New York Medicaid FAQ

Medicaid is a government health insurance program that provides free or low-cost coverage to eligible New York residents. It includes services like doctor visits, hospital care, prescriptions, and preventive care.

Most people apply through the state’s official marketplace, while certain individuals (like seniors or those needing long-term care) apply through their local social services office.

You may qualify if you:

• Live in New York State
• Are a U.S. citizen or have eligible immigration status
• Meet income requirements based on household size

You may also qualify if you are:

• Pregnant
• Age 65 or older
• Living with a disability
• Responsible for a child under 18

Medicaid eligibility in New York is based on a percentage of the Federal Poverty Level, also known as the FPL.

For many adults under 65, caretaker relatives, and parents, Medicaid eligibility is generally available at up to 138% of the Federal Poverty Level.

As of January 2026, this is approximately:

• $22,025 per year for an individual
• $29,864 per year for a household of two
• $37,702 per year for a household of three

These numbers may change annually. Some groups, such as pregnant individuals, children, seniors, people with disabilities, or people needing long-term care, may have different income or resource rules.

Medicaid in New York includes:

• Doctor visits and preventive care
• Hospital and emergency services
• Prescription medications
• Mental health services
• Dental and vision care
• Lab tests and imaging
• Home care services, if eligible
• Long term care services, if eligible

Coverage depends on your eligibility category, health needs, and whether you are enrolled in a Medicaid managed care plan.

Have these ready before applying:

• Proof of identity, such as an ID or birth certificate
• Proof of income, such as pay stubs, tax returns, or award letters
• Proof of New York residency, such as a utility bill or lease
• Current health insurance information, if any
• Immigration documents, if applicable
• Medicare information, if applicable

If you are applying for long-term care or home care services, you may also need additional financial, medical, or care-related documentation.

Option 1: Apply Online

Many New Yorkers can apply through the official New York State of Health marketplace.

This is often the fastest way to:

• Create an account
• Submit your application
• Upload documents
• Receive eligibility results
• Choose a health plan, if required

Option 2: Apply by Phone

You can call the Medicaid Helpline:
1-800-541-2831
A representative can help answer questions about Medicaid eligibility and the application process.

You can also contact NY State of Health customer service for marketplace application help:
1-855-355-5777

Option 3: Apply In Person or Through HRA

If you are age 65 or older, living with a disability, blind, receiving Medicare, or applying for long-term care, you may need to apply through your local Department of Social Services or NYC HRA.

In New York City, you can contact HRA for Medicaid help or visit a Medicaid office for assistance.

Option 4: Get Help from a Certified Agency

You can work with a Medicaid assistor, certified enrollment agency, or home care agency, like Sincere Care Agency, to:

• Avoid application mistakes
• Understand which application path applies to you
• Gather the right documents
• Respond to follow-up requests
• Understand next steps for home care services

1. Confirm eligibility
2. Gather required documents
3. Submit your application online, by phone, or in person
4. Respond to any follow-up requests
5. Receive your eligibility decision
6. Choose a Medicaid plan if required
7. Request home care services if needed
8. Complete any required home care assessments

Applying for Medicaid can feel confusing, especially if you are gathering documents, responding to notices, or trying to understand which home care option is right for you.

If you get stuck, you do not have to complete the process alone.

Several types of organizations may be able to help you understand your options:

• NY State of Health customer service can help with marketplace applications, account questions, eligibility notices, renewals, and enrollment support.
• Certified enrollment assistors and navigators can help you apply, review options, and understand what information is needed.
• NYC HRA or your local Department of Social Services may help if you are age 65 or older, living with a disability, blind, receiving Medicare, or seeking long-term care.
• Home care agencies, such as Sincere Care Agency, can help explain Medicaid home care options, verify your status, and guide you through the next steps for requesting home care services.
• Advocacy organizations may be especially helpful if your issue involves Managed Long-Term Care, CDPAP, reduced home care hours, denied services, or confusion about your rights.

Customer service representatives and enrollment assistors can usually help you:

• Understand application steps
• Identify missing information
• Answer questions about notices
• Explain renewal requirements
• Direct you to the correct agency or program
• Help you understand what action may be needed next

They may not be able to guarantee approval, change eligibility rules, or provide legal advice, but they can help you understand the process and avoid common delays.

Advocacy help may be especially useful if:

• You were denied Medicaid
• You were denied home care services
• You received a notice you do not understand
• Your home care hours were reduced or discontinued
• You are trying to understand MLTC, CDPAP, or self-directed care
• You need help communicating with a plan, agency, or government office
• You believe a mistake was made in your eligibility or service decision
• You are approaching a deadline and are not sure what to do next

If your Medicaid application is denied, read the denial notice carefully.

The notice should explain:

• Why the application was denied
• Whether you can submit more information
• Whether you have the right to appeal
• Any deadline to respond
• How to request a Fair Hearing, if available

Keep a copy of the notice and gather any documents that may support your case. If you do not understand the decision, ask for help as soon as possible.

In many cases, yes. Medicaid applicants and recipients may have the right to challenge a denial, reduction, discontinuance, or other adverse decision.

This is often done through a Fair Hearing or another appeal process, depending on the type of decision and where the application or service request was handled.

Legal or procedural help may be useful if your case involves:

• A denial
• A missed deadline
• A disability-related issue
• A long-term care need
• A home care reduction
• A CDPAP issue
• A disagreement over medical necessity

A legal services organization, Medicaid advocate, or other qualified resource may be able to explain your rights, help you prepare documents, and guide you through the appeal or Fair Hearing process.

Sincere Care Agency can help you understand your Medicaid home care options and identify the next step. If your issue involves a denial, appeal, or legal deadline, we may also recommend contacting the appropriate government office, advocacy organization, or legal services provider.

Medicaid approval usually takes:

• About 30 to 45 days for many applicants
• Faster in some urgent or pregnancy-related situations
• Longer if documents are missing or additional review is needed

Delays are often caused by missing paperwork, incomplete applications, or not responding to follow-up requests on time.

Yes. Medicaid must be renewed periodically.

New York may automatically renew your coverage or request updated information. Always respond to renewal notices to avoid losing coverage.

If you receive a renewal notice, review it carefully and submit any requested information before the deadline.

Once approved:

1. You receive your Medicaid benefits
2. You may select a health plan, if required
3. You can begin using covered healthcare services
4. You can request home care services if needed
5. You may need a separate assessment before home care is approved

Medicaid approval does not always mean home care starts automatically. If you need help at home, additional steps may be required.

Yes. If eligible, Medicaid may cover home care services for people who need help because of age, illness, disability, or long-term care needs.

Medicaid home care may include:

• Personal care assistance
• Home health aide services
• Help with daily living activities
• Long-term care services
• Self-directed care through CDPAP, if eligible

An additional assessment is usually required after Medicaid approval.

New York Medicaid may cover several types of home care and long-term care services, depending on your needs and eligibility.

Common options include:

• Personal Care Services
• Home health aide services
• Managed Long-Term Care
• Consumer Directed Personal Assistance Program, also known as CDPAP
• Other long-term care services, depending on eligibility and need

The right option depends on your health needs, whether you have Medicare, whether you need care for more than 120 days, and whether you want an agency-assigned caregiver or a self-directed care option.

Personal Care Services help people who need assistance with daily activities at home.

This may include help with:

• Bathing
• Dressing
• Toileting
• Grooming
• Walking or transferring
• Meal preparation
• Light housekeeping
• Medication reminders
• Other approved daily care needs

These services are usually provided by an agency-assigned caregiver or home attendant.

Managed Long-Term Care, or MLTC, is a New York Medicaid program for people who are chronically ill or disabled and need long-term care services while remaining at home or in the community.

MLTC plans may help coordinate services such as:

• Home care
• Personal care assistance
• Nursing services at home
• Therapies at home
• Adult day health care
• Medical supplies
• CDPAP services, if eligible

Many adults who have both Medicaid and Medicare, are age 21 or older, and need community-based long-term care services for more than 120 days may need to enroll in an MLTC plan.

This is common for people who need ongoing home care rather than short-term help.

Self-directed care means the person receiving care, or their designated representative, takes a more active role in choosing and managing the caregiver.

In New York, the main self-directed Medicaid home care option is the Consumer Directed Personal Assistance Program, commonly called CDPAP.

CDPAP is a New York State Medicaid program that allows eligible Medicaid members who need home care to choose and hire their own personal assistant.

This can include a trusted friend or qualifying family member, as long as the caregiver meets program rules.

To qualify for CDPAP, a person generally must:

• Be eligible for New York Medicaid
• Need home care services
• Have a stable medical condition
• Complete the required assessment process
• Be able to self-direct care or have a designated representative who can do so
• Meet program rules and care requirements

CDPAP is not right for everyone. It may be a good option for people who want more control over who provides their care and how care is managed.

In CDPAP, the participant or designated representative is responsible for managing parts of the care process.

This may include:

• Choosing a personal assistant
• Recruiting and hiring the caregiver
• Training the caregiver
• Supervising the caregiver
• Scheduling care
• Arranging backup coverage
• Keeping required records
• Working with the fiscal intermediary for payroll and program requirements

CDPAP gives families more control, but it also comes with more responsibility.

With agency home care, a licensed agency generally assigns and manages the caregiver.

With CDPAP, the participant or designated representative chooses and manages the caregiver directly.

Agency home care may be a better fit for someone who wants help coordinating and managing care. CDPAP may be a better fit for someone who wants to choose their caregiver and is comfortable managing the responsibilities of self-directed care.

After a person is approved for Medicaid, they may need a separate home care assessment before services are authorized.

For Personal Care Services and CDPAP, New York uses the New York Independent Assessor process.

This may include:

• A community health assessment
• A clinical appointment
• A review of daily care needs
• Additional review for high-needs cases

The assessment helps determine whether home care is medically necessary, what type of care may be appropriate, and how many hours may be approved.

No. Medicaid approval confirms health coverage eligibility, but home care services usually require a separate assessment and authorization process.

The assessment determines whether home care is needed and what services may be approved.

Activities of Daily Living, often called ADLs, are everyday personal care tasks.

These may include:

• Bathing
• Dressing
• Toileting
• Walking
• Transferring
• Eating
• Personal hygiene

Home care eligibility often depends on how much help a person needs with these activities.

For many adults seeking Personal Care Services or CDPAP, New York applies minimum needs rules.

In general, this means the person must be assessed as needing help with multiple Activities of Daily Living. For people with dementia or Alzheimer’s, supervision or assistance with qualifying daily activities may also be considered.

Because these rules can include exceptions and may depend on enrollment history, families should confirm eligibility before assuming services will be approved.

Applying correctly the first time can make a major difference.

Sincere Care Agency can help you navigate the Medicaid process, avoid delays, and understand your next steps for home care services.