I have Medicaid health insurance. How do I apply for Medicaid Personal Care (Home Care) Services?

Most New Yorkers obtain personal care (home care) services through the State’s Medicaid program. Personal care is one of many community-based long term care services offered by the Medicaid program. If you are approved for personal care, a personal care aide (PCA) comes to your home and helps you with your everyday tasks like bathing, grooming, dressing, cooking, and for people who need a lot more care because of their medical conditions, it may include help with going to the bathroom, walking indoors, and getting off/on from a chair or bed. 

If you are applying for personal care services for the first time or are seeking to enroll in a Managed Long Term Care (MLTC) plan, you must first be evaluated. In New York, the New York Independent Assessor (NYIA) Program is responsible for scheduling and conducting personal care evaluations. The personal care evaluation is conducted over two different meetings (either in-person or tele-health). The first evaluation is conducted by a nurse and the second by a doctor.  To schedule these appointments with NYIA, call 855-222-8350 or visit their website.  

Once you have completed these evaluations, you will receive a decision from NYIA, in writing, and through the mail. The decision notice will determine if you are medically stable. It will also determine, for those seeking to enroll in a managed long term care plan, whether your need for community based long term care is expected to last for more than 120 days. 

• If you are approved, the letter will explain your next step in the process. NYIA’s evaluations do not determine the number of hours you will receive, only that you are eligible for personal care. 
• If you were denied, the letter will provide information on how to appeal your decision by requesting a fair hearing with the Office of Temporary and Disability Assistance (OTDA). 

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* The information does not constitute legal advice. You should always consult an attorney regarding your matter. Legal help subject to capacity and location.