Guide
New York Medicaid long-term care: nursing homes, MLTC and CDPAP
Updated October 15, 2026 · Reviewed against official sources
New York has very broad home care programs, but also lots of acronyms: MLTC, CDPAP, NYIA, PPL, ALP, HRA. This guide helps you understand each one and know where to start, in order.
Medicaid and long-term care in New York
New York Medicaid is overseen by the New York State Department of Health (NYS DOH). Applications are handled by each county's Local Department of Social Services (LDSS). In New York City, the Human Resources Administration (HRA) handles them.
Medicaid can cover:
- A nursing home stay for people who need it and qualify.
- Personal Care Services at home.
- CDPAP: home care directed by the person who receives it.
- Services in certain residences through the Assisted Living Program.
- Adult day centers and other services, depending on the plan.
How much can my loved one have?
New York uses its own income and asset limits for older adults, which are higher than the typical $2,000 limit in other states. They're updated every year. According to the New York State Office for the Aging (NYSOFA), the 2026 levels for community Medicaid are:
| Limit | One person | Couple |
|---|---|---|
| Monthly income | $1,836 | $2,489 |
| Assets (resources) | $33,038 | $44,796 |
Use these numbers as a guide. Check your situation with your LDSS or with HRA before you make plans, because some rules change depending on the program and the family's situation.
Other general rules:
- Medicaid reviews asset transfers from the last 5 years when someone applies for nursing home coverage.
- The spouse who stays at home has protections to keep part of the assets and income.
- If income is over the limit, there's a "spend-down" system for the excess income: the person pays part of their medical bills each month and Medicaid covers the rest. In New York, pooled trusts are also used to handle that excess income; an elder law attorney can advise you.
For more detail on these rules, read Does Medicaid pay for nursing homes?.
The NYIA assessment
Since May 16, 2022, the New York Independent Assessor (NYIA) has done the initial assessment for people who ask for:
- Personal Care Services at home.
- CDPAP.
- Enrollment in an MLTC plan.
Important points:
- The NYIA only assesses people who already have active Medicaid. If your loved one doesn't have Medicaid yet, they first need to apply at the LDSS or HRA.
- The NYIA does a needs assessment and also sets up a clinical appointment with an independent practitioner, who issues the medical order.
- Before 2022, part of this process was handled by the Conflict Free Evaluation and Enrollment Center (CFEEC). If you see that name on old paperwork, it refers to the previous system.
Practical tip: on the day of the assessment, it helps to have a family member there who knows the person's routine well. Keep the medication list handy and write down specific examples of what your loved one can no longer do alone.
MLTC: Managed Long Term Care plans
An MLTC (Managed Long Term Care) plan is a health plan that coordinates long-term services for people who need help at home over a long period. The plan has nurses and care coordinators who put together the care plan and approve the hours of help.
After the NYIA assessment, if your loved one qualifies, they can choose an MLTC plan in their area. Once they're enrolled, reassessments are usually done by the plan's nurse.
Useful questions before choosing a plan: which home care agencies work with it, whether they have caregivers who speak Spanish, and how to ask for more hours if health changes. Always ask for the number of approved hours in writing.
If you don't agree with the hours the plan approves, you can appeal to the plan and then ask the state for a fair hearing. The plan's letters tell you the deadlines.
CDPAP: your loved one chooses their assistant
The Consumer Directed Personal Assistance Program (CDPAP) lets a person with Medicaid choose, hire and direct their own personal assistant. That assistant can be a family member, for example an adult son or daughter. For many Latino families, this means mom or dad can get help from someone they trust who speaks their language and knows their customs. Ask the plan or the LDSS which family members can be hired in your case.
The 2025 change: one intermediary, PPL
In the past, CDPAP payroll was handled by hundreds of "fiscal intermediaries." In 2025, New York switched to a single statewide fiscal intermediary: Public Partnerships LLC (PPL).
- The transition began in January 2025.
- The deadline to switch to PPL was April 1, 2025, with a late registration period until April 30, 2025 for consumers and assistants who were already in the program.
- Today, new consumers and assistants register directly with PPL.
If your loved one used CDPAP before 2025 and has questions about their registration or payments, contact PPL or their MLTC plan. For payroll tasks when you hire a caregiver privately, read home care for seniors.
Minimum wage for home care workers
New York sets a special minimum wage for home care aides, which includes CDPAP assistants:
| Region | Starting January 1, 2026 | Starting January 1, 2027 |
|---|---|---|
| New York City, Long Island and Westchester | $19.65 an hour | $20.00 an hour |
| Rest of the state | $18.65 an hour | $19.00 an hour |
Overtime is paid at 1.5 times the regular rate after 40 hours a week. The state government has proposed adjusting the rates again starting March 1, 2027; for now, it's only a proposal.
Assisted Living Program (ALP) and other residences
The Assisted Living Program (ALP) is a service for people who are eligible for Medicaid and need a nursing home level of care, but who can live in a more independent setting. It operates within an Adult Home or an Enriched Housing Program licensed by the DOH. Not every residence has an ALP, so it's best to ask directly.
New York also has Assisted Living Residences (ALR), with additional certifications such as Enhanced ALR and Special Needs ALR (for dementia). You can check profiles and inspections on NYS Adult Care Facility Profiles and, for nursing homes, on NYS Nursing Home Profiles. An inspection report is a snapshot of one moment; if you see something that raises questions, ask the facility what has changed. Also see our directory of senior living in New York and the guide to nursing homes with Spanish-speaking staff.
How to apply, step by step
- Apply for Medicaid at your county's LDSS or, in New York City, with HRA. Gather ID, proof of income, bank statements and the Medicare card.
- Ask for the NYIA assessment once your loved one has active Medicaid, if they need home care or MLTC.
- Choose an MLTC plan if they qualify, or ask for personal care or CDPAP.
- If you choose CDPAP, the consumer and the assistant register with PPL.
- For a nursing home, the facility's social worker usually helps with the application. Ask about "Medicaid pending" status and what you should confirm in writing while a decision is made.
- Open all mail and respond on time. Keep copies.
Starting January 1, 2027, for new applications from older adults or people with disabilities, federal law cuts Medicaid's retroactive coverage from 3 months to 2 months before the month of the application. Don't wait to apply.
Other help
- PACE program: available in some areas. Read The PACE program.
- Long-term care ombudsman: a free ally for residents, families and staff of nursing homes and assisted living residences. See resident rights and complaints.
- Eldercare Locator: 1-800-677-1116, Monday through Friday, 9 a.m. to 8 p.m. Eastern Time; if you prefer Spanish, ask for it when you call.
- If you're the caregiver: read help for family caregivers.
- If your loved one is leaving the hospital, see our hospital discharge page.
Frequently asked questions
Can my son or daughter get paid to take care of me in New York?
Yes, through CDPAP, if the person has Medicaid and the assessment shows they need the help. The assistant registers with PPL and earns at least the minimum wage for home care aides.
Do I need an MLTC plan to get help at home?
Many people with Medicare and Medicaid who need help at home over a long period enroll in an MLTC plan. The NYIA and the LDSS will tell you which option applies.
What happens to assets if my loved one moves into a nursing home?
Medicaid reviews the last 5 years of transfers and applies protections for the spouse at home. Get advice before you move money or property.
New York Medicaid rules change often. This guide is for information only and is not legal advice.
Sources
- NYSOFA, 2026 financial levels (includes community Medicaid levels): https://aging.ny.gov/system/files/documents/2026/04/26-pi-06-2026-financial-levels-eisep-cse-client-cost-share-potential-medicaid-eligibility-determination.pdf (accessed October 15, 2026)
- NYS DOH, progress on the statewide CDPAP transition (January 17, 2025): https://healthweb-back.health.ny.gov/press/releases/2025/2025-01-17_cdpap_transition.htm (accessed October 15, 2026)
- NYS DOH, CDPAP transition update (March 27, 2025): https://healthweb-back.health.ny.gov/press/releases/2025/2025-03-27_cdpap_update.htm (accessed October 15, 2026)
- NYS DOH, Medicaid Update, special edition on the NYIA (May 2022): https://healthweb-back.health.ny.gov/health_care/medicaid/program/update/2022/no05_2022-05_nyia.htm (accessed October 15, 2026)
- NYS DOH, administrative directive 22 ADM-01: https://healthweb-back.health.ny.gov/health_care/medicaid/publications/22adm01.htm (accessed October 15, 2026)
- NYS DOL, home care aide minimum wage: https://dol.ny.gov/home-care-aide-minimum-wage-fact-sheet-p105 (accessed October 15, 2026)
- New York Governor's Office, 2027 minimum wage: https://www.governor.ny.gov/new-york-state-minimum-wage-2027 (accessed October 15, 2026)
- NYS Adult Care Facility Profiles: https://profiles.health.ny.gov/acf/ (accessed October 15, 2026)
- NYS Nursing Home Profiles: https://profiles.health.ny.gov/nursing_home/ (accessed October 15, 2026)
- CMS, summary of changes under P.L. 119-21 (retroactive coverage): https://www.medicaid.gov/federal-policy-guidance/downloads/cib11182025.pdf (accessed October 15, 2026)
- Eldercare Locator (ACL): https://eldercare.acl.gov/ (accessed October 15, 2026)
- ACL, "Help with Housing or Services" (Eldercare Locator hours): https://acl.gov/HousingandServices/FindHelp (accessed October 15, 2026)
Senior living in the cities with the most options
Only those that accept Medicaid: Brooklyn · Bronx · Rochester · New York · Far Rockaway · Staten Island · Flushing · Syracuse · Williamsville · Ithaca · Yonkers · Albany
This is general information, not medical, legal or financial advice. Rules vary by state and by year: confirm with the official agency that applies to you.
Keep reading
Does Medicaid pay for care?
Yes, Medicaid pays for a nursing home if your loved one qualifies. 2026 limits, the 5-year look-back, spouse protections, waivers and how to apply.
Home care
A caregiver from an agency or hired by your family, Medicare home health and Medicaid (IHSS, STAR+PLUS): typical costs and your duties as an employer.
Care in Spanish
How to find a nursing home, assisted living or caregiver that speaks Spanish, your right to a free interpreter, and what to ask when you visit.
Help for family caregivers
What the National Family Caregiver Support Program is, who qualifies, its five services and how to apply. Plus FMLA and Medicaid for family caregivers.
