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How Families Pay for Senior Care

Private pay, New York's Medicaid programs (MLTC, ALP, NHTD), VA Aid and Attendance, and long-term care insurance.

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How Long Island families actually pay for care

New York fully expanded Medicaid under the ACA in 2014, but that expansion (income-based, for adults under 65) is a completely separate eligibility pathway from long-term-care Medicaid for seniors, which is asset-tested. Do not conflate the two.

For community-based long-term care, most Nassau and Suffolk seniors on Medicaid go through Managed Long Term Care (MLTC) — mandatory in both counties since 2013 for Medicaid recipients who need more than 120 days of community-based long-term care and can remain safely at home. Within a licensed Adult Home or Enriched Housing Program, the Assisted Living Program (ALP) can cover personal care, nursing, therapy and case management for residents who are medically eligible for a nursing home but stay in a lower-cost, licensed setting instead. For residents who want to stay entirely at home, the Nursing Home Transition and Diversion (NHTD) Medicaid waiver funds home and community-based services for those assessed as needing nursing-home-level care.

For 2026, New York's nursing-facility Medicaid figures include a Community Spouse Resource Allowance of $74,820–$162,660, a Minimum Monthly Maintenance Needs Allowance of $4,066.50/month, and a nursing home resident Personal Needs Allowance of just $50/month — among the lowest in the country. VA Aid and Attendance, a federal (not state) benefit, adds up to $29,093/year for an eligible veteran or $18,697/year for a surviving spouse (rates effective through November 2026).

Questions families ask

How much spending money is a Medicaid nursing home resident allowed to keep each month in New York?

New York's Nursing Home Resident Personal Needs Allowance is $50 per month - the amount a Medicaid-funded nursing home resident is permitted to keep from their own income for personal expenses, with the rest going toward the cost of their care. According to the NY State Office for the Aging (NYSOFA), this figure has been unchanged since the 1980s, and NYSOFA notes that 33 other states currently pay a higher PNA, ranging from $52 to $200.

What is the MLTC special income standard for Long Island and why does it matter for Medicaid home care?

The special income standard for housing expenses, available to certain individuals enrolled in a Managed Long Term Care plan, varies by NYSDOH region - for the Long Island region specifically, it is $1,701.00. This regional figure is higher than most upstate regions (for comparison, the Central New York region's is $426 and the Western region's is $341), reflecting Long Island's higher housing costs, and remains in effect until updated federal poverty levels are published.

How much does assisted living cost in New York State?

According to CareScout's 2025 Cost of Care Survey, the median cost of an assisted living community (private one-bedroom) in New York State is $225 per day, or about $7,110 per month and $85,320 per year. This is a statewide median - CareScout's published state-level data tables do not break out a separate Long Island or metro New York figure.

What does a nursing home cost per day in New York?

CareScout's 2025 Cost of Care Survey puts the New York State median at $511 per day ($15,528/month, $186,333/year) for a semi-private room and $550 per day ($16,729/month, $200,750/year) for a private room, both based on 365 days of care. These are statewide figures; CareScout does not publish a separate Long Island-specific nursing home rate.

How much does hourly in-home caregiving cost in New York?

CareScout's 2025 Cost of Care Survey reports a New York State median of $35 per hour for what it now calls non-medical caregiver services, a category that merged the formerly separate homemaker services and home health aide categories in 2025 due to price convergence. Based on a 44-hour week, that works out to roughly $6,673 per month or $80,080 per year. Private duty nursing, a higher-acuity service, runs a New York State median of $120 per hour.

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