New York does not have one license called assisted living. It has three overlapping legal categories that can be layered on top of each other in the same building, which is why two facilities marketing themselves as assisted living can have very different rules, very different price points, and very different paths for who pays. The three categories are Adult Care Facilities (ACFs), Assisted Living Residences (ALRs), and the Assisted Living Program (ALP), and the ALP/ALR distinction is the single most-misreported axis in out-of-state coverage.

The short version: ACF is the oldest license type and covers Adult Homes and Enriched Housing Programs. ALR is the modern assisted living certification created by the 2004 Assisted Living Reform Act, with three sub-types (Basic, Enhanced, and Special Needs). ALP is the Medicaid-funded service overlay on an underlying Adult Home or Enriched Housing Program license. A facility can hold one of these licenses, two layered together, or all three.

This guide walks through what each license type means, who can pay with what, how the 2026 cost picture breaks down by region, how to find a facility through the NYSDOH directory, what resident rights and discharge protections apply, and the misconceptions that show up most often in older directories.

The Three-Tier Architecture

Assisted living in New York is best understood as a stack of license types rather than a single program. Each license was layered on top of an earlier framework, and all three remain in use today.

Adult Care Facility (ACF) is the oldest and most foundational category. Authorized at NY Social Services Law Article 7 and codified across 18 NYCRR Parts 485, 486, 487, 488, 489, and 490, the ACF umbrella covers Adult Homes (Part 487, congregate-style residences with shared dining), Enriched Housing Programs (Part 488, apartment-style residences with services available), Family-Type Homes for Adults (Part 489, up to four unrelated adults in a private home), and the largely vestigial Residences for Adults (Part 490). Licensing is administered by the NYSDOH Bureau of Adult Care Facility / Assisted Living Surveillance.

Assisted Living Residence (ALR) is the modern, branded assisted living certification created by the Assisted Living Reform Act of 2004 (Chapter 2 of the Laws of 2004). The Act added Public Health Law Article 46-B and was operationalized at 10 NYCRR Part 1001. ALR has three sub-types: Basic ALR for general assisted living; Enhanced Assisted Living Residence (EALR) for residents who become unable to perform some ADLs and want to age in place; and Special Needs Assisted Living Residence (SNALR) for memory care and end-of-life care. Critically, an ALR is a certification layered on an underlying Adult Home or Enriched Housing license. It is not a stand-alone facility class.

Assisted Living Program (ALP) is the Medicaid-funded form. Authorized at Social Services Law § 461-l and operationalized at 18 NYCRR Part 494, the ALP is a service-overlay license granted only to applicants who already hold (or simultaneously obtain) an underlying Adult Home or Enriched Housing license. An ALP cannot be operated on top of an ALR-only license. Medicaid pays the service component of an ALP slot through the resident's Managed Long Term Care Partial Capitation plan. The resident pays the room-and-board component from SSI plus the New York State Supplement Program.

The practical implication is that a single building may hold any combination of these licenses. An ACF-only Adult Home accepts private pay or SSI plus SSP residents. An ALR-only facility accepts private pay only. An ACF plus ALP combination accepts Medicaid for services and SSI plus SSP for room and board. An ACF plus ALR plus ALP combination can accept all of the above. Always check the NYSDOH Health Profiles directory at profiles.health.ny.gov/acf/ to confirm a specific facility's license stack.

Adult Care Facilities

The ACF umbrella has four operational sub-types, only two of which are common in modern practice.

Adult Homes under 18 NYCRR Part 487 are the largest sub-type by census. The statutory floor is five or more residents, but most operating Adult Homes are 30 to 250 beds. The service model includes congregate dining, daily personal care assistance, supervision, medication management limited to assisted self-administration under § 487.7(f)(2), 24-hour staffing, housekeeping, laundry, and social and recreational activities. Adult Homes cannot retain residents who require continuous medical or skilled-nursing care, are chronically bedfast, have unmanaged urinary or bowel incontinence, depend on medical equipment that exceeds the facility's capacity, are dangerous to themselves or others, or whose needs the facility cannot lawfully meet. These retention limits are why families often outgrow an Adult Home as a parent's needs increase, and why upgrading to an EALR or SNALR may become necessary.

Enriched Housing Programs under 18 NYCRR Part 488 are apartment-style and were designed to be a step less institutional than Adult Homes. The statutory floor is again five residents, primarily age 65 or older, with separate units that resemble independent housing and services available rather than congregate dining and shared rooms. Enriched Housing is the most common substrate for an ALP license, particularly upstate, because the apartment-style configuration aligns with home and community-based services settings rules.

Family-Type Homes for Adults (FTHA) under 18 NYCRR Part 489 are private family homes that provide long-term residential care to up to four unrelated adults. Licensing is at the Local Department of Social Services level. FTHAs are not technically assisted living under PHL Article 46-B, but they are functionally adjacent and appear in NYSDOH directories as a small-scale residential option.

Transitional Adult Homes under 18 NYCRR § 487.13 are Adult Homes with 80 or more certified beds in which 25 percent or more of residents are people with serious mental illness. These facilities operate under a compliance plan to lower the SMI census over time and to support community transitions, and they are the operational backbone of New York's Olmstead community-integration obligations following the O'Toole v. Cuomo settlement and the December 2024 HOPE Action Plan.

Assisted Living Residences

The ALR framework is the modern license most families think of when they hear assisted living. Public Health Law Article 46-B sets out the licensing structure, the resident agreement, the Individualized Service Plan, the Resident's Bill of Rights, and the discharge protections. 10 NYCRR Part 1001 is the operational rulebook.

A Basic ALR provides daily food service, 24-hour on-site monitoring, case management, ISP development, and personal-care or home-care services either directly or through a Licensed Home Care Services Agency or Certified Home Health Agency contract. Basic ALRs cannot retain residents who require 24-hour skilled nursing or medical care.

An Enhanced Assisted Living Residence (EALR) holds an enhanced certificate under PHL §§ 4654 to 4655. An EALR can admit and retain residents who exceed the standard Adult Home or Basic ALR retention rules, specifically residents who chronically require physical assistance from another person to walk, chronically require physical assistance to climb or descend stairs, are dependent on medical equipment with frequent need for medical-personnel assistance, or have chronic unmanaged urinary or bowel incontinence. EALRs may directly employ an RN or LPN, or may contract through an outside agency. EALRs still cannot retain residents who require 24-hour skilled nursing.

A Special Needs Assisted Living Residence (SNALR) holds a special needs certificate under PHL § 4656, most commonly authorizing services for individuals with Alzheimer's disease, dementia, or cognitive impairments, and in some cases end-of-life care. The applicant must submit a special needs plan describing services, staffing, training, environmental modifications such as locked units and wandering-prevention design, and how the ISP will be tailored. NYSDOH solicits public comment on every SNALR application. Marketing memory care without SNALR licensure is a regulatory violation.

The Resident's Bill of Rights under PHL § 4660 is enumerated as 16 specific rights covering dignity, privacy, freedom from abuse, retention of personal property, autonomy in financial affairs, free communication, religious observance, grievance rights without retaliation, the right to participate in resident councils, and access to an ombudsman. The residency agreement under PHL § 4658 must be provided in writing before admission and must include the full schedule of services and charges, admission and retention criteria, discharge criteria and process, refund policies, and the rate-change methodology.

The Assisted Living Program

The ALP is the most complex piece of the architecture and is the only Medicaid-funded pathway to assisted-living-style care in New York. The ALP service package includes the room-and-board components delivered by the underlying Adult Home or Enriched Housing license, plus case management, home health services delivered through a contracted CHHA or LHCSA, medical equipment and supplies, a Personal Emergency Response System, therapies as medically necessary, and coordination with primary and specialty care.

To enroll in an ALP slot, an applicant must be Medicaid-eligible (or, less commonly, private-pay using the same service model), must be certified as needing nursing-home level of care, must be in a stable medical condition that does not require continuous nursing or chronic bedfast care, must be able to evacuate with assistance in an emergency, and must be appropriate for community placement rather than institutional care. The vast majority of ALP residents are Medicaid recipients. Eligibility is determined through the Uniform Assessment System for New York (UAS-NY), conducted by the ALP's assessing nurse rather than through the New York Independent Assessor Program that governs MLTC enrollment.

The financial mechanics deserve a careful walk-through because they are the most-misreported piece of the New York assisted-living picture. The resident pays the room-and-board component from federal SSI plus the New York State Supplement Program Congregate Care Level 3 add-on for ACF and ALP residents. The resident retains a Personal Needs Allowance for clothing, phone, toiletries, and copays; the facility receives the balance for room and board. (For the current SSI federal benefit rate, see the SSA SSI page; for the current SSP Congregate Care Level 3 figure and the corresponding ALP PNA, consult NYSDOH and the NY Office of Temporary and Disability Assistance State Supplement guidance.) Medicaid pays the service component on top of that, typically through a per-member-per-month payment from the resident's MLTCP plan to the ALP operator at the NYSDOH ALP rate.

Authorized ALP capacity is in the several-thousand range statewide; the historical 7,500 figure that appears in older directories reflects an earlier statutory cap that has not consistently translated into operational beds. For the current slot count and county distribution, consult the NYSDOH Health Profiles directory. Wait lists are common, particularly in New York City, Long Island, and Westchester. ALP is not an entitlement; meeting eligibility does not guarantee placement.

How to Apply for an ALP Slot

For a family seeking ALP placement, the practical pathway is:

  1. Verify Medicaid eligibility. A community Medicaid application can be filed simultaneously with the ALP application; the facility will help coordinate.
  2. Identify ALP-licensed facilities in the senior's county of residence using the NYSDOH Health Profiles directory at profiles.health.ny.gov/acf/, filtering for ALP-licensed Adult Homes and Enriched Housing Programs.
  3. Contact the facility directly to inquire about vacancies, schedule a tour, and begin the application. NYIAP does not gate ALP enrollment; the ALP's own assessing nurse conducts the UAS-NY evaluation.
  4. Complete the UAS-NY assessment and the facility's intake paperwork. The facility verifies NF-LOC and assesses for community-placement appropriateness.
  5. Sign the residency agreement and complete Medicaid enrollment if not already enrolled. The resident is then enrolled in MLTCP, which becomes the service-coordination plan.
  6. Move in the first of the month following enrollment approval. Medicaid pays the service component to MLTCP, MLTCP pays the ALP operator, and the resident pays the room-and-board portion from SSI plus SSP.

For private-pay assisted living without an ALP component, the pathway is considerably simpler: contact the facility directly, tour, sign the residency agreement, and move in once admission is approved.

The 2026 Cost Picture

Private-pay assisted living costs in New York vary dramatically by region. Rural upstate facilities typically run at the lower end of the statewide range; suburban metros (Mid-Hudson, Albany, Rochester, Syracuse, Buffalo) sit in the mid-range; and New York City, Long Island, and Westchester consistently come in at the high end of the national assisted-living market. For current-year figures by metro, consult the most recent Genworth Cost of Care Survey and the NYSDOH Health Profiles for facility-level disclosures.

Memory care SNALR generally carries a meaningful monthly premium over a comparable Basic ALR in the same region, reflecting the additional staffing, environmental modifications, and clinical training required by SNALR licensure.

For ALP residents, the resident's out-of-pocket cost is structured by the SSI plus SSP framework rather than by the regional private-pay market. The facility receives the SSI plus SSP combination for room and board (less the resident's Personal Needs Allowance), plus the Medicaid service rate paid through MLTCP. A resident with income above the SSI threshold but below the Medicaid community level pays the difference directly to the facility for room and board. A resident with income above the Medicaid community threshold can use a Pooled Income Trust to spend down excess income while preserving Medicaid eligibility.

How Assisted Living Connects to Medicaid Long-Term Care

For a senior who is or will become Medicaid-eligible, assisted living interacts with Managed Long Term Care in two ways. ALP residents are typically enrolled in an MLTCP partial-capitation plan, which coordinates community-based long-term services and supports including ALP. The MLTCP plan pays the ALP a per-member-per-month rate derived from the NYSDOH ALP base rate. ALP enrollees are exempt from the September 1, 2025 Minimum Needs Requirement under MLTC Policy 25.04 because their plan-coordinated services are anchored in the ALP slot, not in the standard MLTCP eligibility test. Non-ALP MLTCP enrollees who happen to live in private-pay assisted living follow the standard Minimum Needs Requirement rules.

For seniors who instead enroll in PACE (Programs of All-Inclusive Care for the Elderly), PACE delivers care through its day-center model rather than through an ALP slot. A senior enrolled in PACE typically does not also live in an ALP-funded slot, although a small number of PACE participants live in private-pay ALR or ACF settings while attending the PACE day center.

For seniors who are full Medicare-Medicaid duals enrolled in MAP (Medicaid Advantage Plus) or another FIDE-SNP, the integration logic mirrors MLTCP for purposes of ALP coordination, but the integrated plan handles both Medicare and Medicaid benefit streams.

Resident Rights and Discharge Protections

The rights framework for assisted living residents in New York is layered. PHL § 4660 establishes the ALR Resident's Bill of Rights, with 16 enumerated rights covering dignity, privacy, freedom from abuse, retention of personal property, autonomy in financial affairs, free communication, religious observance, grievance rights without retaliation, participation in resident councils, and access to an ombudsman. 18 NYCRR § 487.5 sets the parallel Adult Home protections. 18 NYCRR Part 488 covers Enriched Housing. 18 NYCRR Part 461 cross-references all sub-types. For ALP residents whose services are Medicaid-funded, the federal Medicaid LTC resident-rights baseline at 42 USC § 1396r(c) applies to the service component.

Before admission, the facility must provide in writing the residency agreement, the NYSDOH Consumer Information Guide, the Resident's Bill of Rights, the schedule of services and charges with all add-on fees, the admission and retention criteria, the discharge criteria and process, the complaint and grievance procedures with ombudsman contact information, a list of free legal-services agencies in the area, and the refund policy including refunds upon death.

Involuntary discharge is governed by 18 NYCRR § 487.5(g) and SSL § 461-h for Adult Homes, and by PHL § 4660 for ALRs. The facility must provide at least 30 days written notice on a department-prescribed form. Permitted reasons include the resident requiring care the facility cannot provide, behavior posing imminent risk, non-payment with assistance offered, repeated rule-impairing behavior, or facility closure. If the resident objects within 30 days or remains after 30 days, the operator must initiate a special proceeding under SSL § 461-h in court before the discharge can take effect. For Medicaid-funded ALP residents whose service plan is being reduced or who face MLTC disenrollment, the 18 NYCRR Part 358 fair-hearing process runs in parallel for the Medicaid coverage issues, with Aid Continuing under § 358-3.6 available if the request is timely.

Two Free Advocacy Resources

Two free advocacy resources are available to every New York assisted-living resident and family.

The New York State Long-Term Care Ombudsman Program is the federally authorized advocate for residents of nursing homes, adult homes, enriched housing programs, family-type homes, ALRs, EALRs, SNALRs, and ALPs. Authority comes from the Older Americans Act Title VII at 42 USC § 3058g, operationalized at the state level by the New York State Office for the Aging under Executive Law Article 19-D. Regional ombudsman coordinators sponsored by area agencies on aging, nonprofits, and independent living centers train volunteer ombudsmen who visit facilities regularly. Services include advocacy, mediation, education, complaint investigation, referral to NYSDOH for severe issues, and support during involuntary discharge proceedings. The statewide hotline is 1-855-582-6769.

The Independent Consumer Advocacy Network (ICAN), at 1-844-614-8800, is the New York State ombudsprogram for people with Medicaid who need long-term care or behavioral health services. ICAN is operated by the Community Service Society of New York and is structurally independent of NYSDOH and Maximus. ICAN explicitly covers ALP residents enrolled in MLTCP, MAP, PACE, mainstream Medicaid managed care, and HARP. Services are free and confidential.

For complaints about a specific facility, the NYSDOH Adult Care Facility Centralized Complaint Intake operates at 1-866-893-6772, weekdays 8:30 a.m. to 4:45 p.m., with voicemail accepted after hours. The complaint hotline is the entry point for NYSDOH inspection responses.

Subsidies Beyond Medicaid

Several non-Medicaid pathways help families fund assisted living in New York.

The State Supplement Program (SSP) Congregate Care Level 3 add-on combines with federal SSI to set the room-and-board floor for ACF and ALP residents. For private-pay Adult Home or Enriched Housing residents who are not in an ALP slot but whose income is at the SSI threshold, the same SSP add-on reaches the facility, with the resident keeping a Personal Needs Allowance. For the current SSP Congregate Care Level 3 amount and the corresponding ALP Personal Needs Allowance, consult NYSDOH and the NY Office of Temporary and Disability Assistance State Supplement guidance.

The Special Needs Assisted Living Voucher (SNALR Voucher), established in a prior enacted state budget and made permanent in a more recent enacted budget, subsidizes a meaningful share of the regional average private-pay rate for SNALR residence for individuals with Alzheimer's disease or dementia who are not Medicaid-eligible. The prior voucher cap was lifted in the permanence legislation, and a previous waitlist has been cleared. For the current funding level, subsidy percentage, and application status, consult the NYSDOH Adult Care Facilities branch.

Long-term care insurance typically covers assisted-living costs once the policyholder needs help with two or more activities of daily living or has a documented cognitive impairment. Coverage triggers, daily benefit limits, and elimination periods vary by policy.

Veterans benefits including Aid and Attendance and Housebound add-ons can be used to pay for assisted living. Aid and Attendance pays a meaningful supplement to a senior veteran or surviving spouse who needs help with daily activities.

Section 8 housing vouchers apply in some cases for residents of Enriched Housing Programs, which are apartment-style and operationally compatible with vouchers, although assisted-living service costs remain separate.

Touring an Assisted Living Facility

When evaluating a facility, families consistently report that the same set of indicators predicts the eventual experience.

Watch for staffing patterns at meal times and in the late afternoon. New York does not impose a minimum staff-to-resident ratio in regulation; rules require "sufficient staff to meet residents' needs." That ambiguity makes direct observation important. Count staff visible in common areas, ask how many aides are on duty per shift, and ask how staffing changes overnight.

Look at dining quality. Sit through a meal if the facility allows. Ask for the rotating menu, ask whether residents have meaningful choice, and check whether dietary restrictions are accommodated.

Test medication management. Ask whether the facility supports assisted self-administration only (Adult Home), or skilled nursing administration through an LHCSA or in-house RN (EALR or ALP). For a senior whose medications include injectable insulin, complex psychotropics, or anticoagulants, the medication-management model is often the determinative fit.

Ask about activities and engagement. A robust activity calendar with resident input is a stronger sign than a generic activity program designed by management. Ask whether residents help plan activities and whether attendance is tracked.

Read the last NYSDOH inspection report. NYSDOH posts inspection results at health.ny.gov/facilities/adult_care/reports.htm and at the Health Profiles directory. Look at recent Statements of Deficiency, the categories of citation (medication, resident funds, ISP, staff training, discharge, environmental, resident rights), and the Plan of Correction. Frequent or repeat citations in resident-rights or medication categories are red flags.

Visit at different times of day. A weekday morning tour is set up to look good. A weekend afternoon, a weekday evening, or an unannounced second visit often surfaces operational reality.

Common Misconceptions

  • Assisted living is not one license. It is a marketing term that maps to several legal categories: Adult Home, Enriched Housing Program, Family-Type Home for Adults, Basic ALR, EALR, SNALR, ALP, or any combination. Always check the NYSDOH license stack.
  • Medicaid does not pay assisted living room and board. Medicaid pays the service component of an ALP slot. Room and board is the resident's responsibility, paid from SSI plus SSP for ACF and ALP residents.
  • An ALR-only facility cannot accept Medicaid. The ALP license is the only Medicaid-funded pathway, and ALP can only be layered on an Adult Home or Enriched Housing Program license, never on an ALR-only license.
  • Memory care marketing requires SNALR licensure. A facility that markets services for individuals with Alzheimer's disease or dementia must hold a Special Needs Assisted Living Residence certificate.
  • EALR is not assisted living plus skilled nursing. EALRs can retain residents who become unable to perform some ADLs and who need limited skilled services through an LHCSA or in-house nurse, but cannot retain residents who require 24-hour skilled nursing care.
  • Continuing Care Retirement Communities are different. CCRCs are licensed under PHL Article 46, not under Article 46-B, and are regulated separately from ALR/EALR/SNALR.
  • ALP eligibility uses UAS-NY, not the NYIAP three-stage assessment. NYIAP applies to MLTC enrollment; ALP intake uses the facility's own UAS-NY assessing nurse.
  • The 7,500 ALP slot figure is outdated. For the current authorized capacity, facility count, and county distribution, consult the NYSDOH Health Profiles directory.

Frequently Asked Questions

An Adult Home is licensed under SSL Article 7 and 18 NYCRR Part 487 and is the older license type. An Assisted Living Residence is licensed under PHL Article 46-B and 10 NYCRR Part 1001, and is a modern certification layered on top of an underlying Adult Home or Enriched Housing license. Most modern assisted living facilities hold both licenses. The ALR layer brings the more detailed residency agreement requirements, the Resident's Bill of Rights at PHL § 4660, and the EALR or SNALR upgrade path. Adult-Home-only facilities still operate but are less common in the modern market.

Medicaid pays the service component of an ALP slot. The room-and-board component is paid by the resident from SSI plus the State Supplement Program. Medicaid does not pay room and board for ALR residents who are not in an ALP slot. To use Medicaid for assisted living, the senior must be admitted to an ALP-licensed facility, must be Medicaid-eligible, must be certified as needing nursing-home level of care, and must be appropriate for community placement.

Private-pay costs vary dramatically by region: rural upstate sits at the low end of the statewide range, upstate metros sit in the middle, and NYC, Long Island, and Westchester are at the high end of the national assisted-living market. Memory care SNALR carries a meaningful monthly premium. ALP residents pay the SSI plus State Supplement Program combination (less the Personal Needs Allowance) directly to the facility for room and board, with Medicaid covering the service component on top. For current dollar figures, consult the most recent Genworth Cost of Care Survey and SSA/NYSDOH guidance.

An Enhanced Assisted Living Residence is an ALR with an enhanced certificate that allows it to retain residents who need physical assistance to walk or climb stairs, who depend on medical equipment with frequent nurse assistance, or who have chronic unmanaged incontinence. EALR is the right fit for a senior who is starting to need more help than a Basic ALR can provide but who does not yet need 24-hour skilled nursing.

A Special Needs Assisted Living Residence holds a special needs certificate under PHL § 4656, most commonly for memory care or end-of-life care. SNALRs typically have locked units, wandering-prevention design, additional staff training in dementia care, and a tailored Individualized Service Plan process. Any facility marketing services for residents with Alzheimer's disease or dementia must hold a SNALR certificate.

The NYSDOH Health Profiles directory at profiles.health.ny.gov/acf/ is the canonical public source. You can search by facility name, county, and license type. Each profile shows the license stack (Adult Home, ALR, EALR, SNALR, ALP, FTHA), bed count, owner, current administrator, recent inspection dates, and inspection deficiencies and corrections. The NYC-specific dataset is at health.data.ny.gov.

Call the NYSDOH Adult Care Facility Centralized Complaint Intake at 1-866-893-6772 weekdays from 8:30 a.m. to 4:45 p.m. For systemic concerns or advocacy support, call the New York State Long-Term Care Ombudsman Program at 1-855-582-6769 or, for Medicaid managed-care issues affecting an ALP resident, ICAN at 1-844-614-8800.

Involuntary discharge requires a 30-day written notice on a department-prescribed form, with permitted reasons specified by 18 NYCRR § 487.5(g) and SSL § 461-h for Adult Homes and PHL § 4660 for ALRs. If the resident objects within 30 days or remains after 30 days, the operator must initiate a special proceeding in court before the discharge can take effect. For Medicaid-funded service plan reductions, the 18 NYCRR Part 358 fair-hearing process applies in parallel.

The Special Needs Assisted Living Voucher (SNALR Voucher) subsidizes SNALR residence for individuals with Alzheimer's disease or dementia who are not Medicaid-eligible. It was made permanent in a recent enacted state budget, with the prior 200-voucher cap lifted. For the current funding level, voucher availability, and application instructions, contact the NYSDOH Adult Care Facilities branch.

ALP residents are typically enrolled in an MLTCP partial-capitation plan that coordinates services. The MLTCP plan pays the ALP a per-member-per-month rate derived from the state's ALP Medicaid base. ALP enrollees are exempt from the September 2025 Minimum Needs Requirement that governs standard MLTCP and MAP enrollments. Non-ALP residents in private-pay ALRs are not directly tied to MLTC but may use MLTCP separately if they have community LTSS needs.

Learn More

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The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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