How Medicaid home care works in New York, in the order it actually happens

The short version

Medicaid home care in New York runs in five steps: an active Medicaid case, an independent assessment by the New York Independent Assessor Program (NYIA), an outcome letter, a plan that authorizes services (your Medicaid managed care plan or a Managed Long Term Care plan), and that plan’s own person-centered care plan, which is where hours are set. Nothing before the last step sets hours. No website, agency, or discharge planner can promise a number.

Step 1: Medicaid first

Everything on this path requires an active Medicaid case. In New York City, the Human Resources Administration (HRA) handles Medicaid citywide; its long-term care page says its home care programs all require that you be eligible for Medicaid. The HRA Medicaid Helpline is 1-888-692-6116. Outside the city, the county Department of Social Services does this. NYIA will not schedule without a Medicaid number, so a case that is in renewal should be finished first.

If the person does not have Medicaid and is 60 or older, there is a separate, non-Medicaid door through NYC Aging or the county Office for the Aging. It is covered on the who to call page and in the blog post on Medicaid MLTC vs EISEP.

Step 2: The NYIA assessment (two appointments)

Since 2022 the assessment for personal care services, consumer directed personal assistance, and Managed Long Term Care enrollment has been done by NYIA, a statewide program run for the Department of Health, rather than by a plan or an agency. Its FAQ describes two appointments:

1. A community health assessment with a nurse, who asks about your current health and medicines, your ability to do everyday tasks like getting around your home, dressing, and bathing, whether you need equipment such as a wheelchair or special bed, and what support you have from family or friends. A family member or caregiver can be with you.
2. A clinical appointment with a doctor, licensed nurse practitioner, or physician assistant, who asks about medical history and current care and, if needed, talks with your own doctor.

Both can happen at your home, a relative’s home, or a facility where you are staying, in person or by video. You schedule by calling 1-855-222-8350 (TTY 1-888-329-1541), Mon–Fri, 8:30 a.m.–8:00 p.m.; Sat, 10:00 a.m.–6:00 p.m., with the Medicaid number ready. Interpreting in any language, including sign language, is available if you ask when you schedule. If you are already in a Medicaid managed care plan and not yet receiving services, the FAQ says to contact your plan, which calls NYIA with you on the line.

If someone else will handle the case, NYIA’s site says to name an authorized representative through its designation form (requested from New York Medicaid Choice at 1-800-505-5678) or by sending a copy of a power of attorney or guardianship order.

Step 3: The outcome letter and the Minimum Needs Requirements

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 and are reassessed under the earlier criteria. This site cannot apply that test to anyone; only the assessment does.

DOH’s guidance says the NYIA assessment “is the first step in determining eligibility” and that afterward the program “will send a notice to the member explaining next steps, including whether they may be eligible for MLTC plan enrollment (in which case they should contact NYIAP), or to contact their MMC plan to complete the care planning and service authorization process if they are eligible to receive PCS/CDPAS.” If you disagree with the results, the FAQ describes a conference and a fair hearing, the latter requested within 60 days of receiving the notice. Questions about the letter go to 1-855-222-8350.

Step 4: Who authorizes the services

This is where Managed Long Term Care enters. The letter points to one of two routes:

• Mainstream plan route. Your existing Medicaid managed care plan does the care planning and authorizes services. DOH notes that people who could join MLTC voluntarily may instead be authorized by their mainstream plan.
• Managed Long Term Care route. 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. To enroll, DOH lists that a person must be determined eligible for Medicaid, determined eligible for MLTC by NYIA, capable of returning to or remaining in the home and community without jeopardy to health and safety, and expected to require at least one covered service for more than 120 days from the enrollment date. People assessed as needing only Level 1 services do not qualify for MLTC.

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 (TTY 1-888-329-1541). Its consumer pages refer to three kinds of long term care plans: MLTC Medicaid plans (partial capitation), Medicaid Advantage Plus, and PACE. Which types and plans exist depends on the county. This site does not compare or name them; New York Medicaid Choice and, for the Medicare side, HIICAP at 1-800-701-0501 are the places to ask.

Step 5: The plan’s own care plan

Choosing a plan is not the same as being enrolled, and the NYIA letter is not an authorization. Plans arrange their own visit, review the NYIA findings, and write a person-centered service plan, which the NYIA FAQ describes as “a written plan created by you and your plan or Local Department of Social Services, that focuses on the needs identified by your assessment and the services and supports that are necessary to meet those needs.” This is where hours are proposed. When a proposed plan of care first includes more than 12 hours per day on average, DOH’s NYIA page notes that an Independent Review Panel evaluates it; families do not request this. Enrollment takes effect on a date New York Medicaid Choice confirms; ask for it in writing.

Once enrolled, the plan is your point of contact for care management, authorizations, changes to hours, and yearly reassessments. Disagreements with a plan’s decision have their own appeal and fair hearing rights, which the plan’s notices must explain.

Where people get stuck

• They think the hospital did the assessment. A hospital’s home care evaluation is useful information, but the Medicaid assessment must be done by NYIA’s independent nurse and clinician.
• 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 treat the NYIA letter as an authorization. Services are authorized by the plan after enrollment.
• They let someone else be the caller without paperwork. An authorized representative must be named on NYIA’s designation form or shown through a power of attorney or guardianship order.
• They lose the Medicaid case in the middle. A lapsed renewal stops everything. Keep HRA or the county informed of any address change.
• They are on the wrong path. A person past 60 with income above the Medicaid line spends months on a Medicaid application when the non-Medicaid program could have started an intake in the meantime.

What this site does not do

We do not name, rate, or recommend plans, home care agencies, or contractors. We do not schedule assessments, enroll anyone, or predict hours. We do not replace notices from NYIA, your plan, HRA, or the State.

Free help

Sources

New York Independent Assessor Program FAQ and contact pages; NYS DOH, New York Independent Assessor Program; NYS DOH, Overview of Managed Long Term Care; NYS DOH, New Minimum Needs Requirements (effective September 1, 2025); New York Medicaid Choice; NYC HRA, Long Term Care. Checked September 10, 2026. Confirm on nyindependentassessor.com, health.ny.gov (MLTC overview), health.ny.gov (Minimum Needs Requirements), and nymedicaidchoice.com.