New York caregiver benefits guide
Last checked: May 18, 2026
New York Medicaid may help pay for care at home when a person needs help with daily tasks and meets Medicaid rules. The right path depends on age, disability, Medicaid status, county, city, care needs, and whether the person is in managed care.
This guide is for family caregivers who need a clear first step. It explains the main New York routes, what to ask for, what papers to gather, and what to do if home care is denied, delayed, or cut.
Quick answer
New York Medicaid may cover home care through personal care services, Consumer Directed Personal Assistance Program services, Managed Long Term Care, PACE, or a home and community based waiver. These programs may help with bathing, dressing, meals, homemaker tasks, adult day care, transportation to medical care, and other supports when the person meets financial and care need rules.
Start with Medicaid eligibility first. Then ask for a home care assessment and the correct route for the person’s situation.
New York warning
Rules can change. Counties, managed care plans, waiver contractors, and local agencies may use different names for the same service. Always confirm the current rule with the New York State Department of Health, the local social services district, NYC HRA if the person lives in New York City, the managed care plan, or NY Connects.
Main programs and routes
| Program or route | Who it may help | Where to start |
|---|---|---|
| Medicaid Personal Care Services | Medicaid members who need hands-on help or cueing with daily tasks at home. | LDSS, Medicaid managed care plan, or NYC HRA Home Care Services Program if in New York City. |
| Consumer Directed Personal Assistance Program (CDPAP/CDPAS) | Medicaid members who can direct their own care, or have a designated representative, and want to choose and train a personal assistant. | LDSS, managed care plan, MLTC plan, or NYC HRA. New York uses Public Partnerships LLC as the statewide fiscal intermediary. |
| Managed Long Term Care (MLTC) | People who need community based long term services and supports for more than 120 days and meet the program’s care need rules. | NYS Medicaid, New York Independent Assessor process when required, then an approved MLTC plan. |
| PACE | People age 55 or older who meet PACE rules and need a nursing-home-level type of care but can live safely in the community with services. | PACE plan in the service area and Medicaid or Medicare rules, depending on coverage. |
| Nursing Home Transition and Diversion (NHTD) waiver | Medicaid-eligible seniors and people with physical disabilities who need waiver services to live in the community instead of a nursing home or other institution. | NHTD Regional Resource Development Center or LDSS if Medicaid is not active yet. |
| NYSOFA, NY Connects, respite, and adult day services | Caregivers and older adults who need local help while Medicaid is pending, not enough, or not the right fit. | NY Connects at 1-800-342-9871 or the local Area Agency on Aging. |
| New York Paid Family Leave | Eligible workers who need paid, job-protected time away from work to care for a family member with a serious health condition. | Your employer or the Paid Family Leave insurer. |
What Medicaid home care may cover in New York
Medicaid home care is not one single program in New York. It is a group of services and routes. The person may get services through regular Medicaid, a Medicaid managed care plan, an MLTC plan, PACE, CDPAP, or a waiver.
Covered help depends on the person’s assessment and plan of care. It may include:
- Help with bathing, grooming, dressing, toileting, walking, and transfers.
- Help with meals, light housekeeping, laundry, and other homemaker tasks when tied to the care plan.
- Home health aide or personal care aide services.
- Consumer directed care through CDPAP, if the person qualifies and can direct care or has a designated representative.
- Adult day health care or social adult day services when the program and plan allow it.
- Non-emergency medical transportation to Medicaid-covered medical care when approved.
- Private duty nursing, therapies, or other health services when covered and medically needed.
- Respite, home delivered meals, personal emergency response systems, home changes, and other supports in some waiver or aging programs.
Medicaid does not pay for every task a family wants. The service must fit the covered program, the assessment, and the written care plan.
State plan, waiver, or managed care: what those words mean
State plan services are regular Medicaid benefits that may be available when the person meets the rules. Personal care and CDPAP can fit here, but the access path may still run through a managed care plan or local district.
Waiver services are extra home and community based services for a specific group. A waiver can cover supports that regular Medicaid may not cover, but it has its own rules and may have a separate process.
Managed care route means a health plan manages the service approval and care plan. In New York, many adults who need long term home care use MLTC, Medicaid Advantage Plus, or PACE, depending on their facts.
Programs to check first
Personal Care Services
Personal Care Services can help a Medicaid member with daily tasks at home. This may include help with bathing, dressing, grooming, toileting, walking, transfers, meal tasks, and household tasks that are part of the care plan.
New York says personal care is handled through local social services districts, Medicaid managed care organizations, and home care agencies. The right door depends on the person’s Medicaid status and plan.
CDPAP or CDPAS
CDPAP lets an eligible Medicaid member choose and hire a personal assistant instead of using only an agency aide. The assistant can be a friend or certain family member. New York says the assistant cannot be the Medicaid member’s spouse, designated representative, or the parent of a CDPAP consumer under age 21.
CDPAP does not mean the family can bill Medicaid on its own. New York uses a fiscal intermediary to handle pay and records. As of this check, New York identifies Public Partnerships LLC as the statewide fiscal intermediary for CDPAP.
For more detail about payment paths, see Can I Get Paid to Be a Caregiver? and the paid caregiver quiz.
Managed Long Term Care
Managed Long Term Care, often called MLTC, is a New York program for people who are chronically ill or disabled and want to stay at home or in the community. MLTC plans can cover community based long term services and supports, such as home care, adult day health care, personal care, nursing in the home, and CDPAP.
For MLTC Partial Capitation and Medicaid Advantage Plus, New York lists minimum need rules. A person generally must need community based long term services and supports for more than 120 days and meet the listed activity of daily living need rule. People with dementia or Alzheimer’s disease may have a different listed minimum need rule. PACE has its own rule tied to nursing home level of care.
PACE
PACE stands for Program of All-Inclusive Care for the Elderly. It can combine medical care and long term care for people age 55 or older who meet program rules. It is not in every area, and it is not the right fit for every household.
Ask whether there is a PACE plan where the person lives. Also ask how using PACE would affect current doctors, Medicare, Medicaid, transportation, and home care.
NHTD waiver
The Nursing Home Transition and Diversion waiver, or NHTD, helps Medicaid-eligible seniors and people with physical disabilities get services in the community instead of in a nursing home or other institution. This can matter when the person needs more than basic help at home.
If the person is in a nursing home, at risk of nursing home placement, or needs a stronger home and community plan, ask NY Connects, the local social services district, or the NHTD Regional Resource Development Center about this route.
For a plain-English overview of waiver terms, see Medicaid HCBS Waivers Explained.
NYSOFA respite, adult day, and local help
New York State Office for the Aging programs do not replace Medicaid. But they can help families find respite, adult day services, meals, caregiver support, and local referrals.
NY Connects is a good first call when you do not know which door to use. It serves older adults, people with disabilities, caregivers, and helping professionals. Call 1-800-342-9871 and ask for the local office for the county.
For caregiver break options, see Respite Care for Caregivers.
New York Paid Family Leave
Paid Family Leave is not Medicaid home care. It is a work benefit for eligible employees. It may give paid, job-protected time away from work to care for a family member with a serious health condition.
This can help while Medicaid home care is pending or while a family is setting up services. It does not pay the caregiver to provide Medicaid care hours. It pays an eligible worker through the Paid Family Leave system.
Who may qualify
Most New York Medicaid home care paths look at two things:
- Financial rules: income, resources, household facts, Medicare status, age, disability, and spenddown rules when they apply.
- Care need rules: whether the person needs help with daily living, needs services for more than a short time, or meets nursing-home-level-of-care rules for some programs.
Do not guess based only on income. Some people may qualify with a spenddown. Some may need Medicare first. Some may need a local district review. Some may need a managed care or MLTC plan review.
If the person has too much income for regular Medicaid, ask the local office about spenddown rules. You can also read Medicaid Spend-Down.
If the family has transferred assets, owns a home, or is planning for nursing home care as well as home care, get legal advice before moving money or property. Rules can be strict and can change. For background, see Medicaid Look-Back Period.
How the assessment works
The assessment is where New York looks at what help the person needs. It is not just a diagnosis. It looks at daily tasks and safety.
Common daily tasks include bathing, dressing, grooming, toileting, walking, transferring, eating, preparing meals, taking medicines safely, and being safe at home. These are often called activities of daily living, or ADLs, and instrumental activities of daily living, or IADLs.
New York uses the New York Independent Assessor Program, or NYIAP, for some initial personal care and CDPAP assessments. New York has also posted minimum need rules for personal care, CDPAP, and MLTC eligibility. These rules changed in 2025, so families should confirm the current rule before relying on older advice.
For some adults, New York’s MLTC page says the person must need community based long term services and supports for more than 120 days and meet minimum need rules. PACE has a nursing-home-level-of-care rule. Children, people in certain plan types, and waiver applicants may have a different process.
Documents to gather before the assessment
- Medicaid card, Medicare card, and other insurance cards.
- Photo ID and proof of address.
- Social Security number or proof of application if available.
- Doctor notes, medication list, diagnoses, hospital discharge papers, rehab notes, and therapy notes.
- A list of falls, wandering, missed medicines, unsafe cooking, weight loss, wounds, or other safety risks.
- A plain list of daily tasks the person cannot do safely without help.
- Current work schedule for the caregiver if job leave or paid leave is an issue.
- Any denial, reduction, discharge, or plan notice.
- Power of attorney, health care proxy, guardianship order, or representative papers if someone is helping with the case.
Caregiver note
Do not say “we manage fine” if the family is only getting by because someone is missing work, sleeping on the couch, or lifting the person without safe help. Explain what would happen if the caregiver was not there.
How to apply
Step 1: Check Medicaid status
If the person already has Medicaid, call the Medicaid plan, MLTC plan, or local district and ask how to request home care. If the person does not have Medicaid, ask where the application belongs.
New York says people apply in different places based on their eligibility group. If the person is 65 or older, blind, disabled, or applying with a spenddown, ask the Local Department of Social Services. In New York City, ask HRA.
Step 2: Ask for the home care route by name
Ask about Personal Care Services, CDPAP, Managed Long Term Care, PACE, and waiver services if the person may need nursing-home-level support. If the worker says no, ask which route fits and why.
Step 3: Ask for an assessment
Say that the person needs an assessment for home care because they need help with daily living. Ask whether NYIAP, the managed care plan, LDSS, HRA, or another assessor will do it.
Step 4: Ask about urgent or immediate need
If the person is unsafe at home, leaving the hospital, or at risk of nursing home placement, say so. Ask the local district, HRA, or plan whether an immediate need request or expedited assessment applies.
Step 5: Get the decision in writing
Ask for a written notice for approval, denial, reduction, or delay. A phone answer is not enough if you need to appeal.
Phone script
“Hi. I am helping my [mother/father/spouse/relative] apply for Medicaid home care in New York. They need help with bathing, dressing, meals, transfers, and staying safe at home. I need to know the right route for Personal Care Services, CDPAP, MLTC, PACE, or a waiver. Can you tell me where to apply, how to request the assessment, and what forms we need?”
Who to call first in New York
- If the person lives outside New York City and is not on Medicaid: call the county Local Department of Social Services and ask for Medicaid for an older adult, disabled person, or spenddown case if that applies.
- If the person lives in New York City: call HRA’s DSS OneNumber at 718-557-1399 or contact the local Home Care CASA office for home care questions.
- If the person already has Medicaid managed care: call the plan and ask for a home care service authorization or reassessment.
- If the person may need long term home care for more than 120 days: ask about MLTC and the New York Independent Assessor process.
- If you do not know where to begin: call NY Connects at 1-800-342-9871 and ask for local long term services and supports help.
- If the person is leaving a hospital or rehab: ask the discharge planner to help start Medicaid, home care, MLTC, NHTD, or other needed referrals before discharge.
What to do while waiting
Home care can take time. Do not wait in silence if the person is unsafe.
Do this now
- Call the office or plan once a week and write down the update.
- Ask if any form, doctor note, signature, or proof is missing.
- Ask the doctor to write clear notes about help needed with bathing, dressing, toileting, transfers, meals, memory, falls, and safety.
- Ask NY Connects about respite, meals, transportation, adult day services, and caregiver support in the county.
- If the person has Medicare, ask the doctor whether short-term home health is available after a hospital stay, rehab stay, or new skilled need.
- If you work, check New York Paid Family Leave and your employer’s leave rules.
- Use caregiver checklists to track medicines, appointments, falls, and care tasks.
- Estimate private pay costs only if you must fill a short gap. Use the care cost calculator to compare options.
Medicaid transportation may help with rides to Medicaid-covered medical appointments when approved. It does not cover every ride. New York says non-emergency medical transportation is for medical appointments, not trips to places like grocery stores, gyms, schools, or pharmacies.
If services are denied or cut
A denial, cut, or delay does not always mean the case is over. It means you need the reason in writing and the deadline to challenge it.
1. Ask for the notice
Ask for the written notice that explains the decision. The notice should say what was denied, reduced, stopped, or delayed. It should also list appeal or fair hearing rights.
2. Read the reason
Look for the real reason. It may say the person did not meet minimum needs, did not need services for long enough, missed an assessment, lacked Medicaid coverage, had missing papers, or asked the wrong office.
3. Fix missing proof
Get doctor notes, discharge papers, fall records, medication lists, and caregiver logs. Ask the doctor to describe what happens without help.
4. Ask about plan appeal, grievance, or fair hearing
If the person is in a managed care or MLTC plan, ask the plan how to file an appeal or grievance. If the decision is from a local social services agency or Medicaid office, ask about a fair hearing with the New York State Office of Temporary and Disability Assistance.
5. Ask about aid continuing if services are being cut
If current services are being reduced or stopped, ask right away whether aid continuing applies. Aid continuing may keep services in place while a fair hearing is pending in some cases. Deadlines can be short. Follow the notice and ask for help fast.
Appeal call script
“I disagree with this home care decision. Please tell me the appeal deadline, fair hearing deadline, and whether aid continuing applies. I also need a copy of the assessment, the care plan, and the rule used to deny or reduce services.”
If you feel stuck, use phone scripts before calling. For legal issues, contact a legal aid group, elder law attorney, or disability rights group in New York.
How this connects to caregiver pay
Medicaid home care coverage and caregiver pay are related, but they are not the same thing.
If the person gets agency personal care, the agency aide is paid by the agency. If the person qualifies for CDPAP, the approved personal assistant may be paid through the fiscal intermediary. Some family members may be allowed. Some are not allowed.
New York Paid Family Leave may pay an eligible worker for time away from work to care for a family member. It does not approve Medicaid care hours and does not replace CDPAP.
Caregivers may also want to read VA Aid and Attendance for wartime veterans or surviving spouses, and Caregiver Tax Deductions for tax questions.
Common problems that slow cases down
- Calling Medicaid but not asking for a home care assessment.
- Using old CDPAP information from before the statewide fiscal intermediary change.
- Missing a phone call or assessment visit.
- Not explaining nighttime needs, falls, wandering, unsafe cooking, or transfer problems.
- Saying the caregiver can keep helping when the caregiver is missing work, getting hurt, or cannot keep going.
- Not asking for a written notice after a denial or cut.
- Missing the appeal or fair hearing deadline printed on the notice.
Resumen en espanol
Medicaid de Nueva York puede ayudar con cuidado en el hogar si la persona cumple con las reglas de Medicaid y necesita ayuda con tareas diarias. Pregunte por Personal Care Services, CDPAP, MLTC, PACE o un waiver si la persona necesita mucha ayuda.
Si vive en la Ciudad de Nueva York, llame a HRA al 718-557-1399. Si vive fuera de la ciudad, llame al Departamento Local de Servicios Sociales del condado o a NY Connects al 1-800-342-9871. Pida la decision por escrito si dicen que no.
FAQ
Does New York Medicaid pay for home care?
It may. The person must meet Medicaid rules and care need rules. The service must be approved through the correct route, such as personal care, CDPAP, MLTC, PACE, or a waiver.
Can I get paid to care for my family member in New York?
Maybe, but only through a real program. CDPAP may allow a friend or certain family member to be a paid personal assistant. New York says a spouse, designated representative, and parent of a CDPAP consumer under age 21 cannot be the personal assistant. Check the current rule before relying on this.
Who should I call first?
If the person is in New York City, start with HRA’s Home Care Services Program or a CASA office. If the person lives outside New York City, start with the county Local Department of Social Services. If you are not sure, call NY Connects at 1-800-342-9871.
What if my loved one already has Medicaid?
Call the Medicaid plan, MLTC plan, or local district. Ask for a home care assessment and ask which route applies. If the person needs long term help, ask about MLTC and CDPAP.
What if Medicaid says my loved one does not qualify?
Ask for the reason in writing. Ask what proof is missing. Ask about appeal rights, fair hearing rights, and aid continuing if current services are being cut.
Does Medicaid cover respite or adult day care?
Sometimes. Adult day health care may be covered through some Medicaid routes. Respite may be available through some waivers or aging programs. NYSOFA and NY Connects can help find local respite and adult day options.
Does Medicaid pay for rides?
New York Medicaid may cover non-emergency medical transportation to Medicaid-covered medical appointments when approved. It does not cover every ride or general errands.
Can I apply if my loved one has Medicare?
Yes, Medicare does not block a person from applying for Medicaid. Many people have both. Medicaid home care rules still apply, and some routes are for people who have both Medicare and Medicaid.
About this guide
This guide was written for family caregivers who need to act, not study policy. It uses official New York and federal sources first. Because New York Medicaid home care rules change often, use the links below to confirm the current rule before applying or appealing.
Official sources used
- New York State Department of Health: New York State Medicaid
- New York State Department of Health: How to Apply for NY Medicaid
- New York State Department of Health: Local Departments of Social Services contact listing
- New York State Department of Health: Personal Care Services Program
- New York State Department of Health: Consumer Directed Personal Assistance Program
- New York State Department of Health: Managed Long Term Care
- New York State Department of Health: New York Independent Assessor Program
- New York State Department of Health: Minimum Needs Requirements for PCS, CDPAS, and MLTC
- New York State Department of Health: Nursing Home Transition and Diversion Medicaid Waiver Program
- New York State Department of Health: Medicaid Transportation
- New York State Office for the Aging: NY Connects
- New York State Office for the Aging: Respite Services
- New York State Office for the Aging: Social Adult Day Services
- NYC Human Resources Administration: Long Term Care Home Care Services Program
- New York State Office of Temporary and Disability Assistance: Request a Fair Hearing
- New York Paid Family Leave: 2026 Updates
- New York Paid Family Leave: Paid Family Leave for Family Care
- Medicaid.gov: Home and Community-Based Services
Disclaimer
This is general information, not legal, tax, medical, or financial advice. Rules can change. For legal or tax questions, talk with a qualified professional in your state.
