How to Get Medicaid Home Care on Long Island Before the Waitlist Catches Up with You

When an older parent suddenly needs help at home, families often discover that Medicaid home care involves more steps than they expected. The process can involve Medicaid eligibility, an independent assessment, medical documentation, care authorization, and enrollment in the appropriate home care program.

For families in Nassau and Suffolk Counties, starting early can make the process easier to manage. This guide explains the major steps involved in getting Medicaid home care in New York, what to prepare, and where families commonly run into delays.

Before You Start: Know What You Are Applying For

New York Medicaid offers several ways to receive long-term care services in the community. Two important options for people who qualify for home care are Personal Care Services (PCS) and the Consumer Directed Personal Assistance Program (CDPAP).

With traditional personal care services, care is generally provided through a licensed home care agency. The agency manages staffing and other administrative responsibilities.

CDPAP works differently. An eligible Medicaid member can choose and direct a personal assistant, including certain family members or friends, subject to program rules. The consumer or their designated representative is responsible for recruiting, hiring, training, supervising, and scheduling the personal assistant.

CDPAP also has an important current distinction: Public Partnerships LLC (PPL) is now New York’s statewide fiscal intermediary. The statewide fiscal intermediary transition took effect April 1, 2025, so older information referring to multiple independent fiscal intermediaries may no longer be accurate.

Before making financial or care decisions, confirm the current requirements with New York State Medicaid or the appropriate local agency. Program rules can change.

Step 1: Determine Medicaid Eligibility

Before Medicaid can authorize Medicaid-funded home care, the individual generally must qualify for Medicaid.

Gather the documentation that may be needed for the Medicaid application, including:

• Proof of identity and Social Security number
• Proof of New York residency
• Citizenship or qualifying immigration documentation when applicable
• Social Security, pension, or other income documentation
• Bank and financial records when applicable
• Medicare information, if applicable
• Property or other asset documentation when required

Do not rely on older income-limit articles when determining eligibility. New York updates Medicaid income and resource standards periodically, and eligibility can differ depending on age, disability status, household circumstances, and Medicaid category.

If income or resources appear to be above a standard limit, that does not necessarily mean the person has no Medicaid options. Different eligibility categories have different rules, including provisions that may apply to older adults or people with disabilities.

Apply through the appropriate New York Medicaid channel or local Department of Social Services and keep copies of everything submitted.

Step 2: Understand the Home Care Assessment Process

Getting Medicaid approval is only one part of the process. The individual must also be evaluated to determine whether they meet the requirements for Medicaid-funded personal care or consumer-directed services.

New York’s current system uses the New York Independent Assessor Program (NYIAP) for initial and subsequent assessments for people seeking Personal Care Services or CDPAP.

The assessment process can include a Community Health Assessment using the UAS-NY. The assessment considers the person’s functional abilities, need for assistance, available informal supports, and other factors relevant to determining care needs.

The assessment is not simply a checklist of diagnoses.

Be prepared to explain what the person actually needs help with at home. Examples may include:

• Bathing
• Dressing
• Toileting
• Transferring
• Eating
• Mobility
• Medication-related assistance
• Other daily activities covered by the applicable program

Family members should provide an accurate picture of the person’s typical functional limitations rather than describing only their best days.

Step 3: Prepare for the Independent Medical Evaluation

The assessment process also includes an independent medical examination and practitioner documentation.

The medical evaluation helps establish the person’s medical condition and need for assistance. The independent assessor and medical professional use the information to determine whether the person meets the applicable requirements for services.

Keep relevant medical records organized before the evaluation. Recent hospital records, diagnoses, medication information, rehabilitation records, and documentation describing changes in functional ability may help provide a clearer picture of the person’s needs.

If the person’s condition changes significantly later, do not assume you have to wait for the next routine reassessment. New York allows reassessments when there is a change in medical condition and under other circumstances established by the program.

Step 4: Understand the Difference Between Agency Care and CDPAP

Once the person is determined eligible for home care, families may need to decide which care arrangement works best.

Traditional Personal Care Services

With agency-based care, the home care agency handles staffing and administrative responsibilities. This can be helpful for families who do not want to recruit and supervise their own personal assistants.

CDPAP

CDPAP gives the Medicaid member substantially more control over selecting and managing a personal assistant.

The consumer or designated representative is responsible for recruiting, hiring, training, supervising, and terminating the personal assistant. Backup coverage is also part of the consumer’s responsibilities.

A qualifying family member may be able to serve as the personal assistant, although there are important restrictions. For example, a Medicaid member’s spouse generally cannot serve as the CDPAP personal assistant, and other restrictions apply depending on the consumer’s age and circumstances.

Because CDPAP rules have changed, make sure you are using current information rather than older articles describing the pre-2025 fiscal intermediary system.

Step 5: Understand Managed Long Term Care

Some Medicaid members who require community-based long-term care for more than 120 days may need to enroll in a Managed Long Term Care plan, depending on their circumstances and Medicaid category.

New York’s MLTC program has specific eligibility requirements. These include Medicaid eligibility, assessment for MLTC eligibility, the ability to remain safely in the community, and an expected need for covered long-term care services for more than 120 days.

Do not assume that every person receiving Medicaid automatically has to enroll in MLTC. Eligibility and enrollment requirements depend on the individual’s circumstances.

When comparing plans, consider factors such as:

• Whether the plan serves your county
• Available care coordination
• Provider and agency networks
• Communication preferences
• How changes in care needs are handled
• Procedures for requesting reassessment or appealing a decision

Use current New York State resources to confirm which plans are available in Nassau or Suffolk County.

Step 6: Review the Authorized Plan of Care

Once the assessment and authorization process is complete, review the resulting plan of care carefully.

Make sure the authorized services correspond with the person’s documented needs. If you believe the determination does not adequately address the person’s circumstances, ask the plan or responsible Medicaid agency about the applicable appeal or reconsideration process.

Keep copies of:

• Assessment results
• Medical documentation
• Plan of care
• Authorization notices
• Correspondence
• Appeal paperwork
• Care logs and other relevant records

Having an organized file can make future reassessments or appeals much easier.

Step 7: Start Services and Keep Good Records

Once services begin, make sure everyone understands the authorized schedule and responsibilities.

CDPAP consumers have additional responsibilities because they manage their personal assistants directly. This includes maintaining required records and working with the statewide fiscal intermediary for payroll and administrative matters.

Electronic Visit Verification may also apply to Medicaid-funded personal care and home health services covered by the federal EVV requirements.

Families should keep a simple record of meaningful changes in the person’s condition, including falls, hospitalizations, new diagnoses, major changes in mobility, or increased assistance with daily activities.

These records can be useful when the person’s care needs change.

Step 8: Request Reassessment When Needs Change

Home care needs can change over time.

New York’s assessment system provides for routine reassessments as well as reassessments in response to changes in a person’s medical condition and other circumstances.

Do not wait for a scheduled review if your loved one’s needs have substantially changed. Contact the appropriate plan, Medicaid agency, or care coordinator and ask about the process for requesting a reassessment.

Examples of changes worth documenting may include:

• A new fall or repeated falls
• A hospitalization
• A significant decline in mobility
• A new diagnosis
• Increased assistance with bathing or dressing
• Changes in cognitive or behavioral functioning
• A caregiver becoming unable to provide previously available support

What If Your Medicaid Application Is Delayed?

Federal Medicaid rules generally require states to make eligibility determinations within 45 days for most applications, with a longer period permitted for applications based on disability.

If your application appears to be delayed, first check whether the Medicaid agency is waiting for additional documentation.

Keep records of:

• The date you submitted the application
• Documents you provided
• Requests for additional information
• Names or departments you contacted
• Dates of phone calls
• Written correspondence

If you believe there has been an improper delay or an incorrect determination, ask the responsible Medicaid agency about your rights to appeal or request a fair hearing.

For questions about Medicaid eligibility, contact the appropriate New York Medicaid or local Department of Social Services office rather than relying on an outdated third-party phone number.

Start Before a Crisis Forces the Decision

Medicaid home care can involve several stages, and the exact path depends on the person’s age, Medicaid category, functional needs, medical circumstances, and type of services requested.

Starting early gives your family more time to gather documentation, understand the assessment process, compare care options, and respond if additional information is requested.

Whether you live in Hempstead, Huntington, Bay Shore, or elsewhere in Nassau or Suffolk County, the first step is to determine which Medicaid home care pathway applies to your loved one.

Our team helps Long Island families understand the Medicaid home care process, including eligibility, assessment preparation, CDPAP, and managed long-term care options.

Get a free eligibility check today.

Contact us to learn more about your options and determine what steps may apply to your family’s situation.

Related: Telehealth Medicaid Therapy Services — learn how virtual sessions are covered under New York Medicaid.

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