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Medicaid Waivers and Assisted Living

New York's Assisted Living Program (ALP) and Managed Long Term Care (MLTC) system, and what each actually pays for inside a licensed community.

HomeCosts & PayingMedicaid Waivers and Assisted Living
Short answer

New York runs several separate community-based Medicaid programs rather than one combined waiver: the Assisted Living Program (ALP) pays for care services inside specific licensed Adult Homes and Enriched Housing Programs, Managed Long Term Care (MLTC) coordinates home care and related services through managed care plans, and the Nursing Home Transition and Diversion (NHTD) waiver funds in-home services for those diverting from or transitioning out of a nursing facility.

What ALP actually pays for

ALP, regulated under 18 NYCRR Part 494, covers personal care, housekeeping, supervision, home health aides, nursing, therapy, medical supplies and RN case management delivered inside the ACF. It does not function as a cash voucher, and it does not fully cover room and board -- confirm the specific split with any community that participates.

Which program pays for in-home-only services

The NHTD waiver and MLTC both fund services delivered at home, not inside a licensed community. Neither covers rent or a mortgage payment.

How families pay for care. New York's Assisted Living Program, NHTD waiver and Managed Long Term Care each pay for different community-based settings. Read the full explanation →

Questions families ask

My parent is being discharged from a Northwell Health hospital on Long Island - who helps plan next steps?

Northwell Health is the largest healthcare system in New York State, with Long Island hospitals including North Shore University Hospital (Manhasset), Long Island Jewish Medical Center (New Hyde Park), Huntington Hospital, Glen Cove Hospital, Mather Hospital (Port Jefferson), South Shore University Hospital (Bay Shore), LIJ Valley Stream, and Peconic Bay Medical Center (Riverhead). Each hospital has its own discharge planning staff who coordinate a patient's transition to home care, rehabilitation, or a skilled nursing facility.

What's the difference between being under observation and being formally admitted to the hospital, and why does it matter afterward?

Observation status and inpatient admission are different Medicare billing classifications that a hospital assigns based on a physician's assessment of the patient's condition, and the distinction significantly affects what Medicare covers afterward. Specifically, Medicare's skilled nursing facility benefit generally requires a prior 3-day qualifying inpatient hospital stay, and time spent under observation does not count toward that requirement. Families should ask hospital staff directly and explicitly which status their parent has been assigned, since it isn't always obvious from where the patient is physically located in the hospital.

Which Long Island hospital system likely serves my area - Northwell, Catholic Health, Stony Brook Medicine, or NYU Langone?

Coverage overlaps, but broadly: Northwell dominates central and western Nassau and much of Suffolk, plus the North Fork via Peconic Bay Medical Center in Riverhead. Catholic Health covers central Nassau and western-central Suffolk, including Rockville Centre, Roslyn, West Islip, Smithtown, Port Jefferson, and Bethpage. Stony Brook Medicine covers central and eastern Suffolk plus the South and North Forks. NYU Langone covers Mineola and central Nassau, with a Suffolk presence as well.

If my parent is discharged from Huntington Hospital, what senior care options are nearby?

Huntington Hospital is a Northwell Health facility located directly in the Town of Huntington, Suffolk County, which this site treats as its hub area for senior care research, covering neighborhoods from Huntington Village and Huntington Station to Cold Spring Harbor, Northport, Dix Hills, and Melville. Discharge planning from Huntington Hospital would coordinate with home care agencies, rehabilitation facilities, and assisted living or nursing communities in this immediate area.

What does Medicare's skilled nursing facility benefit actually require in terms of a prior hospital stay?

Medicare's skilled nursing facility benefit generally requires that the patient first have a qualifying inpatient hospital stay of at least 3 days before Medicare will cover a subsequent skilled nursing facility stay, and only time spent formally admitted as an inpatient counts toward that requirement, not time spent under observation status. This is a critical distinction for Long Island families navigating a hospital discharge, since a stay that looks identical from the patient's bed can be billed either way.

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