Free senior care guidance for Staten Island families. No cost to you, ever.
Call (516) 619-2127
Staten Island Senior Advisor

How New York Licenses Assisted Living

New York's licensing is layered, not single-tier: base Adult Care Facility license, then optional ALR, then optional EALR or SNALR certification on top.

Get matched freeCall (516) 619-2127
Home›State Rules›How New York Licenses Assisted Living

How New York licenses assisted living

New York does not issue one single "assisted living license." The base license is the Adult Care Facility (ACF) category -- an Adult Home (AH), Enriched Housing Program (EHP), or Residence for Adults, for five or more unrelated adults -- issued and inspected by the New York State Department of Health (NYSDOH).

An Adult Home or Enriched Housing Program can then seek additional licensure as an Assisted Living Residence (ALR) under 10 NYCRR Part 1001 -- an ALR must be located inside a licensed AH or EHP, it is not a freestanding license. From there, an ALR can add certification as an Enhanced Assisted Living Residence (EALR), which allows aging in place for residents who need physical assistance walking or using stairs, are medical-equipment-dependent, or have chronic incontinence, or as a Special Needs Assisted Living Residence (SNALR), New York's dementia/memory care certification (see below).

Separately, an Adult Home or Enriched Housing Program can offer the Assisted Living Program (ALP) -- a Medicaid-funded program under 18 NYCRR Part 494 for people who are nursing-home-eligible but can be served in a lower-cost residential setting, covering personal care, room and board, housekeeping, home health aides, personal emergency response systems, nursing, physical/occupational/ speech therapy, medical supplies, adult day health care and RN case management.

Nursing homes are licensed under an entirely separate rule chapter, 10 NYCRR Part 415, and are inspected on a different survey cycle than Adult Care Facilities.

Governing rules: 18 NYCRR Part 487 (Adult Homes), Part 488 (Enriched Housing), Part 490 (Residences for Adults), Part 494 (ALP); 10 NYCRR Part 1001 (ALR/EALR/SNALR); 10 NYCRR Part 415 (nursing homes). Regulator: New York State Department of Health.

Source: NYSDOH Adult Care Facilities program

What each layer changes for a family comparing communities

  • Adult Care Facility (base license) -- an Adult Home, Enriched Housing Program, or Residence for Adults. This alone does not guarantee a community can serve someone who needs help with daily activities at an assisted-living level.
  • Assisted Living Residence (ALR) -- must sit inside a licensed AH or EHP. This is the layer that actually authorizes personal-care-level assisted living services.
  • Enhanced Assisted Living Residence (EALR) -- allows aging in place for residents who need physical assistance walking or using stairs, are medical-equipment-dependent, or have chronic incontinence. Without this certification, those needs can trigger a required move.
  • Special Needs Assisted Living Residence (SNALR) -- New York's memory-care certification (see the dedicated page below).

The practical admission/retention question to ask on a tour: which of these certifications does the community actually hold today, not which it plans to add.

Questions families ask

What's the difference between an Adult Home and an Enriched Housing Program in New York?

Both are base-level Adult Care Facility license types under NYSDOH, but Enriched Housing Programs are generally structured around apartment-style independent units with supportive services, while Adult Homes are typically more institutional in layout. Either can add ALR certification on top to become licensed for assisted-living-level care.

Does New York rate assisted living communities the way it rates nursing homes?

No. Federal CMS star ratings apply only to Medicare/Medicaid-certified nursing homes, published at profiles.health.ny.gov/nursing_home and on CMS Care Compare. Assisted living and memory care communities in New York do not carry CMS star ratings -- the only public quality record for them is the NYS Health Profiles inspection history.

What is Managed Long Term Care (MLTC), and is it mandatory on Staten Island?

MLTC is New York's Medicaid managed-care delivery system for long-term care -- either PACE (age 55+) or MLTC Partial Capitation/Medicaid Advantage Plus. Enrollment has been mandatory in New York City, including Richmond County/Staten Island, since 2012 under Medicaid Redesign Team Initiative #90, approved August 31, 2012.

What is the NHTD waiver, and how is it different from MLTC?

The Nursing Home Transition and Diversion (NHTD) waiver is a Medicaid 1915(c) home- and community-based services waiver, administered through NYSDOH Regional Resource Development Centers, for Medicaid-eligible people 65+ (or younger with a disability) assessed as needing nursing-home-level care who want to receive services in the community instead. MLTC is a managed-care delivery system; NHTD is a specific waiver program.

What is New York's Assisted Living Program (ALP), and does it pay room and board?

The Assisted Living Program (ALP), under 18 NYCRR Part 494, is Medicaid-funded care delivered inside a qualifying Adult Home or Enriched Housing Program setting -- covering personal care, home health aides, nursing, therapy, medical supplies, adult day health care and RN case management. It folds room and board into its rate structure differently than a pure HCBS waiver, so the exact private-pay portion varies by community.

Not sure where to start?

Answer five questions and a local advisor will come back with senior care options in your area that actually fit your situation and budget. It is free, and there is no obligation.

Find care options
Find senior care — free