MLTC vs EISEP: paths to home care in New York

The first question is not "how many hours" or "which agency." It is: does the person have Medicaid, or could they?

If you do not know which column applies, call NY Connects first. It describes itself as free, unbiased information about long-term services and supports for people of all ages and disabilities, and it is the one line built to sort this question.

Step 1: Medicaid. Everything on this path requires an active Medicaid case. In New York City, the Human Resources Administration handles Medicaid citywide (helpline 1-888-692-6116), and its long-term care page says its home care programs all require that you be eligible for Medicaid. Outside the city, the county Department of Social Services does this. Our post on where Medicaid home care starts, HRA vs county DSS covers the form, the documents, and the 2026 limits.

Step 2: The independent assessment. Since 2022, the assessment for personal care services, consumer directed personal assistance, and MLTC enrollment has been done by the New York Independent Assessor Program rather than by a plan or an agency. Its FAQ describes two appointments: a community health assessment with a nurse who asks about your health, your medicines, your ability to do everyday tasks like getting around, dressing, and bathing, and the support you have at home; then a clinical appointment with a doctor, nurse practitioner, or physician assistant who reviews your medical history and may talk with your own doctor. Both can happen at home or by video. You schedule by calling 1-855-222-8350 (TTY 1-888-329-1541) with your Medicaid number ready.

Step 3: The outcome. After the assessment you receive a letter with the results. For anyone first assessed on or after September 1, 2025, the Department of Health's Minimum Needs Requirements apply. In DOH's words, personal care and consumer directed services are available "for members assessed as needing at least limited assistance with physical maneuvering with more than two ADLs," or "for members with a Dementia or Alzheimer's diagnosis, assessed as needing at least supervision with more than one ADL." People authorized before that date have what DOH calls Legacy Status. This site cannot apply that test to anyone; only the assessment does. For a plain-English walkthrough of the test, read the Minimum Needs Requirements, explained.

Step 4: Who authorizes the services. This is where MLTC enters. DOH's MLTC overview says that people with both Medicare and Medicaid, age 21 and older, who are receiving community-based long-term services for more than 120 days must enroll in an MLTC plan to continue receiving them. People with Medicaid only, through a mainstream managed care plan, may have services authorized by that plan instead. Where MLTC is the route, plan selection goes through New York Medicaid Choice, the state's enrollment program, at 1-800-505-5678 or the long term care line 1-888-401-6582.

Step 5: The plan's own care plan. The plan builds a person-centered service plan with you and sets the hours. No website, no agency, and no discharge planner can promise a number before that happens.

The Expanded In-home Services for the Elderly Program is a State Office for the Aging program delivered through each county's Office for the Aging. The State's page describes it as coordinated, nonmedical services for older adults who are not eligible for Medicaid, for people at least 60 years old who need assistance with at least one activity of daily living or two instrumental activities of daily living. Case management is, in the State's words, "the heart of EISEP." Services can include in-home help with personal care and household tasks, respite for caregivers, and ancillary items such as home repairs or assistive devices.

In New York City, NYC Aging runs this as in-home services for residents 60 and older. Its page says a case management agency contracted for the person's neighborhood does a phone intake, a case manager conducts a home visit to determine eligibility and coordinate services, and, depending on income, the person may be asked to pay a fee or make a suggested contribution for some services. Case managers do not charge for their time. NYC Aging also states that Medicaid recipients are not eligible for its funded home care, which is the clearest statement of the fork.

The door is NY Connects at 1-800-342-9871 statewide, or Aging Connect at 212-244-6469 in the city. The fee rules, the waiting lists, and the intake steps are in our EISEP explainer.

They are on the wrong path. A homeowner past 60 with income just above the Medicaid line spends months on a Medicaid application when the non-Medicaid program could have started an intake in the meantime. Or a person who has had Medicaid for years is told by a senior center about EISEP and waits for a program that, by its own rules, is not for them.

They think the hospital did the assessment. A hospital's home care evaluation is useful information, but the Department of Health's program page says the Medicaid assessment must be done by an independent nurse and clinician with no prior relationship to the person.

They ask for hours before anyone has assessed anything. The NYIA scheduler cannot answer, the plan has not met the person yet, and any website that gives a number is guessing.

They let someone else be the caller without paperwork. NYIA's site says an authorized representative must be named on its designation form, requested from New York Medicaid Choice, or shown through a power of attorney or guardianship order.

1. Decide which column fits. If unsure, call NY Connects.
2. On Path A, confirm Medicaid status with HRA or the county, then call NYIA.
3. On Path B, call NY Connects or Aging Connect and ask for in-home services for someone 60 or older.
4. Write down who you spoke with, the date, and what they said to do next.