New York Managed Long-Term Care (MLTC) Program Waiver
The New York MLTC Program Waiver provides long-term supports for chronically ill or disabled residents in danger of nursing home placement. The primary goal is to prevent/delay admission to a nursing home through home and community-based services. Eligible individuals can live at home, with a relative or within assisted living but can’t be simultaneously enrolled in the New York MLTC and the ALP programs or reside in an adult foster care home. Each person’s plan of care determines which benefits they receive, so programs vary. Benefits that are helpful to those in assisted living might include:
- Audiology services
- Personal care assistance
- Durable medical equipment
- Care management
- Personal emergency response systems
- Dental services
- Medical supplies
- Optometry services
- Podiatry
- Private duty nursing
- Occupational, physical and speech therapies
While many services provided through the MLTC program can be provided in an assisted living setting, the cost of room and board isn’t covered. To be eligible, applicants must meet specific functional and financial requirements, which include requiring long-term care for more than 120 days and hands-on assistance with three activities of daily living. The application process includes:
- Applying via the local Department of Social Services office
- Calling NY Medicaid Choice’s Conflict-Free Evaluation & Enrollment Center at 855-222-8350 to request a functional needs assessment
- Choosing an MLTC plan and completing a second assessment to create an individualized care plan
New York Assisted Living Program
New York’s ALP provides a supportive residential environment for seniors or disabled individuals who are at risk of being admitted to a nursing home. The goal is to prevent or delay nursing home care by providing personal and home health assistance in a long-term adult care facility licensed as an assisted living program. Based on financial means, a program participant may/may not pay for room and board out of their pocket. Other possible benefits include:
- Personal care assistance
- Case management
- Housekeeping
- Medical supplies/equipment
- Nursing services
- Personal emergency response services
- Occupational, physical and speech therapies
Medicaid pays for long-term care under this program but won’t cover room and board. However, Supplemental Security Income will supplement an individual’s income to cover room and board for those with limited income and assets. Those who don’t qualify for SSI can pay privately. The ALP has a limited number of available beds and a waitlist starts when all beds are full.
To be eligible, applicants must not be bedridden, require 24/7 nursing care or present a danger to other residents but are at risk of being placed into a nursing home. Applicants undergo a Uniform Assessment System eligibility assessment to determine whether they have a nursing home level of care. Income limits are higher for the ALP than other Medicaid programs and applying for ALP services requires getting approved in advance by the local Social Services District.