Our Knowledgeable NY Lawyers Discuss How Medicaid Can Help Cover the Costs of Assisted Living
The New York Medicaid Assisted Living Program (ALP) provides a combination of financial assistance and service-support to senior citizens who need a “nursing facility level of care” but are still capable of living at home or remaining in less-restrictive communities. However, qualifying for benefits isn’t easy, and it can entail making big sacrifices. 
You shouldn’t have to sacrifice your health, your wealth, or your happiness to obtain care for yourself or a loved one. The experienced elder law attorneys at Landskind & Ricaforte Law Group, P.C. could help protect your assets. Here, we discuss the details of obtaining assisted living benefits.
New York Medicaid: What to Know About Assisted Living Benefits
Only certain assisted living facilities are authorized to receive payment through Medicaid. The state distinguishes between the following:
- Assisted Living Facilities, or “ALFs,” which are private-pay-only and cannot accept Medicaid
- Assisted Living Programs, or “ALPs,” which can accept either private-pay residents or applicants receiving Medicaid benefits
Medicaid-authorized ALPs offer varying levels of support, but participation is typically contingent on meeting strict eligibility criteria.
The Empire State’s Strict Criteria for Long-Term Living Assistance
Medicaid long-term care and assisted living programs are only available to low-income applicants who require what the state terms a “nursing facility level of care.”
In New York, Medicaid officials determine whether a senior citizen needs a “nursing facility level of care,” or NF-LOC, through a complex scoring index. The scoring index considers factors including the following:
- The Medicaid recipient’s limiting medical conditions, such as bladder or bowel incontinence
- The applicant’s cognitive function, memory, and short-term recall
- The senior citizen’s ability to communicate and make themselves understood
- The extent to which an individual is capable of performing basic tasks like dressing, eating, and using the bathroom
If a senior citizen receives a high enough score on the state’s NF-LOC index, they are typically entitled to participate in an ALP. However, approval doesn’t mean immediate placement. Many programs have long waiting periods and offer little interim relief for recipients already struggling to care for themselves.
The 3 Types of Medicaid Nursing Home and Assisted Living Benefits in New York
New York Medicaid offers different types of benefits in accordance with a recipient’s living preferences and individual level of need. If somebody meets the criteria for a “nursing home level of care,” they may be eligible for the following:
Nursing Home and Institutional Medicaid
New York’s Nursing Home Medicaid covers most of the costs of long-term care for low-income residents with limited sets. Coverage is comprehensive, but it does not authorize payments for private rooms or personal comfort items.
If a recipient has any form of income, they may be required to repay Medicaid for a portion of their benefits.
Community Medicaid
Community Medicaid programs are designed to provide a “nursing home level of care” to applicants who wish to remain in their own homes, live with a relative, or reside in an assisted living facility. Benefits can be used to compensate an in-home aide and, in some cases, to cover all or part of the costs of participating in an assisted living program.
Disable, Aged, or Blind (DAB) Medicaid
Disabled, Aged, and Blind Benefits—sometimes referred to as “DAB Medicaid”—are typically reserved for disabled New Yorkers who still live in their community but need help fulfilling their daily needs.
How to Protect Your Right to New York Medicaid
Assisted living is expensive everywhere, and it’s no exception in New York. The costs of home health care or placement in a nursing home facility typically amount to tens of thousands of dollars per year—enough to drain bank accounts and enough to force families into making very difficult decisions about how best to allocate their remaining assets.
You don’t have to sacrifice your financial independence for the sake of your physical well-being. The Landskind & Ricaforte Law Group, P.C. could help you or a loved one qualify for Medicaid without sacrificing your life’s savings by doing the following:
- Assess a family member’s eligibility for different Medicaid programs
- Talk you through your options for asset protection, which could include establishing a special Medicaid trust or strategically “spending down” to benefit your heirs
- Help ensure you don’t make common mistakes during Medicaid’s look-back period that cost many New Yorkers their right to benefits