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).
