Nursing Homes in New York
Nursing homes provide 24-hour monitoring, skilled nursing services, comprehensive clinical care and rehabilitation therapies and are suitable for seniors who have high-level care needs but don’t need to stay in a hospital. New York has over 600 nursing homes, with an average of about 185 beds per facility. As of July 2022, 92,784 people were residents in the state’s nursing facilities.
New York is home to around 19.7 million people and seniors aged 65 or older compose approximately 17.5% of the state’s population. Retirees get tax breaks on private pensions and retirement accounts, and income from Social Security benefits, government pensions and military pensions are tax-free. Statewide, crime rates are lower than the national average. New York has more doctors per capita than many other places in the country, with 264 physicians for every 100,000 people. Seniors have access to many top-ranking medical centers statewide, including Lenox Hill Hospital, Rochester General Hospital, Stony Brook University Hospital and Vassar Brothers Medical Center.
This guide looks at ways to pay for nursing home care in New York and details the regulations nursing facilities must follow. It also provides information about supportive resources.
Popular Cities in New York
Cost of New York Nursing Homes
The average cost of nursing homes in New York is $361 per day. This is higher than the national average which is $228 per day.
Can You Use Medicaid to Pay for Nursing Home Care in New York?
New York’s state Medicaid program may cover nursing home fees for low-income seniors who meet level-of-care requirements. As of December 2022, almost 7.4 million New Yorkers were enrolled in Medicaid and CHIP. Per KFF, 3 in 5 nursing home residents in New York receive Medicaid funding, with seniors and disabled people accounting for over 60% of the state’s total Medicaid spending.
Older adults who meet medical criteria may be eligible to receive care at home or in the community through a Medicaid Managed Care program. Managed care organizations, known as health maintenance organizations, provide necessary care services for those who qualify. Participation in the program is limited and seniors may need to go on a waitlist to receive services. The program is designed to delay or prevent transition into an institutional care setting.
Eligibility for Medicaid in New York
Older individuals must satisfy stringent financial criteria to qualify for Medicaid assistance in New York. Per year, single applicants can earn no more than $20,124. For couples where both parties apply for Medicaid, the income limit increases to $31,536. Individuals may keep a personal allowance of $50 each month. With limited exceptions, all remaining income must be paid toward nursing home fees. Asset caps also apply. Single applicants can have maximum countable resources of $30,180, while couples have an enhanced asset limit of $40,820.
| Income Limits* | Asset Limits | |
|---|---|---|
| Single Person | $20,124 | $30,180 |
| Two-Person Household | $31,536 | $40,820 |
*Per year
In New York, Medicaid eligibility also has criteria related to medical need, residency and citizenship. Individuals must:
- Live in New York on a permanent, full-time basis
- Be a U.S. citizen, national or legal resident
- Need the level of care typically provided by a nursing home
Applying for Medicaid in New York
Older adults can apply for New York Medicaid via their nearest New York State Department of Social Services office. They can call their local office to apply over the telephone or visit the relevant office to complete an in-person application. Alternatively, applicants can download and print a paper form and return it by mail or by hand to their local DSS office.
What Information You Will Need
Seniors typically need to provide various documents and information with benefits applications. Not producing all requested items can slow down claim processing. Medicaid assessors may ask to see:
- Proof of identification
- Social Security card
- Medicare card
- Birth certificate
- Proof of current residence
- Proof of citizenship or legal residency
- Bank statements
- Proof of all income
- Details of all countable assets, including property title deeds, car registration documents and bond certificates
- Insurance policies
- Mortgage details or rental agreement
- Medical bills
- Any active powers of attorney
- Veteran discharge papers
Additional Medicaid Support & Resources in New York
Although applying for Medicaid may feel daunting, several agencies and organizations offer free assistance and support to those navigating the process. Services include eligibility checks, help to complete application forms and fraud avoidance. Seniors and their family members can contact the below organizations for assistance.
| Contact | Service | |
|---|---|---|
| Medicaid Hotlines | (800) 541-2831 | New York State Department of Health staffs several dedicated Medicaid Hotlines to help people understand the system and obtain appropriate funding and coverage. Individuals can obtain general information, eligibility advice and application assistance via the general Medicaid Helpline. There’s a phone line for managed care and another for reporting fraud. |
| NY Connects | (800) 342-9871 | NY Connects provides a wide range of aging-related information and support. Assistance is available in person and over the phone. Advisors can perform Medicaid eligibility checks, explain how the program works and help people complete applications. They can also help seniors appeal any adverse decisions. |
| American Council on Aging | Online only | The American Council on Aging maintains the free Medicaid Planning Assistance website, which provides in-depth information on all related matters. Seniors can use the site to find local Medicaid advisors. The website also covers general information about nursing homes and VA pension planning. |
Can You Use Medicare to Pay for Nursing Home Care in New York?
Medicare provides limited coverage for short-term stays in a skilled nursing facility following a hospital stay, but seniors must meet a number of specific requirements. This benefit is available to beneficiaries who have been hospitalized for at least three days, excluding the date of discharge, so it's most valuable for those who are recovering from an injury, illness, or surgery.
Once seniors meet the hospitalization requirement, Medicare will pay for up to 100 days of skilled nursing per benefit period. The first 20 days are covered in full. Starting on day 21, beneficiaries must pay a daily coinsurance rate. After day 100, seniors are responsible for the entire cost.
What Does Medicare Cover?
Medicare covers a number of specific services, including:
- Meals
- A semiprivate room
- Medications
- Skilled nursing
- Physical therapy
- Occupational therapy
- Speech therapy
- Audiologist care
- Medical supplies
- Medical social services
- Nutritional counseling
- Ambulance transportation
What Isn't Covered by Medicare?
Medicare does not cover long-term custodial care that addresses seniors' day-to-day needs. This includes help with daily activities, such as bathing, dressing and using medical equipment.
For more information about Medicare and when it covers Nursing Home Care, read our Guide to Nursing Homes.
Medicare Support & Resources in New York
Medicare beneficiaries and applicants have various support resources at their disposal. Services include free Medicare and health insurance counseling, fraud education, prescription drug programs and assistance with getting replacement Medicare cards.
| Contact | Service | |
|---|---|---|
| New York State Health Insurance Information Counseling and Assistance Program | (800) 701-0501 | This program provides free, unbiased Medicare and health insurance counseling through a statewide network of trained volunteers. Advisors can help seniors find the most suitable plans for their needs and provide information on all parts of Medicare, including prescription drug coverage. |
| Social Security Administration | (800) 772-1213 | The SSA operates more than 100 local field offices throughout New York. Seniors can contact their nearest office for Medicare guidance, to apply for the Medicare Prescription Drug Program, to update changes in circumstances and to order a replacement Medicare card. |
| New York Senior Medicare Patrol | (800) 333-4374 | New York’s Senior Medicare Patrol provides peer-to-peer education and information aimed at empowering seniors to recognize and report Medicare fraud and scams. Volunteers can help seniors understand their medical bills and spot any irregularities. Certified SMP counselors also provide outreach services to raise community awareness. |
Other Financial Assistance Options for Nursing Home Care in New York
While Medicaid and Medicare are two of the most common programs used to pay for Nursing Home Care, there are other financial assistance options available, depending on your unique situation.
| How to Apply | How It Works | |
|---|---|---|
| Aid and Attendance | Learn more and apply online at va.gov. | Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for skilled nursing care. |
| Reverse Mortgages | Learn more about your options and how to apply at ftc.gov. | If you own a home, you may be able to use a reverse mortgage to help pay for nursing care. Reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home's equity into cash. This type of funding can be especially useful for married couples when only one partner needs nursing care, as the other residents of the home may continue living there. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan. |
| Long-Term Care (LTC) Insurance | Learn more about Long-Term Care Insurance and how to apply for a policy at acl.gov. | Seniors who already have long-term care insurance may be covered for skilled nursing care. Most policies cover at least a portion of the cost of nursing home care, but it depends on the specific policy terms. Note that older adults who are already in need of skilled nursing care will not be eligible to sign up for a LTC insurance policy. |
Nursing Home Laws and Regulations in New York
| Licensing Requirements | Nursing facilities must hold an up-to-date license from the New York State Department of Health, Division of Quality and Surveillance for Nursing Homes and ICF/MR. The department makes sure facilities follow licensing terms and alll state and federal regulations. |
| Staffing Requirements | Nursing homes must employ a full-time director of nursing. Staff should be available at all times to care for residents according to their tailored care plans. Staffing should aim to provide the highest levels of care possible and promote physical, social and mental well-being. Every shift must have a charge nurse on duty to supervise other staff members. |
| Staff Training Requirements | Skilled staff, such as rehabilitation therapists and nurses, should have appropriate training and hold relevant licenses. Nurse aides must be registered with the New York State RHCF Nurse Aide Registry. All staff members must complete ongoing professional development. |
| Admission Restrictions | Nursing homes in New York can only accept residents on a doctor's orders. Additionally, facilities can't admit anyone who they can't provide suitable care for. |
| Care Planning Requirements | Staff must complete an assessment within 14 days of a resident's admission. It should cover care needs, levels of functioning, medical issues and resident preferences. Staff should use the assessment to inform a care plan that details all services. Care plans should be reviewed quarterly. |
| Dietary and Nutritional Services Requirements | Nursing homes must hire or retain a dietitian to provide nutritional guidance. Dieticians can work on a full-time, part-time or consultancy basis. The culinary team must create nutritious meals that taste good and appeal to residents' senses. The team must also cater to diverse dietary requirements. |
| Specialized Rehabilitative Services | Facilities must provide specialized services as detailed in a resident's unique care plan. These may include speech-language therapy, occupational therapy or physical therapy. Therapists must be suitably qualified. They may be employees or contracted to provide services. |
| Medication and Pharmaceutical Services | Facilities must provide pharmaceutical services from a registered pharmacist. Staff members must follow prescribed policies and procedures to make sure drugs are correctly administered to residents. |
| Activities Requirements | A qualified activities staff member must manage enrichment and engagement programming. Activity programs should be geared toward supporting holistic wellness needs. |
| Infection Control Requirements | Facilities must develop and adhere to infection control policies and procedures to prevent the spread of infectious diseases. Any outbreaks must be reported to the Office of Health Systems Management. All new staff must have a tuberculosis test. |
| Medicaid Coverage | Older adults who need nursing home care and have limited assets and income may qualify for Medicaid funding for care. Medicaid covers the full costs of nursing home care for qualifying individuals, including room, meals, therapies, durable medical equipment and care services. |
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