Medicaid HCBS Waivers in New York: Who Qualifies and How to Apply

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Managing Editor · Communications degree, Universidad Católica Andrés Bello · 11 years helping families access government benefits

New York caregiver benefits guide

Last checked: May 18, 2026

New York has several Medicaid home and community-based services routes. Some are true HCBS waivers. Some are Medicaid managed long-term care or state plan home care routes that families often use first.

This guide explains where a caregiver should start, what to ask for, and what to do if the first answer is no.

Family caregiver pay
How to apply
Denials and appeals
Caregiver pay quiz

Quick answer

In New York, Medicaid may help pay for care at home through Managed Long Term Care, Personal Care Services, CDPAP, PACE, and several HCBS waivers. The right path depends on age, disability, medical need, Medicaid status, county, and whether the person needs long-term services for more than 120 days.

If you are trying to get paid as a family caregiver, ask about CDPAP first. CDPAP may allow a Medicaid member to choose a friend or certain family member as a paid personal assistant, but not every relative can be paid, and the care must be approved.

Start here: the first 3 actions

Confirm Medicaid status. If the person does not have Medicaid, apply through the correct New York route first. Older adults, people with Medicare, and people who need long-term care often work with the Local Department of Social Services, or HRA in New York City.
Ask for a long-term care assessment. Use the words “home care,” “personal care,” “CDPAP,” “MLTC,” and “long-term services and supports.”
Write down every call. Keep the date, office name, person you spoke with, and what they told you. Ask for a written notice if care is denied, reduced, delayed, or stopped.

Main New York programs and routes

Program or route	Who it may help	Where to start
Managed Long Term Care (MLTC)	Adults who have Medicaid and need community-based long-term care, such as home care or adult day health care, usually for more than 120 days.	Ask New York Medicaid, the Local Department of Social Services, HRA in New York City, or the New York Independent Assessor Program about MLTC enrollment.
Personal Care Services	Medicaid members who need help with daily tasks such as bathing, dressing, toileting, walking, transferring, feeding, meal tasks, and other approved supports.	Ask the Medicaid managed care plan, MLTC plan, or Local Department of Social Services for a personal care assessment.
CDPAP	Medicaid members who qualify for home care and can direct their care, or have a designated representative who can help direct it.	Ask the plan or Local Department of Social Services for Consumer Directed Personal Assistance Program screening and authorization.
PACE	Adults age 55 or older who meet program rules and need a high level of coordinated care. PACE combines Medicare, Medicaid, and long-term care services when available in the area.	Ask Medicaid, Medicare, NY Connects, or local PACE programs whether the person lives in a service area.
Nursing Home Transition and Diversion (NHTD) Waiver	Medicaid-eligible seniors and people with physical disabilities who can live in the community with waiver supports instead of a nursing home or other institution.	Contact the NHTD Regional Resource Development Center for the person’s region.
Traumatic Brain Injury (TBI) Waiver	Adults with traumatic brain injury who meet nursing facility level of care and can live in the community with waiver supports.	Contact the TBI waiver regional contact or ask New York Medicaid for the TBI waiver office for your county.
OPWDD HCBS Waiver	Children and adults with developmental disabilities who meet OPWDD and Medicaid waiver rules.	Start with OPWDD Front Door, a care manager, or your Developmental Disabilities Regional Office.
Children’s Waiver	Children and youth who meet specific medical, behavioral health, developmental, or disability rules and need home and community-based services.	Ask the child’s Health Home care manager, Medicaid managed care plan, or New York State children’s HCBS contact route.
New York Paid Family Leave	Eligible workers who need paid, job-protected time off to care for a close family member with a serious health condition.	Ask your employer or employer’s Paid Family Leave insurance carrier for Forms PFL-1, PFL-3, and PFL-4.

⚠️ Rules can change. Counties, managed care plans, waiver contractors, and state agencies may use different names for the same first step. Confirm the current route with official New York sources before you rely on it.

What an HCBS waiver is

HCBS means home and community-based services. These are Medicaid services that can help a person stay at home or in the community instead of moving to a nursing home, hospital, intermediate care facility, or other institution.

A waiver is a special Medicaid approval. It lets a state cover services that regular Medicaid may not cover in the same way. It can also target services to a group, such as older adults, people with physical disabilities, people with traumatic brain injury, children with complex needs, or people with developmental disabilities.

In plain English, an HCBS waiver may help pay for supports that make home life safer and more possible. It does not mean every person gets every service. A care plan must be approved, and services depend on need, program rules, local providers, and funding.

For a broader plain-English guide, see Medicaid HCBS Waivers Explained.

Main waivers in New York

Nursing Home Transition and Diversion (NHTD) Waiver

The NHTD Waiver is for Medicaid-eligible seniors and people with physical disabilities who need a nursing facility level of care but want to live in the community. The goal is to help the person remain outside a nursing home when safe supports can be arranged.

Services may include service coordination, respite, assistive technology, home and vehicle changes, moving help, transportation, home and community support services, independent living skills training, peer mentoring, meals, and other approved supports.

Start with the Regional Resource Development Center for your area. If the person is not yet on Medicaid, the Local Department of Social Services usually must decide Medicaid eligibility before waiver enrollment can move forward.

Traumatic Brain Injury (TBI) Waiver

The TBI Waiver is for adults with traumatic brain injury who meet program rules and need a nursing facility level of care. It can help with services that support community living.

Possible services include service coordination, respite, assistive technology, community integration counseling, home and community support services, independent living skills training, structured day programs, transportation, and behavioral supports.

Ask New York Medicaid or the regional waiver contact which office handles TBI waiver referrals in the person’s county.

OPWDD HCBS Waiver

The OPWDD HCBS Waiver serves children and adults with developmental disabilities who meet OPWDD and Medicaid rules. OPWDD means the New York State Office for People With Developmental Disabilities.

Services may include community habilitation, day habilitation, respite, supported employment, assistive technology, environmental modifications, family education and training, and self-direction supports.

Start with OPWDD Front Door or a care manager. OPWDD says people who are eligible for OPWDD services and enrolled in the HCBS Waiver may choose self-direction.

Children’s Waiver

The Children’s Waiver can serve children and youth with certain complex needs. This may include children with serious medical, developmental, behavioral health, or disability needs who meet level-of-care and Medicaid rules.

Services can include respite, caregiver and family supports, care coordination, home and vehicle changes, palliative care supports, and other approved services based on the child’s plan of care.

Start with the child’s Health Home care manager if the child has one. If not, ask the child’s Medicaid managed care plan or New York State children’s HCBS contact route how to request an HCBS eligibility review.

Important: MLTC is often the adult home care door

Many older adults and adults with disabilities in New York do not start with a 1915(c) waiver. They start with Medicaid home care, CDPAP, MLTC, Medicaid Advantage Plus, or PACE.

MLTC plans cover community-based long-term services and supports such as home care, adult day health care, private duty nursing, home health aide services, personal care services, and CDPAP when approved.

Services that may help caregivers

New York Medicaid home care and waiver services are not paid “help for the caregiver” in a general way. They are approved services for the Medicaid member. But they can reduce the work and stress on the family when they are approved.

Personal care

Personal care may help with daily tasks such as bathing, dressing, toileting, walking, transferring, feeding, meal tasks, and other approved activities.

CDPAP

CDPAP may let the Medicaid member choose and hire a personal assistant, including some friends or family members. The person must qualify for services, and the plan or district must approve the hours and tasks.

Respite

Respite means temporary relief for the caregiver. It may be available through some waivers, NYSOFA programs, Area Agencies on Aging, and caregiver support programs.

Adult day care or adult day health care

Some people may qualify for adult day health care or social adult day services through a plan, waiver, or aging-services route. The name and rules depend on the program.

Home changes

Some waivers may cover approved environmental modifications, such as changes that help a person enter the home, use the bathroom, or move more safely.

Transportation

Transportation may be covered for approved medical or waiver-related needs. Ask whether transportation is part of the care plan or covered through regular Medicaid transportation.

Caregiver training or family supports

Some waiver and aging programs may cover caregiver education, family supports, counseling, or caregiver support services. Ask the exact program what is covered.

Care planning

Waiver service coordination, care management, or a plan care manager can help set up approved services. This does not replace your right to ask questions or appeal.

Use the care cost calculator to estimate what unpaid care is costing your household. Use caregiver checklists to track tasks before an assessment.

Can family caregivers be paid through a waiver?

Sometimes, but the answer is not a simple yes.

In New York, the main Medicaid route for paying a family caregiver is usually CDPAP, not the waiver name itself. CDPAP stands for Consumer Directed Personal Assistance Program. It allows an eligible Medicaid member to choose a personal assistant for approved home care tasks.

A friend or family member may be allowed to work as the personal assistant. But New York rules bar some people from serving in that paid role. A spouse cannot be the personal assistant. A designated representative cannot be the personal assistant. A parent of a CDPAP consumer under age 21 cannot be that child’s aide. Other adult relatives may be allowed if the rules are met.

CDPAP does not mean the family decides the pay rate, hours, or tasks alone. The Medicaid plan, Local Department of Social Services, or other assigned process must approve the care. A fiscal intermediary or statewide fiscal process handles payroll and worker paperwork.

CDPAP rules have changed in recent years. Always confirm the current fiscal intermediary, forms, and service authorization rules with the New York State Department of Health, the person’s managed care plan, or the Local Department of Social Services.

☎️ What to say when asking about caregiver pay

“My family member has New York Medicaid and needs help at home with daily care. I want to ask for a home care assessment and ask whether CDPAP is an option. Can you tell me who authorizes CDPAP for this case, what assessment is needed, and what written notice we will get if it is denied?”

For more help, read Can I Get Paid to Be a Caregiver? and try the caregiver pay quiz.

If the person may be a veteran or surviving spouse, also check VA Aid and Attendance. VA benefits are separate from New York Medicaid.

If you are taking time off work, check New York Paid Family Leave. It can pay an eligible worker for time away from work to care for a close family member with a serious health condition. It is not the same as being hired as a Medicaid aide.

Waitlists and priority

New York does not have one single waitlist rule for every Medicaid home care route. The process depends on the program.

MLTC, Personal Care Services, and CDPAP use assessments and service authorization rules. NHTD, TBI, OPWDD, and the Children’s Waiver have their own referral and enrollment steps. Some routes may have limited provider space, regional processing delays, or enrollment caps.

Official public pages do not give one clear statewide wait time for every waiver. If an office says there is a wait, ask these questions:

“Is this a wait for Medicaid approval, assessment, plan enrollment, waiver slot, provider staffing, or service start date?”
“Can you give me the reason in writing?”
“Are there priority rules for risk of nursing home placement, unsafe discharge, homelessness, caregiver loss, or health and safety risk?”
“What services can start while we wait?”
“Can we also request personal care, CDPAP, MLTC, PACE, NY Connects, or Area Agency on Aging respite?”

⚠️ Do not wait without a backup plan

If a person is unsafe at home, ask about immediate or urgent home care assessment options, hospital discharge planning, Adult Protective Services when there is danger or neglect, NY Connects, and Area Agency on Aging help. If there is a medical emergency, call 911.

How to apply

Step 1: Confirm Medicaid or apply

New York says where you apply for Medicaid depends on the person’s eligibility category. Some people apply through NY State of Health. Others apply through the Local Department of Social Services. In New York City, the office is HRA.

If the person has Medicare, is age 65 or older, has a disability, needs nursing home care, or needs long-term home care, ask whether the Local Department of Social Services or HRA is the correct Medicaid office.

If income or assets are a problem, read Medicaid Spend-Down and Medicaid Look-Back Period. Do not transfer money or property without legal advice.

Step 2: Ask for the right home care route

For many adults, ask for a home care assessment for Personal Care Services, CDPAP, MLTC, or PACE. If the person is already in a Medicaid managed care plan or MLTC plan, call the plan’s member services number and ask for care management.

If the person is not in a plan or you do not know who handles the case, call the Local Department of Social Services or HRA and ask which office authorizes home care or CDPAP.

Step 3: Ask about the New York Independent Assessor Program

New York uses the New York Independent Assessor Program, often called NYIAP, for certain initial assessments tied to personal care, CDPAP, and MLTC enrollment. The rules and timing can change, so ask the plan or local district whether NYIAP is required for the person’s case.

Step 4: Use the waiver-specific door when needed

NHTD: Ask for the Regional Resource Development Center for your region.
TBI: Ask for the TBI waiver regional contact for your county.
OPWDD: Start with OPWDD Front Door, a care manager, or the Developmental Disabilities Regional Office.
Children’s Waiver: Ask the child’s Health Home care manager, Medicaid managed care plan, or children’s HCBS referral contact.

📄 Documents to gather before calls and assessments

Medicaid card or Medicaid case number, if the person has one
Medicare card, if any
Managed care plan or MLTC plan card, if any
Photo ID and proof of address
Social Security number or immigration documents, if requested
Income proof, bank statements, and insurance information
Doctor names, diagnoses, medication list, and recent hospital or rehab papers
List of daily tasks the person cannot do alone
Fall history, wandering risk, memory concerns, unsafe cooking, missed medicines, or toileting needs
Current caregiver schedule and times when the person is alone
Any denial, reduction, discharge, or managed care notice
Power of attorney, health care proxy, guardianship papers, or signed permission forms, if you have them

☎️ Phone script for the first call

“I am calling for my family member who lives in New York and needs long-term help at home. They need help with bathing, dressing, meals, medicines, transfers, and safety. I need to know whether to request Personal Care Services, CDPAP, MLTC, PACE, or an HCBS waiver. Can you tell me the next step, the assessment process, and how to get a written decision?”

Need more scripts? See caregiver phone scripts.

If denied or waitlisted

A denial is not always the end. A delay is not always the end. First, find out what kind of problem it is.

If Medicaid is denied

Ask for the denial notice. Check the reason. It may be income, assets, missing documents, residency, immigration status, or the wrong application route. Ask the Local Department of Social Services, HRA, or NY State of Health what proof is missing.

If home care hours are denied or too low

Ask for the written notice and the assessment summary. Compare it with the person’s real daily needs. Write down what was missed, such as nighttime toileting, transfers, dementia supervision, meal help, falls, or times when no caregiver is available.

If CDPAP is denied

Ask whether the denial is about Medicaid eligibility, medical need, self-direction, the designated representative, the proposed personal assistant, or paperwork. Ask what can be corrected and whether regular agency home care can be approved instead.

If a waiver says there is a wait

Ask whether the person can get other Medicaid services while waiting. Ask about personal care, CDPAP, MLTC, PACE, NY Connects, Area Agency on Aging services, and respite.

Act fast if services are reduced or stopped

Notices often have deadlines. If current Medicaid home care is being reduced, stopped, or changed, read the notice right away. Ask about plan appeal rights, Fair Hearing rights, and whether “aid continuing” can keep services in place while the appeal is pending. Do not miss the deadline on the notice.

New York Fair Hearings are handled by the Office of Temporary and Disability Assistance. A Fair Hearing lets you explain why you think a local agency or plan decision is wrong. You can request one online, by phone, by fax, by mail, or in person using OTDA’s current instructions.

☎️ What to say after a no

“Please send me the written notice for this decision. I also need the appeal instructions, the Fair Hearing information, and any deadline to keep services in place while we appeal.”

Other benefits caregivers should check

Medicaid is not the only possible source of help.

VA Aid and Attendance may help some veterans and surviving spouses pay for care.
Caregiver tax deductions may matter if you pay care costs or claim a dependent. Ask a tax professional for advice.
NYSOFA and Area Agencies on Aging may offer caregiver support, respite, meals, counseling, and local referrals.
NY Connects can help people of any age or disability type look for long-term services and supports.

Common mistakes that slow families down

Asking only, “Can I get paid?” instead of asking for a Medicaid home care assessment and CDPAP screening.
Waiting for a verbal answer instead of asking for a written notice.
Forgetting to say the person needs help for more than one task or at unsafe times of day.
Not telling the assessor about falls, memory problems, wandering, toileting, transfers, or caregiver gaps.
Assuming a spouse can be paid through CDPAP. New York rules do not allow a spouse to be the CDPAP personal assistant.
Missing appeal or aid-continuing deadlines after a reduction or denial notice.

Resumen en español

En Nueva York, Medicaid puede cubrir ayuda en el hogar por medio de MLTC, cuidado personal, CDPAP, PACE y algunos waivers de HCBS. Para preguntar si un familiar puede recibir pago, pida una evaluación de cuidado en el hogar y pregunte específicamente por CDPAP.

No prometa que le van a aprobar. Pida una decisión por escrito si dicen que no. Si reducen o niegan servicios, revise la fecha límite de apelación de inmediato.

FAQ

Is MLTC the same as an HCBS waiver?

No. MLTC is New York’s managed long-term care program. It is not the same as the NHTD, TBI, OPWDD, or Children’s Waiver. But for many adults, MLTC is the main route to Medicaid home care and CDPAP.

Can I get paid to care for my parent in New York?

Possibly. If your parent has New York Medicaid and qualifies for approved home care, CDPAP may allow an adult child to work as the paid personal assistant. The plan or district must approve the care, and all CDPAP rules must be met.

Can a spouse be paid through CDPAP?

No. New York rules do not allow the Medicaid member’s spouse to be the CDPAP personal assistant for that member.

Does New York Medicaid pay for respite?

Some waivers include respite. NYSOFA and Area Agencies on Aging may also offer respite through state and federal caregiver programs. Ask both Medicaid and the local Area Agency on Aging because the funding route may differ.

What if the person has too much income for Medicaid?

New York may have Medicaid spend-down or other rules that could matter. Do not guess. Ask the Local Department of Social Services or HRA, and consider legal advice before moving money or property.

What if the first office says no?

Ask for the decision in writing. Ask what rule was used. Ask what can be fixed. If it is a Medicaid or managed care decision, ask for appeal and Fair Hearing instructions.

About this guide

This guide is written for family caregivers who need practical benefit steps in New York. It uses official state and federal sources first. Program names, offices, and rules can change, so confirm details with the agency, plan, waiver office, or local district handling the case.

Disclaimer

This is general information, not legal, tax, medical, or financial advice. For legal or tax questions, talk with a qualified professional in your state.

Official sources used

About the author

Analic Mata-Murray

Managing Editor, CaregiverBenefits.org

🎓 BA Communications & Journalism 📋 11+ years in benefits navigation 🌎 Bilingual English / Spanish 🤝 Salvation Army volunteer translator

Analic Mata-Murray holds a Communications degree with a focus on Journalism and Advertising from Universidad Católica Andrés Bello. She has spent over 11 years as a volunteer translator for The Salvation Army, helping Spanish-speaking families access government programs, emergency aid, and poverty alleviation resources — often during the most difficult moments of their lives.

That experience taught her that the biggest barrier to getting help is not eligibility — it is understanding. Most families who miss out on benefits do not miss out because they do not qualify. They miss out because the system is written in a language nobody actually speaks. That is the problem she set out to fix at CaregiverBenefits.org.

As Managing Editor, Analic oversees all content on this site to make sure every guide is accurate, up to date, and written in plain English that a sixth grader could follow. Her specialties are community resources, Medicaid programs, housing assistance, and emergency aid — the exact programs that most caregivers need and most websites bury in jargon.