Nursing Home Vital Access Provider Assurance Program (VAPAP)

The Department of Health will be accepting VAPAP applications for the Fiscal Year 2026. The deadlines to submit a Nursing Home VAPAP application for financial assistance will be:

  • For the 1st half of the State Fiscal Year 2025/2026 - July 1, 2025
  • For the 2nd half of the State Fiscal Year 2025/2026 - October 1, 2025

All nursing homes seeking financial assistance should submit a formal application through this process.

Purpose

Up to $25 million was made available to support New York State's nursing homes pursuant to the Fiscal Year 2026 Enacted Budget. Under this announcement, nursing homes in severe financial distress can apply for short-term financial relief dollars to maintain operations and vital services while they plan for the implementation of longer-term solutions to achieve financial sustainability.

The primary purpose of this pool of funding is to provide one-time, non-reoccurring, short-term financial assistance to distressed providers while they thoughtfully plan for the future of their facility. Applications for Nursing Home VAPAP funds should include only requests for short-term financial assistance.

Successful applicants will identify and begin implementation of initiatives during the funding period that will improve the likelihood of future financial sustainability while maintaining essential services to their communities.

Nursing Home VAPAP is not intended for emergency situations or immediate payroll concerns. If a nursing home is not able to provide adequate care to a resident at any time during that resident's stay, the nursing home is required to contact their respective regional office of the Department of Health and must provide the necessary information to assist with any relocation needs, including but not limited to assistance with arranging transportation to an alternate facility that can provide the necessary care and services for the resident.

The following describes eligibility for financial assistance, the criteria on which the State will base awards, and the process through which facilities should apply for awards.

Eligibility Criteria

Eligibility requirements for the Nursing Home VAPAP program are listed below.

  • Be defined as an Article 28 residential health care facility; AND
  • Have less than 15 days of cash and equivalents on hand; AND
  • Has had a negative operating margin within the last two (2) complete calendar years; AND
  • Has no outstanding payments due to the Department; AND
  • The applicant must have submitted the facility-appropriate cost report to the Department; AND
  • The applicant, along with any related or affiliated entities, is not currently the subject of known investigation or enforcement action by CMS, the Department of Justice, HHS-OIG, the Office of the Attorney General, or the Office of the Medicaid Inspector General.

Evaluation Criteria for Awards

DOH will assess the following criteria in evaluating the facility's application for funding and related initiatives plan:

  • Quality of care, as reflected in CMS Star ratings and Nursing Home Quality Incentive pool rankings;
  • The extent to which the RHCF's application provides a specific plan for transformation and long-term sustainability, which addresses the service needs of the community;
  • Alternative residential health care facility (RHCF) capacity and availability of other forms of long-term care in the immediate region;
  • Special services and populations served or to be served;
  • Historical and projected financial sustainability;
  • Amount and length of assistance required compared to the number of beds at risk of loss;
  • Applicants must detail the extent to which the affected community has been engaged and consulted on potential projects of the application, as well as any outreach to stakeholders and health plans; and,
  • Applicants current and/or planned engagement in a change of ownership, including adherence to all State and Federal requirements governing the facility's operating certificate,
  • Additional factors subject to the Department's discretion.

Sustainability Plan

The primary purpose of the VAPAP pool of funding is to provide one-time, non-reoccurring, short-term financial assistance to distressed providers while they thoughtfully plan for the future of their facility. As such, all applicants must complete the initiatives tab on the VAPAP Financial Assistance Template Attachment to detail the activities that will be undertaken to demonstrate how the provision of VAPAP funds will help the facility reach long-term sustainability. The presented initiatives should have a positive impact on the baseline projections provided on the financial projections tab.

Providers that apply for VAPAP funds should consider whether their overall plan for long-term sustainability will instead require funding through the Vital Access Provider (VAP) program. The VAP program provides temporary (up to three years) operating assistance to financially distressed providers for the purpose of redesigning their healthcare delivery systems to promote financial sustainability. Funding is provided for operational costs associated with transformation initiatives that address financial viability, community service needs, quality of care, and health equity.

Providers interested in filing a VAP should direct all inquiries to NHVAP@health.ny.gov with "VAP" in the subject line. VAP is the primary funding vehicle the Department will use to support multiyear transformation initiatives. Although factors specific to individual applicants will determine the nature and scope of the transformation plan, applicants may be required to commit to significant changes in governance, affiliation relationships, and service types and levels if such changes are determined necessary to achieve long-term financial sustainability.

VAPAP Application Process

Eligible applicants for funding under the Nursing Home VAPAP program should complete an application online via Nursing Home VAPAP. The application must include the VAPAP Financial Assistance Template Attachment and the following supplemental information:

Supplemental documents must include (the applications will not be reviewed if all the documents are not submitted with the application):

  1. Copy of audited financial statements for the applicant for the years ended December 31, 2022, 2023, 2024, and the latest 2025 internal financials year to date. If applicable, copies of audited financial statements for each affiliated entity in addition to an audited consolidated financial statement must be included
  2. Using your facility’s most recent audited financial statement, please present a breakdown of all assets to provide evidence that no assets can be monetized other than those vital to operations
  3. Evidence that the operator has exhausted all efforts to obtain resources from corporate parents and affiliated entities to sustain operations, in the form of a signed letter provided by an authorized individual on the organization's letterhead
  4. High-level description and dollar value of your organization's long-term debt, including purpose, terms, and covenants
  5. A statement from the lender of the long-term debt providing details on compliance related to debt covenants, the total amount of debt with the due date, and the amount outstanding as of the date of the VAPAP application
  6. A listing of the most recent accounts payable and receivable by vendor and
  7. Long term Strategic Plan: If available, please provide a copy of the applicant’s strategic plan. This submission should include a brief narrative describing how the proposed VAPAP initiatives for the facility align with, support, or are integrated into the broader long-term strategy
  8. An organizational chart identifying the corporate structure, including entity relationships and the core purpose of each organization
  9. A report of executive management salaries.

Review Process

Each application will be reviewed by DOH staff with expertise in health care finance, reimbursement, and health care programs. The Department will review and assess the applicant's eligibility, the applicant's current and projected financial status, the proposed use of funds to maintain critical services needed by its community, the anticipated impact of the loss of such services, and the transformation plan to determine whether the applicant will be awarded funds. Award amounts will be determined in consultation with the Division of the Budget.

The Department's request for clarifying information in the course of evaluation will be made exclusively to the authorized contacts (i.e.: Operator/Authorized Officer) listed on the application. Any inquiries regarding the application must be made only by these contacts. Any changes in the contacts after application submission require a change request to be forwarded to NHVAPAP@health.ny.gov.

Awards

Awards will be made after the Department's analysis of an eligible nursing home's application. Awards are made at the Department's discretion, in consultation with the Division of the Budget, and may be an amount that is lower than the awardees' requested funding.

Successful applicants will be subject to specific reporting requirements as specified by the Department. This includes monitoring of progress towards a defined sustainability plan and commitment to implement the identified transformation initiatives.

Notice of Awards

The Department will communicate the award determination notice by email to the authorized contacts. Any changes in the authorized contacts after application submission requires a change request to be forwarded to NHVAPAP@health.ny.gov.

Eligible Expenses

Eligible expenses shall include costs directly related to the sustainability of operations. The VAPAP statute (NY Public Health Law §2826) excludes funding of capital expenditures, including, but not limited to: construction, renovation and acquisition of capital equipment, including major medical equipment; or bankruptcy-related costs.

Payment Process

Payments under the VAPAP program may be awarded as a temporary adjustment to rates or as temporary lump sum payments.