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New York home care payment guide
Last updated: 13 September 2026
For many New Yorkers, Medicaid is the main public program for ongoing personal care at home. Other paths include aging services, PACE, limited Medicare home health, veterans benefits, insurance, or private payment. The right route depends on care needs, finances, coverage, and location.
Bottom Line
If you need regular help with daily tasks, check New York Medicaid and aging services together. Call NY Connects at 1-800-342-9871 for guidance. If you already have Medicaid and need personal care for the first time, the New York Independent Assessor Program may be required.
Do not assume Medicare will pay for ongoing custodial home care. Medicare home health is narrower and generally requires a covered skilled-care need.
Need Help Right Now?
If an older adult cannot be safely left alone or is being discharged without a workable care plan, tell the hospital discharge planner or social worker before discharge. Call 911 for an immediate emergency.
For an urgent Medicaid personal-care need with no safe caregiver arrangement, ask the local Department of Social Services about New York’s Immediate Need process and its current forms.
Start Here
- Define the care need. Write down which daily tasks need hands-on help, how often help is needed, and whether skilled nursing or therapy is also needed. Our home care basics guide can help you sort the terms.
- Call NY Connects. Ask which programs serve your county and whether the local Office for the Aging can screen you for EISEP or other services.
- Check Medicaid early. If long-term personal care is needed, do not rule out Medicaid based only on gross income. New York has special long-term care rules, deductions, spenddown rules, and protections for some married couples.
Which Payment Route Should You Check First?
| Situation | First route to check | Main limitation |
|---|---|---|
| Needs ongoing hands-on personal care and may qualify financially | New York Medicaid PCS/CDPAP or managed long-term care | Financial and functional rules apply; assessment is required |
| Age 60+ and not eligible for the same Medicaid services | EISEP through the local aging office | Local service capacity and cost sharing can apply |
| Needs short-term skilled care after illness or injury | Medicare home health | Does not cover ongoing custodial care by itself |
| Age 55+ with Medicaid and nursing-home-level care needs | PACE, if available locally | Must meet program and service-area rules |
| Veteran or eligible surviving spouse | VA home care or pension add-ons | Eligibility and local availability vary |
Medicaid Is the Main Route for Ongoing Home Care
New York Medicaid can pay for long-term services that Medicare usually does not cover. Two important home-care routes are Personal Care Services (PCS) and the Consumer Directed Personal Assistance Program (CDPAP). PCS may cover help with tasks such as bathing, toileting, grooming, meal preparation, and housekeeping. The state’s Personal Care Services page explains the service.
CDPAP is different because the Medicaid member directs the care. A qualified member can choose and train a personal assistant. A friend or family member may sometimes be paid, but New York restricts who can serve in that role. A spouse, the consumer’s designated representative, and a parent of a consumer under age 21 cannot be the paid personal assistant. See the state’s CDPAP rules. For a practical family-focused overview, see our family caregiver pay guide.
CDPAP now uses one statewide fiscal intermediary
Public Partnerships LLC (PPL) is the statewide fiscal intermediary for CDPAP. New York says PPL became the only authorized fiscal intermediary on 1 April 2025. The Department of Health maintains current CDPAP information.
New minimum-needs rules matter
New York changed important functional eligibility rules effective 1 September 2025. For many adults seeking PCS or CDPAP for the first time, the person must be assessed as needing at least limited assistance with physical maneuvering for more than two activities of daily living. A person with a documented Alzheimer’s disease or dementia diagnosis may meet the rule by needing at least supervision with more than one activity of daily living. The state explains the minimum-needs requirements.
People who were already authorized for PCS or CDPAP before the change can have “legacy” status and may be assessed under earlier criteria. Managed Long Term Care also has legacy rules for people continuously enrolled before the change. Do not assume a new applicant and a long-time recipient are judged under the same functional test.
The New York Independent Assessor may be involved
For many adults seeking PCS or CDPAP for the first time, the New York Independent Assessor Program (NYIAP) conducts the initial assessment process. An applicant or authorized representative can call 1-855-222-8350; TTY is 1-888-329-1541. The state’s NYIAP FAQ explains how initial appointments are requested. If you already belong to a Medicaid managed care plan, also contact the plan because its role can differ by enrollment status and reassessment type.
Managed Long Term Care can organize services
Some adults who need community-based long-term services for more than 120 days receive services through Managed Long Term Care (MLTC). New applicants to an MLTC Partial Capitation plan or Medicaid Advantage Plus generally must meet the newer minimum-needs rules as well as the program’s long-term-care requirement. The state’s MLTC eligibility page has the current framework. Plan choice and mandatory enrollment rules can depend on Medicare status, age, and other facts.
2026 Medicaid Financial Screen: Use It as a Starting Point
New York’s official 2026 non-MAGI chart lists the Medicaid income level at $1,836 per month for one person and $2,489 per month for a two-person household. It lists resource levels of $33,038 for one person and $44,796 for two people. These figures are effective 1 January 2026. You can verify them in the state’s 2026 Medicaid chart.
These numbers are not a complete eligibility test. Deductions, spenddown, married-couple rules, and the treatment of some resources can change the result. If you are above the screen, still ask for a full review. Our Medicaid for seniors guide explains common terms.
| Figure | One person | Two people | What it means |
|---|---|---|---|
| Community Medicaid prescreen income | $1,836/month | $2,489/month | A 2026 screening level; special Medicaid rules may change the result |
| Medicaid resource level | $33,038 | $44,796 | Applies to relevant non-MAGI categories; not every asset is necessarily countable |
| EISEP cost-share threshold | $1,995/month | $2,705/month | Income protected from EISEP cost sharing, effective 1 April 2026; it is not an EISEP eligibility cutoff |
Important: a local Medicaid office makes the actual eligibility decision. For long-term care applicants, financial treatment can be more complex than this quick table.
Where you apply depends on your Medicaid category. New York’s Medicaid application guide explains when to use NY State of Health and when to work with the local Department of Social Services or, in New York City, the Human Resources Administration. People seeking community-based long-term care often need additional financial and resource information.
EISEP Can Help Some Adults Age 60+ Who Are Not Using Medicaid for the Same Care
The Expanded In-home Services for the Elderly Program (EISEP) is one of New York’s most important non-Medicaid home-care paths. The program is for people age 60 or older who need help because of illness or disability, can remain safely at home, and are not eligible for the same services through Medicaid. New York says a person generally must need help with at least one activity of daily living or two instrumental activities of daily living. The official EISEP page describes the program.
EISEP can include case management, in-home help, respite, and other supports. Local Area Agencies on Aging run the program, so services and capacity can differ by county. Find local contacts through our New York aging offices guide.
EISEP uses cost sharing for some clients. Effective 1 April 2026, the monthly cost-share threshold is $1,995 for an individual and $2,705 for a couple. At or below it, the client cost-share rate is zero; above it, a sliding calculation can apply. See the 2026 EISEP instruction. This is a cost-share threshold, not an eligibility cutoff.
PACE Can Combine Medical Care and Long-Term Support
PACE can combine medical and long-term care for people who can still live safely in the community. New York requires age 55+, residence in a plan’s service area, Medicaid, applicable Medicare enrollment, nursing-home-level care, and at least one community-based long-term service for more than 120 days. See the PACE eligibility rules.
PACE enrollment itself is not subject to the newer MLTC minimum-needs test. PACE is not available everywhere, so location matters. Our PACE guide can help you prepare questions before calling a plan.
Medicare Home Health Is Useful but Limited
Medicare can cover home health when a person is homebound and needs qualifying skilled nursing or therapy under a clinician’s care plan. A Medicare-certified agency must provide the care. A home health aide may be covered when the person is also receiving covered skilled services. See Medicare home health.
Medicare does not generally pay for long-term custodial care when that is the only help needed. Its long-term care page explains this limit. Ongoing personal care may instead require Medicaid, EISEP, insurance, VA benefits, or private payment.
If a Medicare home health agency or Medicare plan says covered skilled home health should stop or be denied, keep the written notice and appeal instructions. Our home-health denial guide explains common next steps.
Veterans May Have Additional Home-Care Paths
Veterans enrolled in VA health care may qualify for Homemaker and Home Health Aide services when clinical requirements are met and the service is available locally. A VA social worker can help arrange homemaker and aide care.
In participating areas, Veteran-Directed Care gives eligible Veterans more control over a care budget and may allow hiring family, friends, or neighbors.
A Veteran or surviving spouse who qualifies for a VA pension may also qualify for an Aid and Attendance or Housebound add-on. See the VA’s Aid and Attendance page. It is a pension add-on, not a stand-alone home-care program.
Long-Term Care Insurance and Private Pay Can Fill Gaps
If you have long-term care insurance, check the home-care benefit before paying out of pocket. Review the benefit trigger, waiting period, payment limit, approved-provider rules, and family-caregiver rules. See New York’s long-term care guide and our long-term care insurance guide.
For private-pay care, compare cost, supervision, scheduling, payroll duties, and backup coverage. The New York Department of Health’s home care profiles can help you check licensed or certified organizations.
Helpful tip
Before signing, ask about minimum shifts and extra weekend, overnight, transportation, or cancellation charges. Confirm participation with your exact insurance plan.
Do Not Rely on NHTD as an Immediate New Route Right Now
The Nursing Home Transition and Diversion (NHTD) Medicaid Waiver can support eligible New Yorkers who need nursing-home-level care and can live safely in the community. However, this program has an important current limitation. As of 13 September 2026, the New York Department of Health says the waiver has reached its federally approved participant maximum and cannot process additional referrals. New referrals are being closed rather than moved forward to intake. Check the NHTD status page before making plans around this waiver.
If NHTD is closed to new referrals, ask NY Connects or your Medicaid office about other community-based services instead of waiting without a backup plan.
How to Start Without Wasting Time
- Make a one-week care log. Record each task another person must do or supervise, including personal care, transfers, meals, household tasks, and safety needs.
- List current coverage. Note Medicare, Medicaid, managed care, VA coverage, and long-term care insurance.
- Call the right entry point. For general navigation, start with NY Connects. For an existing Medicaid plan, call the plan. For a first PCS/CDPAP assessment when directed to NYIAP, call 1-855-222-8350.
- Apply for Medicaid if needed. If you need long-term care, tell the application worker that clearly. Ask what financial forms and resource documents apply to your category.
- Keep every notice. Do not throw away denial, reduction, enrollment, assessment, or appeal letters. Deadlines can depend on the date and type of notice.
Documents and Information to Gather
- Photo ID and proof of New York residence.
- Medicare, Medicaid, and insurance cards.
- Income records and, when required, bank or other resource records.
- Medication list, doctors’ names, and recent discharge papers.
- A list of daily tasks needing hands-on help or supervision.
- Long-term care insurance policy, if any.
- Any denial, reduction, or termination notice.
Reality Checks
- Financial eligibility is only one step. Medicaid home care also requires a functional and service assessment.
- Hours are not automatic. Qualifying for a program does not guarantee a particular number of care hours.
- Local capacity varies. EISEP, PACE, VA services, agencies, and individual caregivers can differ by county or service area.
- Medicare is not long-term custodial coverage. Skilled home health rules are different from ongoing personal care.
- Program status can change. NHTD is a clear example: the state currently says new referrals cannot be processed because the participant cap has been reached.
Common Mistakes to Avoid
- Assuming income slightly above a Medicaid screen means there is no possible Medicaid path.
- Calling all home care “home health” and expecting Medicare to pay for months of custodial support.
- Hiring privately before checking whether an insurance policy or public program requires an approved provider.
- Assuming any family member can be paid through CDPAP.
- Ignoring the 1 September 2025 minimum-needs rules when applying for PCS, CDPAP, or certain MLTC plans.
- Waiting for one program without asking for a backup route.
Denied, Delayed, or Overwhelmed?
First, read the notice and identify who made the decision: a local Medicaid office, NY State of Health, a managed care plan, Medicare, or another program. Appeal routes and deadlines are not the same.
If the problem involves Medicaid long-term care, MLTC, MAP, PACE, or a related plan decision, the Independent Consumer Advocacy Network (ICAN) provides free, independent help. Call 1-844-614-8800 or use the state’s ICAN information page. ICAN can explain coverage, complaints, and appeal options.
For a Medicaid eligibility decision made by a local Department of Social Services or New York City HRA, the state Medicaid application page lists fair-hearing routes, including the statewide hearing line at 1-800-342-3334. Keep the notice because it tells you the exact appeal path for your case.
Backup Options When the First Route Does Not Fit
If Medicaid is not available, ask the local aging office about EISEP and other services. If there is a skilled medical need, ask whether Medicare home health fits. Veterans should ask the VA about home-care options, and policyholders should review long-term care insurance before spending savings.
Also look at the broader New York benefits guide if the care problem is tied to food, housing, utilities, transportation, or another expense. Reducing another bill can sometimes free money for care even when that program does not pay the caregiver directly.
Useful New York Contacts
| Need | Contact | What to ask |
|---|---|---|
| Local long-term care options | NY Connects: 1-800-342-9871 | Which home-care and aging programs serve my county? |
| Initial Medicaid home-care assessment | NYIAP: 1-855-222-8350 | Do I need an initial assessment, and what should I have ready? |
| Medicaid application help | Medicaid Helpline: 1-800-541-2831 | Where should I apply for Medicaid long-term care in my situation? |
| MLTC or appeal help | ICAN: 1-844-614-8800 | Can you help me understand this plan notice or appeal? |
Phone Scripts You Can Use
NY Connects / local aging office
“I am looking for help paying for in-home care for a person who is [age] and lives in [county]. They need help with [tasks]. Please tell me which local programs should screen us, including EISEP if it may fit.”
Medicaid long-term care
“I need to apply for Medicaid coverage that includes community-based long-term care. Please tell me where I should apply, which financial forms I need, and whether I need to provide resource information.”
NYIAP assessment
“I am requesting an initial assessment for home-care services. Please confirm which appointments I need and what medical records, medication list, or other information I should have ready.”
ICAN / appeal help
“I received a notice about my Medicaid long-term care or home-care services. I want to understand the reason, the deadline, and my appeal options. Can you review the notice with me?”
Resumen en Español
En Nueva York, Medicaid es una de las principales formas de pagar cuidado personal de largo plazo en el hogar. Para orientación local sobre servicios y programas, llame a NY Connects al 1-800-342-9871. Las personas de 60 años o más que no reciben los mismos servicios por Medicaid también pueden preguntar por EISEP.
Medicare puede pagar ciertos servicios de salud en el hogar cuando existe una necesidad médica calificada, pero normalmente no paga cuidado personal de largo plazo cuando ese es el único servicio necesario. Si ya tiene Medicaid y necesita cuidado personal por primera vez, pregunte si debe pasar por una evaluación de NYIAP. Guarde todas las cartas de denegación o reducción. Para ayuda independiente con Medicaid de cuidado a largo plazo y apelaciones, puede llamar a ICAN al 1-844-614-8800.
Frequently Asked Questions
Does Medicare pay for long-term home care in New York?
Usually not when the only need is ongoing custodial help. Medicare can cover qualifying home health when a homebound person needs covered skilled nursing or therapy.
What are New York’s 2026 Medicaid income and resource figures for older adults?
New York’s 2026 non-MAGI chart lists income levels of $1,836 per month for one person and $2,489 for two people, with resource levels of $33,038 and $44,796. These are screening figures; special Medicaid rules can change the result.
Can a family member be paid through CDPAP?
Sometimes. Many relatives or friends can serve as CDPAP personal assistants, but a spouse, the consumer’s designated representative, and a parent of a consumer under 21 cannot be paid in that role. Medicaid and service rules still apply.
What changed for New York Medicaid home care on 1 September 2025?
New minimum-needs rules took effect for many new PCS, CDPAP, MLTCP, and MAP applicants. They use a new activities-of-daily-living threshold, with a separate dementia pathway. Many people already authorized or continuously enrolled before the change have legacy protection.
What if I am 60 or older but do not qualify for Medicaid home care?
Ask your local Area Agency on Aging about EISEP. It can provide in-home support to some adults age 60 or older who are not eligible for the same Medicaid services. Local availability and cost sharing can apply.
Is the NHTD waiver accepting new referrals in September 2026?
No. As verified on 13 September 2026, New York says NHTD has reached its approved participant maximum and cannot process additional referrals. Check the official status page before relying on this route.
About This Guide
Sources: This guide uses official federal, state, local, and other high-trust nonprofit and community sources linked in the article.
Editorial note
This guide is produced under the GFS Editorial Standards using official and other high-trust sources. GFS is not affiliated with a government agency and is not a substitute for official agency guidance. Individual eligibility outcomes cannot be guaranteed.
Review dates
Last verified 13 September 2026. Next review 13 December 2026.
Corrections
Despite careful verification, errors may occur. Readers may email info@grantsforseniors.org with corrections.
Disclaimer
This article is for informational purposes only and is not legal, financial, medical, tax, disability-rights, immigration, or government-agency advice. Program rules, policies, funding, and availability can change. Readers should confirm current details directly with the responsible official program before acting.
Last updated: 13 September 2026 · Next review: 13 December 2026
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