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New York - Assisted Living Facility — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The New York State Department of Health (NYSDOH) licenses congregate residential care under the Assisted Living Residence (ALR) framework and funds Medicaid services through the Assisted Living Program (ALP). To bill Medicaid for personal care and supervision in these settings, operators must first secure base licensure as an Adult Home (AH) or Enriched Housing Program (EHP), obtain ALR licensure, and hold or contract for Licensed Home Care Services Agency (LHCSA) or Certified Home Health Agency (CHHA) certification.

Approval for the Medicaid ALP requires navigating a strict state need methodology where the NYSDOH authorizes a specific number of ALP beds per county. Applicants cannot simply enroll as Medicaid providers; they must apply during specific procurement windows or when bed need is identified, submitting a Certificate of Need (CON) application through the New York State Electronic Certificate of Need (NYSE-CON) system.

1. Service Definition and Scope

New York defines the Medicaid-funded Assisted Living Program (ALP) as an entity providing long-term residential care, room, board, housekeeping, personal care, and supervision to individuals who are medically eligible for nursing home placement but can be safely maintained in a less restrictive environment. The ALP operates within facilities licensed as Adult Homes or Enriched Housing Programs.

The state offers additional certification tiers for facilities that wish to provide higher levels of care, allowing residents to age in place or receive specialized dementia care.

2. Regulatory and Oversight Agencies

The New York State Department of Health (NYSDOH) is the primary regulatory body governing both the physical facility licensure and the Medicaid Assisted Living Program. Multiple divisions within NYSDOH handle different aspects of the approval and oversight process.

Medicaid enrollment and claims processing are managed through the state's eMedNY system, operated in conjunction with the Office of Health Insurance Programs.

3. Gatekeeping Prerequisites: Who Can Even Apply

New York strictly controls the expansion of Medicaid Assisted Living Programs through a statutory bed need methodology. An applicant cannot submit an ALP application unless the NYSDOH has published a solicitation or identified an unmet bed need in the target county.

Even when a need is identified, applicants must meet structural prerequisites regarding base licensure and home care agency affiliation before their application is reviewed.

4. Licensure and Certification Requirements

Licensure as an Assisted Living Residence (ALR) is governed by 10 NYCRR Part 1001. Applicants must submit comprehensive architectural, financial, and programmatic plans through the NYSE-CON system.

Facilities seeking to offer specialized care must apply for EALR or SNALR certification, which requires additional architectural and programmatic reviews.

5. Medicaid Provider Enrollment

Once licensed and authorized as an ALP, the facility must enroll as a billing provider through eMedNY. The enrollment process requires adherence to the Provider Compliance Program requirements under 18 NYCRR Part 521.

Providers must submit specific forms to link their banking information and electronic transmitter identification numbers to their Medicaid file.

6. Staffing, Training and Background Checks

ALP staffing must meet both adult care facility regulations and home care standards. Direct care staff must complete state-approved training programs.

Facilities must designate specific administrative roles, such as a program coordinator and case manager, to oversee resident care and regulatory compliance.

7. Documentation, Policies and Records

Federal and state regulations require ALPs to maintain extensive health and financial records. Facilities must document all resident assessments, care plans, and absences.

Prior to admission, facilities must execute specific agreements and provide state-mandated consumer information to the resident.

8. Billing, Rates and Claims

Medicaid reimbursement for ALP services is based on regional rates and the resident's Resource Utilization Group (RUG) category. The ALP is fiscally responsible for required home care services even during certain resident absences.

Medicaid only pays for the health care and personal care components of the service; room and board must be covered by other means.

9. Approval Sequence and Timeline

The approval process for a new ALP is lengthy, often taking 12 to 24 months due to the CON review, architectural approvals, and dual licensure requirements.

Applicants must clear the physical plant inspection and receive their operating certificate before they can submit their Medicaid enrollment application to eMedNY.

10. Common Denials and Survey Findings

NYSDOH inspects all licensed facilities every 18 months. Deficiencies often stem from inadequate documentation, failure to meet physical plant standards, or improper medication management.

Facilities with enhanced certifications must strictly manage their bed allocations to avoid citations for exceeding authorized capacity.

11. Key Contacts and Resources

Prospective ALP providers must utilize official NYSDOH portals and guidance documents to navigate the complex licensure and enrollment landscape.

The eMedNY call center provides technical assistance for the Medicaid enrollment and billing phases.

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