New York Medicaid Long Term Care Programs, Benefits & Eligibility Requirements

Summary
Medicaid’s rules, benefits and name can all vary by state. This article focuses on New York Medicaid Long Term Care for seniors, which will pay for care in a nursing home, a beneficiary’s home and other settings through one of three programs – Nursing Home Medicaid, Community Medicaid or Disabled, Aged or Blind (DAB) Medicaid. This is different than regular Medicaid, which is for financially limited people of all ages.

Last Updated: Mar 27, 2024

NY Medicaid Long Term Care Programs Nursing Home Care Care at Home via Community Medicaid Care at Home via DAB Medicaid Eligibility Criteria Nursing Homes Community Medicaid DAB Medicaid How Medicaid Treats the Home Applying Choosing a Nursing Home

New York Medicaid Long Term Care Programs

Nursing Home / Institutional Medicaid

New York Nursing Home Medicaid will cover the cost of long-term care in a nursing home for financially limited New York seniors who require a Nursing Facility Level of Care. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:

Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
Skilled nursing care
Physician’s visits
Prescription medication
Medication management
Mental health counseling
Social activities

Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.

New York Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover care expenses. They are only allowed to keep a “personal needs allowance” (PNA) of $50/month, which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are “dual eligible,” and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid applicants or recipients.

New York Nursing Home Medicaid is an entitlement. This means all qualified applicants are guaranteed by law, aka “entitled,” to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.

A Nursing Home Alternative – New York Nursing Home Medicaid beneficiaries who want to leave their nursing home and return to living “in the community” can receive financial and functional help with that transition through New York’s Money Follows the Person program (MFP). This help can include paying for moving expenses, as well as long-term care services and supports in the new residence. MFP beneficiaries must be moving from a Medicaid-approved facility and into their own home, the home of a relative or a small group home with a maximum of four unrelated residents. In New York, MFP is also known as Open Doors Transition Center and is administered by the New York Association on Independent Living.

Community Medicaid

New York’s Community Medicaid will pay for long-term care services and supports that help financially limited New York seniors who require a Nursing Facility Level of Care remain living in the community instead of moving to a nursing home. Community Medicaid will cover long-term care services and supports for qualified seniors who live in their home, the home of a family member or friend or a long-term adult care facility. New York’s Community Medicaid program is similar to Home and Community Based Services (HCBS) Waivers in other states.

Eligible New York seniors can receive Community Medicaid long-term care benefits through the Managed Long Term Care (MLTC) Program and the Assisted Living Program.

1. Managed Long Term Care (MLTC) Program
New York’s Managed Long Term Care (MLTC) Program provides long-term care services and supports to New York Medicaid beneficiaries who require a Nursing Facility Level of Care, need long-term care for a minimum of 120 days and live in the community. MLTC Program participants can live in their own home, the home of a friend or a family member or an assisted living residence, as long as that residence does not provide its own long term care benefits.

MLTC Program benefits include adult day care, in-home nursing services, home modifications, Personal Emergency Response Systems, medical equipment and personal care assistance with the Activities of Daily Living (moving, bathing, dressing, eating, toileting). MLTC Program participants receive their long-term care benefits, and all of their medical care, through a single Medicaid plan. This plan can assign a licensed caregiver to provide benefits, but MLTC Program participants also have the option to self-direct some of their benefits, like personal care assistance. This means they can hire caregivers of their choosing, including friends and family members, although spouses can not be hired as MLTC caregivers.

MLTC Program members who also have Medicare, which is known as “dual eligible,” can receive both Medicaid and Medicare benefits through MLTC’s Medicaid Advantage Plus plan.

The MLTC Program is an entitlement. This means that all eligible applicants are guaranteed by law to receive the program benefits without any wait.

2. Assisted Living Program (ALP)
New York’s Assisted Living Program provides long-term care benefits to New York Medicaid recipients who require a Nursing Facility Level of Care and live in a long-term adult care facility that is a licensed “assisted living program,” which is different than a private assisted living residence. An “assisted living program” is typically a unit within an adult home, which is an adult care facility that provides 24-hour supervision and care for 5-200 residents.

ALP will pay for long-term care services and supports in this setting, and the state will help pay for room and board costs for those who can’t afford it. ALP beneficiaries have a higher Medicaid eligibility income limit than other Medicaid beneficiaries for the purpose of paying for the room and board at the assisted living program. However, if the beneficiary doesn’t have enough income, the state will supplement it so they can afford the room and board costs. Income limit dollar amount details can be found below under Eligibility Criteria for Community Medicaid.

ALP benefits include skilled nursing care, adult day care, housekeeping, medical supplies, personal emergency response services and other help with Activities of Daily Living (mobility, bathing, dressing, eating, toileting).

There are a limited number enrollment spots for ALP (about 10,000 per year as of 2022). Once those spots are full, additional eligible applicants will be placed on a waitlist.

Disabled, Aged, or Blind (DAB) Medicaid

New York’s Disabled, Aged or Blind (DAB) Medicaid provides healthcare coverage and long-term care services and supports to qualified New York residents who are disabled, aged (65 and older) or blind and live in the community. DAB Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for low-income people of all ages. DAB Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive healthcare coverage without wait. Access to long-term care benefits via DAB Medicaid depends on the availability of funds, programs and caregivers in the area where the beneficiary lives. DAB Medicaid is comparable to Aged, Blind, and Disabled (ABD) Medicaid in other states.

DAB Medicaid beneficiaries who show a functional or medical need for long-term care benefits can receive at least some of those benefits through the Community First Choice Option (CFCO) or the Program of All-Inclusive Care for the Elderly (PACE).

1. New York Community First Choice Option (CFCO)
New York’s Community First Choice Option (CFCO) provides long-term care benefits to DAB Medicaid recipients who require a Nursing Facility Level of Care but live in their own home, the home of a friend or family member or an assisted living residence, as long as that residence does not provide its own long term care benefits.

CFCO benefits include home health aides, home modifications, meal delivery, transportation and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning, laundry, medication management). These benefits can be provided by licensed caregivers, and CFCO beneficiaries also have the option to self-direct some of their benefits, like personal care assistance. This means they can hire caregivers of their choosing, including friends and family members, although spouses can not be hired as CFCO caregivers.

Like DAB Medicaid itself, CFCO is an entitlement. This means that all eligible applicants are guaranteed by law to receive the program benefits without any wait.

2. Program of All-Inclusive Care for the Elderly (PACE)
New York residents who are age 55 or older and have Disabled Aged and Blind (DAB) Medicaid can cover their medical, social service and long-term care needs with one comprehensive plan and delivery system using the Program of All-Inclusive Care for the Elderly (PACE). PACE program participants are required to need a Nursing Facility Level of Care, but they must live in the community. New York’s PACE programs can be used by people who are “dual eligible” for Medicaid and Medicare, and it will coordinate the care and benefits from those two programs into one plan. PACE also administers vision and dental care, and PACE day centers provide meals, social activities, exercise programs and regular health checkups and services to program participants. PACE can also be known as LIFE (Living Independence for the Elderly). New York’s PACE/LIFE programs are located in Buffalo (Catholic Health LIFE and Fallon Health Weinberg-PACE), New York City (ArchCare Senior Life and CenterLight Healthcare), Niagara Falls (Complete SeniorCare), Olean (Total Senior Care, Inc), Rochester (ElderONE), Schenectady (Eddy SeniorCare) and Syracuse (PACE CNY). To learn more about PACE, click here.

Eligibility Criteria For New York Medicaid Long Term Care Programs

To be eligible for New York Medicaid, a person has to meet certain financial requirements and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid and what program they are applying for – Nursing Home Medicaid, Community Medicaid or Disabled, Aged or Blind (DAB) Medicaid.

Just For You: The easiest way to find the most current New York Medicaid eligibility criteria for your specific situation is to use our Medicaid Eligibility Requirements Finder tool.

New York Nursing Home Medicaid Eligibility Criteria

Financial Requirements
New York residents have to meet an asset limit and an income limit in order to be financially eligible for Nursing Home Medicaid. For a single applicant in 2024, the asset limit is $31,175, which means they must have $31,175 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for New York Nursing Home Medicaid for a single applicant is $1,732/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. However, New York Medicaid beneficiaries who reside in nursing homes must give most of their income to the state to help pay for the cost of care. They are only allowed to keep $50/month of their income as a “personal needs allowance,” and they are allowed to make Medicare premium payments if they are “dual eligible,” and they can make any allowable spousal income allowance payments to financially needy, non-applicant spouses.

For married applicants with both spouses applying, the 2024 asset limit for Nursing Home Medicaid through New York Medicaid is a combined $42,312 and the income limit is a combined $2,351/month. For a married applicant with just one spouse applying, the 2024 asset limit is $31,175 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The income limit is $1,732/month for the applicant, and the income of the non-applicant spouse is not counted.

Plan Ahead: There are alternative pathways to eligibility for New York Nursing Home Medicaid applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, New York has a Look-Back Period of five years for Nursing Home Medicaid. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for NY Medicaid’s Nursing Home Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is usually associated with a nursing home. To determine level of care need for Medicaid purposes, New York uses its Uniform Assessment System eligibility tool, completed by a registered nurse from the NY Medicaid Choice’s Conflict-Free Eligibility & Enrollment Center. This tool takes into consideration an applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting), as well as their cognitive abilities.

Community Medicaid Eligibility Criteria

Financial Requirements
New York residents have to meet an asset limit and an income limit and in order to be financially eligible for Community Medicaid. For a single applicant in 2024, the asset limit is $31,175, which means they must have $31,175 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for Community Medicaid for a single applicant is $1,732/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.

For married applicants with both spouses applying, the 2024 asset limit for Community Medicaid is $42,312 combined between the two applicants/spouses, and the income limit is a combined $2,351/month. For a married applicant with just one spouse applying for Community Medicaid, the applicant spouse has a $31,175 asset limit and a $1,732/month income limit for 2024, and the non-applicant spouse has a $154,140 asset limit and no income limit.

Assisted Living Program (ALP) Waiver Income Limit
The Assisted Living Program (ALP) Waiver has its own unique income limit that provides married ALP beneficiaries with the income flexibility needed to afford room and board costs at the licensed “assisted living program” where they receive ALP services. The 2024 income limit for the ALP Waiver is $1,732/month for single applicants, just like it is with other Community Medicaid programs, but it’s a combined $3,464/month for couples (compared to $2,268/month for other Community Medicaid programs). For people who don’t reach those limits, SSI will supplement their income until it reaches the $1,732/month or $3,464/month limits. They will then be required to pay most of that money to the “assisted living program” to cover the cost of room and board.

Plan Ahead: There are alternative pathways to eligibility for New York Community Medicaid applicants who don’t meet their financial limits, such as Medicaid Planning. While New York has a Look-Back Period period of five years for Nursing Home Medicaid, there is no Look-Back Period for Community Medicaid (at least until 2025). However, Community Medicaid applicants should be cautious about giving away their assets. They might eventually need Nursing Home Medicaid, but they could be denied acceptance into that program for giving away assets.

Functional Requirements
The functional, or medical, criteria for Community Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is usually associated with a nursing home. New York uses its Uniform Assessment System eligibility tool, completed by a registered nurse from the NY Medicaid Choice’s Conflict-Free Eligibility & Enrollment Center, to determine if an individual requires a NFLOC. This tool takes into consideration an applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting), as well as their cognitive abilities.

New York Disabled, Aged or Blind (DAB) Medicaid Eligibility Criteria

Financial Requirements
New York residents have to meet an asset limit and an income limit in order to be financially eligible for Disabled, Aged 65 or Blind (DAB) Medicaid. For a single applicant in 2024, the asset limit is $31,175, which means they must have $31,175 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2023 income limit for DAB Medicaid for a single applicant is $1,732/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.

For married applicants, the 2024 asset limit for DAB Medicaid is a combined $42,312 and the income limit is a combined $2,351/month. These limits are used for both married couples with both spouses applying for DAB Medicaid and married couples with only one spouse applying.

Plan Ahead: There are alternative pathways to eligibility for New York ABD Medicaid applicants who are over the asset limit and/or the income limit, such as Medicaid Planning. While New York has a Look-Back Period period of five years for Nursing Home Medicaid, there is no Look-Back Period for DAB Medicaid. However, DAB applicants should be cautious about giving away their assets. They might eventually need Nursing Home Medicaid, but they could be denied acceptance into that program for giving away assets.

Functional Requirements
The only functional requirement for receiving basic healthcare coverage through Disabled, Aged 65+ or Blind (DAB) Medicaid is being aged (65 and over) blind or disabled. To receive long-term care benefits through DAB Medicaid, the state will conduct an assessment of DAB Medicaid applicants/beneficiaries and their ability to perform Activities of Daily Living (mobility, bathing, dressing, eating, toileting), as well as their cognitive abilities, to determine the kind of long-term care services the beneficiary needs and the state will cover.

To qualify for NY Medicaid’s Managed Long Term Care (MLTC) Program, which is available via DAB Medicaid, an applicant must require a Nursing Facility Level of Care (NFLOC), and they must need long term care for more than 120 days. New York uses its Uniform Assessment System eligibility tool, completed by a registered nurse from the NY Medicaid Choice’s Conflict-Free Eligibility & Enrollment Center, to determine if an MLTC Program applicant requires a NFLOC. The 120-day criteria requirement is met if the applicant needs hands-on/physical assistance with three of the five Activities of Daily Living (mobility, bathing, dressing, eating, toileting). New York makes this determination using an in-home, face-to-face Functional Needs Assessment. If the MLTC Program applicant has Alzheimer’s Disease or a related dementia, hands-on/physical assistance is not required. Instead, the Alzheimer’s/dementia applicant is required to need supervision of two Activities of Daily Living.

To qualify for NY Medicaid’s Community First Choice Option (CFCO), which is available via DAB Medicaid, an applicant also must require a Nursing Facility Level of Care (NFLOC) and need help with three of the five Activities of Daily Living (mobility, bathing, dressing, eating, toileting). New York uses the Uniform Assessment System and the Functional Needs Assessment to make these determinations.

How New York Medicaid Treats the Home for Eligibility Purposes

One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many situations the home is not counted against the asset limit:

If the applicant lives in their home and the home equity interest (the portion of the home’s equity value that the applicant owns minus any outstanding mortgage/debt) is less than $1,071,000 (as of 2024) then the home is exempt.
If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives.
If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $1,071,000.

These rules apply to all three types of Medicaid, with one important exception – DAB Medicaid applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status. To learn more about the impact of home ownership on Medicaid eligibility, click here.

New York Medicaid Long Term Care applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in New York and how you can protect your home from it, click here.

Applying For New York Medicaid Long Term Care Programs

The first step in applying for a NY Medicaid Long Term Care program is deciding which of the three programs discussed above you or your loved one want to apply for – Nursing Home Medicaid, Community Medicaid or Disabled, Aged or Blind (DAB) Medicaid.

The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Applying for NY Medicaid when not financially eligible will result in the application, and benefits, being denied.

During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the NY Medicaid applicant. These documents will be needed for the official NY Medicaid application. Necessary documents may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.

After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, there are several ways New York residents can apply for NY Medicaid. They can go to the NY State of Health Marketplace webpage, they can go to this NY State Health page to find an Enrollment Assistor, or they can call (855) 355-577 (TTY: 1-800-662-1220) to speak with the Marketplace Customer Service Center. They can also call the Medicaid Helpline at (800) 541-2831, or go through their Local Department of Social Services Office.

Once the application is received, it will usually take 45-90 days to be reviewed and approved or denied by the state. It’s also possible applications that are missing information or have mistakes will be returned.

For step-by-step guides to applying for each of the three types of Medicaid Long Term Care, just click on the name: 1) Nursing Home Medicaid 2) Community Medicaid 3) ABD Medicaid.

Professional Help: Many seniors need support when it comes to Medicaid Long Term Care’s rules, benefits and application process. These are all complicated, constantly changing and vary by state. The best place to get help with Medicaid Long Term Care is through a professional like a Certified Medicaid Planner or an Elder Law Attorney.

Choosing a New York Medicaid Nursing Home

After being approved for Nursing Home Medicaid through NY Medicaid, seniors need to choose which Medicaid-accepting nursing home best meets their needs. Even though Nursing Home Medicaid is an entitlement, not all nursing homes accept Medicaid, and those that do might not have any available spaces. Finding the right nursing home can be difficult and time-consuming, especially if you’re looking in a specific location.

There are roughly 600 nursing homes in New York state, and most of them accept Medicaid. There are approximately 100 nursing homes in New York City that take Medicaid. And there are more than 300 nursing homes within 25 miles of New York City, extending east to Long Island and north into Westchester County. The eastern half of Long Island has about 50 more nursing homes that take Medicaid. Moving north into the Hudson River Valley, there are about 20 facilities within 25 miles of Poughkeepsie and another 30 or so around Albany. Buffalo has roughly 40 nursing homes that accept Medicaid in the far western part of the state, and there are nearly 40 more around Rochester. Outside of those cities, the clusters of nursing home start to dwindle in size. There are about 20 around Syracuse and a dozen or so in the Binghamton and Ithaca areas.

Residents in some New York communities often travel across state lines for personal and business reasons, including healthcare. Medicaid coverage, however, does not cross state lines. So, someone with New York Medicaid would not be covered for a nursing home in Stamford, Connecticut, or Erie, Pennsylvania, if facilities in those areas are well-suited or convenient for the New York resident.

TOOLS: To find and compare nursing homes, New York residents can use Nursing Home Compare, which is a search tool administered by the Centers for Medicare & Medicaid Services (CMS) that has information on more than 15,000 nursing homes across the country. They can also use this New York Department of Health interactive map to find and compare facilities in their area.

When you’ve found nursing homes in your area that accept Medicaid, you can start comparing them, if you have multiple options. The New York Department of Health map mentioned in the blue box above has comparable statistics about the quality of care, quality of life, resident safety, inspections and complaints for all of the state’s nursing homes, so it is a great place to start. The search on Nursing Home Compare can be filtered by staffing, health inspections, quality measures and overall rating, which can also be helpful. The healthcare professionals who work with you are another great source of information. And you can contact your local Area Agency on Aging to find out more information about nursing homes in the state.

After doing some research, you or someone you trust should visit any nursing homes you’re considering before making a final decision. Call first to make an appointment for the visit, and arrive with a list of questions, like: Does the residence offer social activities? How does it handle dental and vision care? Who are the staff doctors? What is the food like? CMS has a comprehensive “Nursing home checklist” you can use to evaluate a nursing home while visiting.

CMS data reveals that nursing homes in New York state have a good record when it comes to health conditions. New York nursing homes averaged 15.5 health deficiencies from 2019-2022, which was much less than the national average of 25.7 during that same time frame. However, 13.2% of residents in New York had depressive symptoms, which is noticeably higher than the national average of 8.1%.