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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.

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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

What's the difference between standard assisted living and memory care in New York?

Standard assisted living in New York is licensed as an Assisted Living Residence (ALR) under 10 NYCRR Part 1001. Memory care is not a separate license; it's delivered through a Special Needs Assisted Living Residence (SNALR) certification, an additional certification an ALR can obtain to serve residents with dementia or cognitive impairments per an Individualized Service Plan, regulated under the same Part 1001 rules.

What's the difference between a nursing home and an assisted living residence in New York, regulation-wise?

Nursing homes are licensed under 10 NYCRR Part 415, Nursing Homes - Minimum Standards, a distinct regulatory chapter focused on skilled, medically intensive care. Assisted Living Residences are licensed under 10 NYCRR Part 1001, and can only exist as an additional certification on top of an already-licensed Adult Home or Enriched Housing Program, themselves licensed under 18 NYCRR Parts 487 and 488.

At what point does hourly in-home care cost more than assisted living in New York?

Using CareScout's 2025 New York State medians, in-home non-medical caregiving costs $35 per hour, or about $6,673 per month at 44 hours a week, compared to assisted living's median of $7,110 per month ($225 per day). At roughly 45 to 46 hours per week of paid in-home care, the monthly cost crosses over and exceeds the assisted living median; families needing care beyond that, including any overnight or 24/7 coverage, would generally spend more on home care than on a private one-bedroom assisted living apartment.

What's the difference between a CCRC or Life Plan Community and a standalone assisted living or nursing facility on Long Island?

A Continuing Care Retirement Community (CCRC), also called a Life Plan Community, offers a full continuum of care, independent living, assisted living, memory care, and skilled nursing, on one campus, so a resident can move between levels of care as needs change without relocating to a different facility or provider. Long Island examples include Jefferson's Ferry in South Setauket, which describes itself as Long Island's first Life Plan Community, and Peconic Landing in Greenport, which describes itself as New York's only equity-based CCRC; a standalone assisted living or nursing facility, by contrast, offers only one level of care and requires a resident to move elsewhere if their needs change.

Who regulates assisted living facilities on Long Island?

New York State Department of Health (NYSDOH) licenses and regulates assisted living as part of its Adult Care Facility (ACF) program, which covers Adult Homes, Enriched Housing Programs, and Assisted Living Residences (ALR). Long Island facilities are overseen locally through NYSDOH's Metropolitan Area Regional Office - Long Island (MARO-LI) in Central Islip. Nursing homes are licensed separately by NYSDOH under a different set of regulations (10 NYCRR Part 415).

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