skip to Main Content

Assisted Living residences are playing a larger role in the care and treatment of the elderly population. As Nursing Home facilities continue to focus on short-term rehabilitation and skilled nursing care, Assisted Livings are now “filling the gap” in providing adequate accommodation to the elderly in need of assistance with activities of daily living. Some individuals who would have been Nursing Home patients are now finding that they are better served in an Assisted Living facility. Many seniors find that they can receive the care they require in a less restrictive, more cost effective environment.

A common problem associated with long-term care is its lack of affordability. Due to the high monthly cost of long-term care facilities, many seniors deplete their available resources within a short period of time, forcing them to apply for Medicaid in order to obtain required services. Until recently, Medicaid had been an option available only to Home Care or Nursing Home patients. Individuals could not access Medicaid to enter or remain in an Assisted Living residence.

However, with the introduction of the Assisted Living Program (ALP) certain government approved Assisted Living residences have begun to accept Medicaid as a typical form of payment. The Assisted Living Program is Medicaid funded with specific income & resource criteria. For those who are eligible, payment is made through a combination of Medicaid (for required health care services) and Supplemental Security Income or private pay (for Room & Board). Now, many seniors who thought they could never afford to live in an Assisted Living residence are finding that they can, due to many ALP facilities’ acceptance of Medicaid payment.

As the first of the baby boomer generation reaches “old age,” we are faced with the challenge of providing proper care to an increasing percentage of our population. A recent expansion by New York State calls for the establishment of up to 6,000 new Assisted Living beds in the program. Conversely, the state also requires that one Nursing Home bed be decertified for each new ALP bed approved. We can conclude from this requirement that there will be a major transformation in the type of housing and available treatment offered to the future elderly.

As Nursing Homes continue to focus on skilled nursing and short-term rehabilitation, Assisted Living residences offering ALP are providing increased levels of care to allow their residents to remain longer or “age in place” in a less clinical setting. The Assisted Living Program is often a better alternative for those in need of daily assistance, yet do not require skilled nursing care. Furthermore, Assisted Living residences provide an atmosphere where seniors possess increased independence, social opportunity and dignity throughout their twilight years.

Admission into an Assisted Living Program is a process requiring proper guidance and strategic planning. In order to qualify for Medicaid one must meet specific medical and financial criteria. Community eligibility is used when applying for Medicaid with admission into the Assisted Living Program. Although Community Medicaid does not require a “look back” period regarding transfers of personal assets, some Assisted Living residences have imposed their own standards regarding individual evaluation of financial information.

The Assisted Living Program has strict income and resource guidelines. The maximum allowable monthly income established by the New York State Department of Health is $1,368. Of this amount, $1,190 must be paid to the ALP facility to cover Room & Board and the remaining $178 goes to the resident as a monthly allowance for their personal needs. With regard to the applicant’s resources (i.e., their financial assets), for an individual with an income of $1,368 or greater the maximum allowable is $13,800. Those with income below $1,368 can apply for Social Security Income (SSI) to help supplement the cost of ALP; however, in order to receive SSI benefits, resources may not exceed $2,000.

Furthermore, those who have transferred assets within the previous three years will lose SSI benefits for up to 36 months. A penalty period will be determined by dividing the amount of the transfer by your monthly benefit amount. Individuals receiving monthly income in excess of $1368 are obligated to pay all “surplus” income over to the ALP facility, as additional payment for required care. However, a New York State Pooled Income Trust can be established with these “surplus” funds, allowing an individual to retain their excess income for their own personal benefit while still remaining income eligible for the Assisted Living Program. For example, if an individual has a monthly income of $2,000, they would have a surplus amount of $632 ($2,000 – $1368). Instead of giving this surplus income to the ALP facility, they would deposit it in a Pooled Income Trust, where it would be available for the individual’s benefit.

Note that some of the amounts referenced above will change slightly in 2012.

An Elder Law Attorney can help you navigate through the rigorous procedures set forth by New York State Medicaid and the Assisted Living Program, making you income and resource eligible for acceptance into either program. Contact an experienced Elder Law Attorney for further strategies on how to protect your assets while continuing to qualify for Medicaid and/or ALP.

Back To Top