How New York licenses assisted living
New York does not use a single, flat “assisted living license.” The base license is an Adult Care Facility (ACF) — an Adult Home, an Enriched Housing Program, or a Residence for Adults, licensed under 18 NYCRR Parts 487, 488 and 490. An Adult Home or Enriched Housing Program can then apply for Assisted Living Residence (ALR) certification, which adds 24-hour on-site monitoring, case management and an individualized service plan, under 10 NYCRR Part 1001.
From there, an ALR can seek two further certifications. An Enhanced Assisted Living Residence (EALR) lets a resident age in place despite needing physical assistance to walk or use stairs, dependence on medical equipment, or chronic incontinence. A Special Needs Assisted Living Residence (SNALR) is New York’s designation for dementia and cognitive-impairment care. New York State Department of Health (NYSDOH) licenses and inspects every tier, through its Metropolitan Area Regional Office – Long Island (MARO-LI), 631-851-3098.
Separately, some Adult Homes and Enriched Housing Programs also participate in the Assisted Living Program (ALP), a Medicaid-funded program for residents who are medically eligible for nursing home placement but can be served in a lower-cost, licensed community setting instead.
Why the layered structure matters for families
Because New York licenses in layers rather than a single tier, two communities both marketed as “assisted living” can hold meaningfully different certifications. A base ALR license alone does not include EALR or SNALR unless the community separately applied for and received that certification. Ask any Long Island community which certifications it actually holds, and verify the answer yourself, free, on NYS Health Profiles (profiles.health.ny.gov/acf).
