How to Get a Home Health Aide Through Medicaid in New York


# How to Get a Home Health Aide Through Medicaid in New York

If your family member has New York Medicaid and needs help at home, you may be entitled to a certified Home Health Aide — paid for by Medicaid — coming to the home as often as several hours a day.

Most families don’t know how to access this. This is the step-by-step process for getting Medicaid home health aide services in New York State.

Step 1: Confirm Active New York Medicaid

Medicaid home health aide services require active New York State Medicaid coverage. If your family member does not currently have Medicaid:

  • Apply at HRA (Human Resources Administration) for NYC residents, or at your county Department of Social Services
  • Apply online at NY State of Health (nystateofhealth.ny.gov)
  • Call 1-800-541-2831 for Medicaid enrollment assistance

Most low-income seniors and adults with disabilities in New York qualify. Processing time is typically 45 days.

Step 2: Identify Your Managed Care Plan

Most New York Medicaid beneficiaries are enrolled in a Managed Care health plan — not straight “Fee-for-Service” Medicaid. Your plan authorizes and pays for your home health aide hours.

Look at your Medicaid card. It will show the name of your managed care plan (examples: MetroPlus, Healthfirst, Fidelis Care, AgeWell New York, VillageCareMax, RiverSpring Health Plans, etc.).

If you are in Managed Long-Term Care (MLTC), your home care is coordinated through your MLTC plan. If you are not yet in MLTC but need ongoing long-term home care, your plan will likely initiate MLTC enrollment.

Step 3: Get a Physician Order

Your primary care physician must write an order for home health aide services. The order should specify:

  • Which activities the patient needs help with (bathing, dressing, grooming, meal preparation, mobility, medication reminders)
  • How often assistance is needed (daily, twice daily, etc.)
  • Any relevant medical conditions driving the care need

This step is critical. The number of authorized HHA hours is directly tied to what the physician documents. Be specific and thorough when describing your loved one’s actual daily needs to the physician. A vague order results in fewer authorized hours.

Step 4: Managed Care Plan Assessment

Once your physician submits the order, your managed care plan conducts a needs assessment — typically in the home — to evaluate your daily care needs and determine how many HHA hours per week to authorize.

The assessor uses a standardized tool (in most cases, the Uniform Assessment System, or UAS-NY) to evaluate functional limitations. Bring documentation to the assessment: the physician’s order, a list of medications, and a written description of daily care needs.

If the authorized hours are insufficient for the person’s actual needs, you have the right to appeal the authorization through the plan’s appeal process.

Step 5: Choose a Licensed Home Care Services Agency (LHCSA)

Once hours are authorized by your managed care plan, you choose a licensed home care agency to provide your aide. In New York, home care agencies must be licensed by the NY Department of Health as a Licensed Home Care Services Agency (LHCSA).

What to ask a potential agency:

  • Are you licensed by the NYSDOH as an LHCSA?
  • Are you contracted with my managed care plan?
  • Do you have aides who speak my language?
  • What is your backup coverage process when my aide is unavailable?

Priority Groups is a NYS-licensed LHCSA serving New York City boroughs and Monroe County (Rochester area).

Step 6: Care Begins

After the agency is confirmed and the managed care plan authorizes the placement, a supervising nurse conducts an initial in-home visit, creates a care plan, and assigns a certified aide.

The aide visits on the authorized schedule. A supervisor checks in periodically to monitor care quality and update the care plan as needs change.

What If the Care Needs Are Greater Than Standard HHA Covers?

Standard Medicaid HHA authorization works well for individuals who need a moderate level of support. For individuals with higher-acuity needs — those at risk of nursing home placement, or those with complex behavioral or physical care needs — two additional programs may apply:

NHTD Waiver: For adults with physical disabilities or seniors who meet nursing-facility level of care criteria. Covers a broader range of services than standard HHA. [See our NHTD Waiver guide.]
TBI Waiver: Specifically for adults ages 18–64 with traumatic brain injuries. [See our TBI Waiver guide.]
MLTC: Managed Long-Term Care — bundles all long-term services under one plan for seniors needing 120+ days of ongoing home care.

Getting Help Navigating the Process

Priority Groups serves New York City boroughs (Brooklyn, Queens, the Bronx, Manhattan, Staten Island) and Monroe County (Rochester). We help families navigate Medicaid managed care, physician orders, and plan authorization so they can focus on their loved one rather than paperwork.

Call us at (718) 841-8000 for a free consultation on Medicaid home care eligibility and how to access HHA services in New York.