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How Families Pay for Senior Care

Private pay, New York's Medicaid programs (MLTC, ALP, NHTD), VA Aid and Attendance, and long-term care insurance.

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How Long Island families actually pay for care

New York fully expanded Medicaid under the ACA in 2014, but that expansion (income-based, for adults under 65) is a completely separate eligibility pathway from long-term-care Medicaid for seniors, which is asset-tested. Do not conflate the two.

For community-based long-term care, most Nassau and Suffolk seniors on Medicaid go through Managed Long Term Care (MLTC) — mandatory in both counties since 2013 for Medicaid recipients who need more than 120 days of community-based long-term care and can remain safely at home. Within a licensed Adult Home or Enriched Housing Program, the Assisted Living Program (ALP) can cover personal care, nursing, therapy and case management for residents who are medically eligible for a nursing home but stay in a lower-cost, licensed setting instead. For residents who want to stay entirely at home, the Nursing Home Transition and Diversion (NHTD) Medicaid waiver funds home and community-based services for those assessed as needing nursing-home-level care.

For 2026, New York's nursing-facility Medicaid figures include a Community Spouse Resource Allowance of $74,820–$162,660, a Minimum Monthly Maintenance Needs Allowance of $4,066.50/month, and a nursing home resident Personal Needs Allowance of just $50/month — among the lowest in the country. VA Aid and Attendance, a federal (not state) benefit, adds up to $29,093/year for an eligible veteran or $18,697/year for a surviving spouse (rates effective through November 2026).

Questions families ask

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.

What is New York's Assisted Living Program (ALP) and how is it different from private-pay assisted living?

The Assisted Living Program (ALP) is New York's Medicaid-funded alternative to nursing home placement, operating inside licensed Adult Homes or Enriched Housing Programs rather than as a separate building type. It serves people who are medically eligible for nursing home care but can safely be served in a less medically intensive, lower-cost setting, covering personal care, room and board, housekeeping, home health aides, nursing, therapy, medical equipment, adult day health care, and RN case management. ALP is regulated under 18 NYCRR Part 494.

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.

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