In their journey through the golden years, many seniors find themselves in a gray area where they are past the point of living safely and independently in their homes, but not yet (or ever!) ready for the move to a skilled nursing facility. In these scenarios, an assisted living facility (ALF) presents a comfortable middle ground—particularly ALFs that offer different “tiers” (levels of care) should one require additional services as time goes on.
There are a myriad of ALFs to choose from, many of which present more like a luxury hotel than a care facility, offering gourmet dining, state-of-the-art fitness centers, cultural activities, high-end designs and, unfortunately, a hefty price to match. Indeed, the cost to reside at these lovely ALFs can be prohibitive for many. While most ALFs must be paid for privately, some permit a Medicaid-paid aide at the facility. If one can afford basic rent at the ALF, using Medicaid to pay an aide to assist them with their activities of daily living (instead of utilizing costly services at the ALF or higher levels of care) is one way to save money.
There are also a handful of facilities in New York State that are licensed to participate in the “Assisted Living Program” (ALP) and will accept residents in receipt of community Medicaid / home care Medicaid (CMA/HCMA). (The ALP facility is regarded as one’s home.) Typically, the resident must contribute a portion of their income to the ALP facility on a monthly basis, which contribution, together with CMA/HCMA, covers room and board. ALP facilities are great options for those who are in need of supportive housing and home care services but prefer (and are suitable for) a less restrictive environment than a nursing home.
The financial requirement to obtain CMA/HCMA at an ALP is akin to those for nursing home Medicaid (NHMA): One’s liquid non-retirement assets must total below $31,175 for the year 2025. However, where NHMA has a 5-year “lookback period”—meaning that if an applicant has transferred assets out of their name within the past 5 years, and such transfers were not “exempt” for Medicaid purposes, a penalty (disqualification) period is imposed—there is currently no lookback period for CMA/HCMA. This may not always be the case, as in 2020, the State passed legislation to put in place a 2.5-year lookback period for CMA/HCMA. Though the pandemic delayed its implementation, the possibility may soon be realized nearly 5 years later. (Still, if one applies for CMA/HCMA before the lookback period is implemented, they will be “grandfathered” in).
By acting now, seniors may be able to take advantage of opportunities that may not be available to them in the future. Speak with your local elder law attorney to determine whether an ALP (or a Medicaid-paid aide at an ALF or at home) makes sense for you and your family before the law changes.
