DSS-2855: Adult Care Facility Personal Allowance Summary - health ny-2026

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  1. Click ‘Get Form’ to open the DSS-2855 in the editor.
  2. Begin by entering the date at the top of the form. This is essential for tracking your personal allowance summary accurately.
  3. In the 'Receipts' section, record all deposits made into the personal allowance account. Use the provided fields to enter each deposit amount along with corresponding dates.
  4. Next, move to the 'Payments' section. Here, document any withdrawals from the account. Ensure you include both amounts and dates for clarity.
  5. Calculate and enter the monthly total amounts for both receipts and payments at the bottom of their respective sections. This will help maintain an accurate balance.
  6. Finally, check that all information is correct before saving or exporting your completed form for submission.

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The New York State Department of Health regulates the ALP, a Medicaid State Plan service that operates in facilities that are licensed as either an adult home or enriched housing program.
To be eligible, both Medicaid recipients and private-payers must be medically eligible for, and would otherwise require, placement in a nursing home due to the lack of a home or suitable home environment.
Assisted living facilities (ALFs) may be owned by a range of entities, from large corporations to individuals to nonprofit organizations.
Assisted Living Facility or Adult Home Complaint Agency: New York State Department of Health. Division: Assisted Living Facilities and Adult Homes. Phone Number: (866) 893-6772. Business Hours: Monday - Friday: 8:30 AM - 4:45 PM.
While some federal rules and regulations may apply to assisted living communities, state-level regulation of assisted living services and operations ensures a coordinated, comprehensive licensure system.

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A personal needs allowance (PNA) is the monthly stipend that Medicaid recipients who live in nursing homes are allowed to keep from their income to spend on personal items and services. The PNA is $50, has not been adjusted or increased since the 1980s. $50 in the 1980s is equivalent to $177 today.

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