The Assisted Living Program Around Rochester: Where the Medicaid Beds Are and How the Money Works

Why ALP exists

New York's Medicaid program pays for nursing home care but not for rent in ordinary assisted living. The Assisted Living Program fills part of that gap. Created under Social Services Law 461-l, it pays for personal care, aide services, nursing, therapy and case management inside an adult home or enriched housing program, for people who are medically eligible for a nursing home but can live safely in a residence. The state saves money compared with a nursing home, and the resident lives in an apartment rather than a semi-private nursing room.

Where the beds are

In the Department of Health's 2026 Q2 capacity report:

Several of these residences also hold private-pay ALR beds, and a few hold SNALR memory care beds. That mix matters: a private resident whose savings run out may be able to move into an ALP bed in the same building if one opens.

How room and board is paid

ALP residents pay room and board from their own income. Residents on SSI receive New York's Congregate Care Level 3 rate, $1,688 a month in 2026: $994 federal SSI plus a $694 state supplement. The resident keeps a $262 personal needs allowance and the residence receives $1,426, about $46.88 a day.

Because that payment is fixed, residences limit their ALP beds and most keep waiting lists.

Who qualifies

Two tests apply. Medically, the person must be eligible for nursing home placement without needing continuous nursing care, as assessed by the ALP provider and their physician. Financially, they must qualify for Medicaid, which in 2026 means income at or under $1,836 a month for a single person and resources under $33,038, with spend-down and other rules for people above. The county Department of Social Services decides the financial side.

Why ALP beds sit mostly in older adult homes

Several of the residences with the largest numbers of ALP beds are established adult homes that have served residents on SSI for decades, such as larger buildings in and near the city of Rochester, in Henrietta and in Canandaigua. For those operators, the Assisted Living Program adds Medicaid payment for care on top of the fixed SSI room-and-board rate, which makes it possible to serve people with nursing-home-level needs at a price the state will pay. Newer private-pay campuses hold fewer ALP beds, though a few, such as a large Penfield residence, combine private ALR beds with an ALP allotment.

For families, the practical consequence is that ALP residences can feel quite different from one another. Some serve mostly older adults; others serve a mix that includes younger adults with disabilities. Visit, eat a meal there, and ask who lives in the building before deciding.

ALP compared with a nursing home on Medicaid

A person who qualifies for the Assisted Living Program would also qualify medically for a nursing home, so the choice is often between the two. A nursing home provides round-the-clock nursing, which matters for unstable medical conditions, and Medicaid pays for everything except the resident's own income contribution. An ALP residence provides a private or semi-private apartment, more independence and a less clinical setting, with nursing visits rather than nurses on every shift.

For many people with stable chronic conditions who need daily help but not daily nursing, ALP is the better life. For people with frequent medical changes, it may not be safe. The ALP provider's assessment and the person's physician decide the medical question; the family and the resident decide which life they want within what is safe.

How to get on a list

Call each ALP residence directly, ask how many ALP beds it has, how many are open, how long its list runs, and whether it takes hospital referrals first. Hospital discharge planners at Strong, Highland, Rochester General and Unity refer to ALP providers regularly, so if a parent is hospitalized, ask the planner to send an ALP referral before agreeing to a nursing home. Outside Monroe County, the ALP beds are in Canandaigua and Newark, which can be a long drive for family; weigh that against the wait.