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guardian of an adult with disabilities

Exploring the Benefits of Assisted Living Facilities

Generally, the answer to this question is “No”.

However, Medicaid does have a program, aptly named the “Assisted Living Program” (or “ALP”) that does provide Medicaid coverage for an assisted living.  There are a number of facilities in New York, and about a half-dozen or so on Long Island, in the ALP program.

Most assisted living facilities (“ALF”) accept only private pay or insurance (such as long term care insurance).  The cost of an ALF can be $7,000 or more per month.  For those are cannot afford the private cost of a typical ALF, they may be able to turn to the ALP program.

The Medicaid eligibility for the ALP program follows along the rules for community Medicaid.  Most importantly, there is no “look-back” period for this type of Medicaid and therefore no penalty for a transfer of assets (or gifts) that may have been made in the past, or planning as part of becoming eligible for community Medicaid.

When applying for Medicaid for ALP, the asset rules are the same (ie, a single person cannot have more than $15,450 in assets [for 2019], with a few exceptions), however, the monthly income limitations are different than the typical community Medicaid levels. Whereas with traditional community Medicaid the applicant is entitled to keep about $879/month of their income, in the ALP program the amount varies depending on the level of care but is less.

However, the recipient will still be permitted to utilize the services of a pooled income trust for the excess monthly income.  This will allow the recipient to use a portion of the excess income instead of having to spend it on care.

The ALP program can be an excellent way for someone with limited means to be able to live in an assisted living setting instead of having to go to a nursing home, perhaps prematurely, because they cannot afford a typical ALF.

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