Where Medicaid home care starts: NYC HRA vs your county DSS

Medicaid is one program run by the State, but applications are handled locally. The Department of Health's directory says it plainly: "To find contact information for an LDSS by county, select a county from the dropdown box or the map below." It lists all 62 counties. The five boroughs share one entry, HRA, with the DSS OneNumber 718-557-1399.

There is a third door, and it causes the most wrong turns. DOH's how-to-apply page says adults under 65 without Medicare, children, pregnant women, and parents "should apply with NY State of Health." But "all other non-MAGI eligibility groups should continue to work with their Local Department of Social Services (LDSS) or a Facilitated Enroller for the Aged, Blind and Disabled," and DOH names two groups that matter here: "Individuals seeking Community Based Long-Term Care" and "those individuals with an immediate need for Personal Care Services (PCS) or Consumer Directed Personal Assistance Services (CDPAS)."

The NY State of Health FAQ is candid about one limit: "You cannot currently apply for coverage of nursing home care through NY State of Health. You need to apply for Medicaid coverage of nursing home care through your Local Department of Social Services." It says nothing about home care, which is why families under 65 sometimes apply in the wrong place and lose weeks. If the goal is home care, use the local door.

HRA's public health insurance page lists the ways to apply for the people it serves (over 65, disabled, or on Medicare without minor children):

• Online through ACCESS HRA.
• By phone kit: call the HRA Medicaid Helpline at 1-888-692-6116 "to request an application kit be mailed to you."
• By mail to the Initial Eligibility Unit, HRA Medical Assistance Program, PO Box 24390, Brooklyn, NY 11202.
• By fax to 917-639-0732. An authorized representative can fax to 917-639-0731.
• In person at a Medicaid office. HRA keeps a locator on nyc.gov/hra; one Brooklyn office was listed as closed until further notice at the time of writing, so check before traveling.

Free in-person help exists. DOH's Facilitated Enrollers for the Aged, Blind and Disabled "provide free, in person help in your community," and HRA's line for that program is 347-396-4705. This site does not name the enrollers; DOH's list is linked below.

Home care has its own desk inside HRA. Its long-term care page says: "Home Care programs ... all require that you be eligible for Medicaid," and routes questions to "the DSS OneNumber at 718-557-1399 or visit your local Home Care CASA Office." That office handles fee-for-service home care cases for people not in a managed care plan. If the person is in a plan, the plan authorizes services, not HRA.

Outside the city, the county Department of Social Services does the same job. Every county has a Medicaid unit, a mailing address, and a phone number on DOH's directory. Two ways to get there:

• DOH's LDSS directory at health.ny.gov, linked in the sources.
• NY Connects at 1-800-342-9871, which the State describes as "help from a locally trained specialist." Say your county and that you are applying for Medicaid to get help at home.

Facilitated Enrollers also work upstate; DOH's list is organized by county.

The form is the same statewide: "Access NY Health Care," form DOH-4220, plus Supplement A. DOH's instructions say the application "along with Supplement A, must be filled out completely if you are 65 years old or older, certified blind, certified disabled or institutionalized, and/or if you are applying for coverage of nursing home care." The current Supplement A is form DOH-5178A; some pages still link an older supplement number. The form also says "you DO NOT need to visit your local department of social services or an Assistor for an interview."

The form's own documents list, in plain terms:

• Proof of income for the last four weeks from every source: pay stubs, the Social Security award letter or annual statement, pension statements.
• Proof of resources, which the form says applies "only if you are age 65 or older, certified blind or disabled": bank statements for checking, savings, and retirement accounts; stock, bond, and certificate statements; a copy of any life insurance policy; a burial trust, plot deed, or funeral agreement; the deed for any real estate other than the home.
• Health insurance: the "Medicare Card (Red, White and Blue Card)," any other insurance card or policy, and any termination letter.
• Proof of residence: a driver's license issued within six months, a government ID with the address, a postmarked envelope, or a mortgage or property tax statement.
• Identity, age, and citizenship or immigration status. DOH says a match with Social Security usually verifies these for people born in the United States; others should bring documents.

Make copies of everything and write the date you sent it on your copy. If someone else is handling the case, put their name on the application as the authorized representative.

For people 65 and older or with a disability, Medicaid at home in New York has both an income test and a savings test. DOH's 2026 chart, issued February 2026, sets them at:

Being over the income line does not end the conversation. New York allows a "spend-down" of medical bills, and DOH's trust page says that income placed into a pooled income trust "is not counted as income," which is a tool for people with a certified disability of any age. A spouse who declines to contribute income can file what HRA's pages call a spousal refusal, which can lead to a later recovery claim. All three are worth asking the local office or a Facilitated Enroller about; none is a do-it-yourself step.

One thing families keep hearing about has not happened. The State proposed a 30-month look-back at transfers for community Medicaid, and DOH's own page says "the earliest date that the State will seek implementation is March 31, 2024." As of September 11, 2026, no DOH directive has put it into effect. The nursing home look-back of 60 months still applies to nursing home applications only. Check DOH before relying on this; it has changed dates before.

DOH's rules include an "immediate need" process for people who need personal care or consumer directed assistance right away and have no one to provide it. A doctor's statement and an attestation of immediate need go with the application, and the directive says the district decides the Medicaid application "within seven days of the date of a complete Medicaid application." HRA lists the forms on its long-term care page. If this fits, say "immediate need" on the first call to HRA or the county, and see our post on leaving the hospital and getting help at home.

The Medicaid door closes behind you and the assessment door opens. NYIA's FAQ says people "who have Medicaid, or both Medicaid and Medicare, can be assessed," and that "Individuals who do not have Medicaid should contact their Local Department of Social Services." The State's directive describes the handoff: once NYIA's representative confirms the person has active Medicaid, it schedules both the nurse's visit and the clinical appointment.

How you start depends on whether the person is in a plan:

• In a Medicaid managed care plan: the FAQ says to contact your plan, which calls NYIA with you on the line. After the assessment, "your Medicaid Managed Care plan will review the results."
• Not in a plan (fee-for-service): contact HRA or the county, which refers the case to NYIA. In the city, that is the Home Care Services Program at 718-557-1399.
• Either way, the scheduling line is 1-855-222-8350 (TTY 1-888-329-1541), weekdays 8:30 a.m. to 8 p.m. and Saturday 10 a.m. to 6 p.m.

If the assessment points to Managed Long Term Care, plan selection goes through New York Medicaid Choice at 1-800-505-5678 or the long term care line 1-888-401-6582. Our NYIA prep checklist covers the two appointments.

• Applying on NY State of Health for a parent who needs home care. The marketplace does not process long-term care applications. Use HRA or the county.
• Sending the application without Supplement A. For anyone 65 or older or disabled, the application is incomplete without it.
• Forgetting the resource documents. Bank statements are what slow most cases down.
• Calling NYIA before the case is active. NYIA will not schedule without a Medicaid number.
• Letting a renewal lapse mid-process. A closed case stops the assessment, the enrollment, and the services.
• Copying a phone number from an old guide. DOH's own consumer guide has printed the HRA home care number with a typo. The number is 718-557-1399.

Can I apply for Medicaid home care through NY State of Health?

No. The marketplace handles coverage for adults under 65 without Medicare, children, and families. People 65 and older, people with disabilities, and anyone seeking long-term care at home apply through HRA in New York City or the county Department of Social Services elsewhere.

What form do I use?

Access NY Health Care, form DOH-4220, plus Supplement A (form DOH-5178A) for anyone 65 or older, certified blind or disabled, or applying for nursing home coverage. Both are on health.ny.gov.

What are the 2026 income and resource limits?

DOH's 2026 chart lists $1,836 a month in income and $33,038 in resources for one person, and $2,489 and $44,796 for a couple. These are educational figures; the local office applies them, and spend-down and trust rules can change the outcome.

Is the 30-month look-back in effect?

Not as of September 11, 2026. DOH's page still says the earliest implementation date the State would seek was March 31, 2024, and no directive has started it. The 60-month look-back applies to nursing home applications only.

How does NYIA fit in?

NYIA schedules the home care assessment only after Medicaid is active. If the person is in a plan, the plan starts the call; if not, HRA or the county refers the case. The number is 1-855-222-8350.