How families actually pay for care
New York fully expanded Medicaid under the ACA effective January 1, 2014, for adults 19-64 up to 138% of the federal poverty level, with no asset test. That expansion pathway is completely separate from the asset-tested Long-Term Care Medicaid pathway seniors use -- do not confuse the two.
Managed Long Term Care (MLTC)
MLTC is New York's Medicaid long-term-care delivery system: either PACE (Program of All-Inclusive Care for the Elderly, for age 55+) or MLTC Partial Capitation / Medicaid Advantage Plus. Generally it requires needing nursing-home-level services for 120+ days and being age 65+ (55+ for PACE). Mandatory MLTC enrollment in New York City -- including Richmond County / Staten Island -- began under Medicaid Redesign Team Initiative #90, approved August 31, 2012. NYC was actually the first region in the state with mandatory MLTC enrollment, predating the later rollout on Long Island.
Nursing Home Transition and Diversion (NHTD) Waiver
NHTD is a Medicaid 1915(c) home- and community-based waiver, administered through NYSDOH Regional Resource Development Centers, for Medicaid-eligible adults 65+ (or younger with a disability) who are assessed as needing nursing-home-level care but want to receive services in the community instead.
Assisted Living Program (ALP)
ALP (18 NYCRR Part 494) is Medicaid-funded and pays for personal care, room and board, home health aides, nursing, therapy and case management inside a qualifying Adult Home or Enriched Housing setting -- for people who are nursing-home-eligible but can be served at lower cost residentially.
VA Aid and Attendance
VA Aid and Attendance is a federal pension benefit, not state-specific -- see our dedicated page for current rates.
Source: NYSDOH Managed Long Term Care
Source: NYSDOH NHTD Waiver
