaid in New York is an entitlement once a senior is financially and medically eligible -- 2026 figures include a Community Spouse Resource Allowance of $74,820-$162,660 and a Minimum Monthly Maintenance Needs Allowance of $4,066.50/month. New York's community-based alternatives -- Managed Long Term Care (MLTC), the Assisted Living Program (ALP), and the NHTD waiver -- pay for different settings and are not automatically available the moment someone qualifies.

The practical difference

Nursing home Medicaid is not capacity-limited the way New York's community-based programs can be. MLTC enrollment is mandatory in Nassau and Suffolk for qualifying Medicaid recipients, but ALP beds and NHTD waiver capacity depend on the specific facility or regional allocation having room.

New York's nursing home resident Personal Needs Allowance is just $50/month, among the lowest in the country -- a figure worth knowing before assuming Medicaid covers everything once someone is admitted.

Questions families ask

What is an Enhanced Assisted Living Residence (EALR) and when would my parent need one?

An Enhanced Assisted Living Residence (EALR) is an additional certification an Assisted Living Residence can obtain to let residents age in place despite higher physical needs, specifically those who chronically need physical help walking or using stairs, depend on medical equipment requiring frequent professional assistance, or have chronic, unmanaged bowel or bladder incontinence. EALR care is delivered per an Individualized Service Plan and is regulated under the same 10 NYCRR Part 1001 rules as standard ALR and SNALR certifications.

Is there a local New York State office that oversees senior care facilities specifically on Long Island?

Yes. Long Island Adult Care Facilities fall under NYSDOH's Metropolitan Area Regional Office - Long Island (MARO-LI), located at 320 Carleton Avenue, Suite 5000, Central Islip, NY 11722, phone 631-851-3098. This regional office handles licensing oversight and inspections for Nassau and Suffolk County facilities rather than families needing to go through a statewide-only office.

Do I have to enroll in an MLTC plan for home care in Nassau or Suffolk County?

Yes - Managed Long Term Care (MLTC) enrollment is mandatory in both Nassau and Suffolk counties for dual-eligible Medicaid recipients age 21 and older who need community-based long-term care services for more than 120 days. NYSDOH extended mandatory MLTC enrollment to Nassau, Suffolk, and Westchester counties beginning in the 2013 transition period, and that mandatory enrollment structure remains in effect. MLTC plans coordinate home care, adult day care, nursing home care, and related services through a single managed care plan rather than fee-for-service Medicaid.

What is the NHTD Medicaid waiver and could it help my parent stay out of a nursing home?

The Nursing Home Transition and Diversion (NHTD) Medicaid Waiver is a federal 1915(c) Home and Community-Based Services waiver administered by NYSDOH through Regional Resource Development Centers. It helps Medicaid-eligible people age 65 and older, and younger people with physical disabilities, who have been assessed as needing nursing-home-level care receive services in the community instead, either transitioning out of a nursing facility or diverting from being admitted to one in the first place.

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