Medicaid Funded Assisted Living

Robin Marks

Loosely defined, assisted living is the union of residential needs and supportive care provided in a social environment. It is generally geared for the 65-plus population and designed to safely maximize independence. The model can be likened to a "senior citizen hotel." While there are great advantages to this lifestyle, many would find the expenses extend beyond their financial reach.

However, for those who qualify, there is an affordable option - the Assisted Living Program (ALP). It serves people who are eligible for nursing home placement in a setting that is less medically intensive and more cost effective. Typically, ALP candidates struggle at home with activities of daily living (ambulating, eating, bathing, dressing, transferring, maintaining hygiene, etc.). While these individuals would clearly benefit from help, they would be considered high functioning in a medicalmodel skilled care facility. By utilizing community based Medicaid and monthly Social Security or S.S.I. entitlements, participants are provided with: personal care, room, board, housekeeping, supervision, home health aides, various types of therapy, case management and other vital services. It should be noted that some medical issues exceed levels that the ALP can address such as a need for continual nursing care. Additionally, ALP residents cannot be chronically bedfast, chairfast, or impaired to the degree that they endanger the safety of other residents.

To determine eligibility requirements, medically and financially, contact the Department of Social Services. Also, request a list of approved assisted living facilities offering the Medicaid funded ALP. Currently, there are four on Long Island - two in Nassau County and two in Suffolk. Medicaid recipients must have their ALP services approved in advance by the local Department of Social Services. It is also possible to private pay for the ALP and transition onto Medicaid after meeting the necessary criteria. Information is available fromthe Department of Health website: www.health.state.ny.us. (Search Consumer Guide to Long Term Care). Empire State Association of Assisted Living (www.esaal.org) is another excellent resource for guidance.

Veterans and their spouses may also find it worthwhile to explore eligibility requirements for Aid and Attendance benefits. This higher level of pension payout can add significant monthly income if there is a demonstrated need for ongoing caregiver assistance. Contact the Veterans Administration for more information or visit them online: www.va.gov.