New York has some of the most layered Medicaid home care rules in the country. Most clients arrive through MLTC plan contracting, not direct Medicaid billing. A Certificate of Need governs where you can operate. The Wage Parity Law sets the highest home care compensation floor in the nation. And the 2025 CDPAP consolidation reshaped the participant-directed care landscape entirely. This page covers what an operating New York agency needs to know.
Most Medicaid home care in New York flows through the Managed Long-Term Care system, not through fee-for-service Medicaid. For most eligible members, MLTC enrollment is mandatory before they can access personal care or home health aide services. NYSDOH Medicaid enrollment is necessary but not sufficient — the practical revenue question is which MLTC plans you're contracted with, and in which counties.
For consumer-directed services, CDPAP now runs entirely through PPL following the 2025 FI consolidation. LHCSAs are no longer in the CDPAP payment chain. The traditional agency world in New York is Personal Care Services through MLTC plan contracts.
MLTCP plans manage only the Medicaid portion of a member's community-based long-term services — they do not touch Medicare. Enrollment is mandatory for dual-eligible members age 21+ needing CBLTSS for 120+ days and meeting the Minimum Needs Requirements (effective September 1, 2025: need for 2+ ADL assistance, or Alzheimer's/dementia with 1+ ADL supervision).
Agencies contract with MLTCP plans for their service counties. The plan authorizes hours, pays the agency on its own schedule, and manages care coordination. Claims go to the plan, not eMedNY. Service authorization levels flow from the NYIAP UAS-NY independent assessment.
Medicaid Advantage Plus (MAP) and PACE (age 55+) are fully capitated — they manage both Medicaid and Medicare in a single plan. Members can only receive services from in-network providers. PACE members receive services through the plan's adult day centers with an integrated care team managing all medical and social needs.
MAP and PACE do not require the same Minimum Needs assessment as MLTCP. Agencies working with MAP or PACE plan members follow each plan's specific authorization and billing workflow independently.
CDPAP allows Medicaid members to hire their own personal assistants, including family members. As of August 1, 2025, all CDPAP participants and personal assistants transitioned to Public Partnerships LLC (PPL) — consolidating from 600+ fiscal intermediaries to one. PPL manages payroll, EVV (Time4Care app), and consumer support through 8 state offices.
LHCSAs are no longer in the CDPAP revenue chain. Agencies that previously operated as CDPAP FIs needed to realign capacity to PCS through MLTC plans after the transition. CDPAP remains a live program — the structure changed, not the program.
A limited population of Medicaid members exempt from MLTC enrollment — typically Medicaid-only individuals with specific exclusions — receive services through direct FFS billing to eMedNY. Always verify member eligibility through ePACES before billing eMedNY. The most common billing error is sending a claim to eMedNY for a member who is MLTC-enrolled — the claim routes to the plan, not the state system.
eMedNY is New York's Medicaid billing system. CMS-1500 for professional claims. Provider and eligibility verification through the ePACES portal.
Agencies providing personal care or home health aide services in New York must hold a Licensed Home Care Services Agency (LHCSA) license from NYSDOH under Public Health Law §3605. This is not a simple registration — it requires a Certificate of Need (CON) that evaluates public need for an additional agency in the requested county, the financial feasibility of the proposed operation, and the character and competence of the owners and operators.
Updated August 6, 2025: NYSDOH's CON methodology now approves county expansion applications only when fewer than 5 LHCSAs are actively serving patients in the requested county. In most urban and suburban markets, this threshold is exceeded — which effectively prevents new county additions in those areas. Agencies planning geographic expansion need to check active LHCSA density in target counties before investing in a CON application. Processing timelines for approved applications run 6 to 12+ months.
The NY Independent Assessor Program (NYIAP) conducts independent UAS-NY assessments that determine member eligibility and service levels. Service authorization levels flow from the UAS-NY assessment, not from the agency or the MLTC plan alone. The September 2025 Minimum Needs Requirements update affects new members assessed after that date — members with Legacy Status (enrolled before September 1, 2025 and continuously enrolled since) are reassessed under the prior criteria as long as they remain in MLTC.
New York's Home Care Worker Wage Parity Law applies to agencies employing home care workers in New York City (all five boroughs), Nassau County, Suffolk County, and Westchester County. It does not apply to agencies operating exclusively elsewhere in the state.
2026 Wage Parity thresholds: The base wage is $19.65/hour in NYC and the downstate counties (Nassau, Suffolk, Westchester). The supplemental benefit portion — which can be health insurance premiums, retirement contributions, paid time off value, or cash in lieu — differs by geography. In New York City: $2.54/hour supplement = $22.19/hour total. In Nassau, Suffolk, and Westchester: $1.67/hour supplement = $21.32/hour total. The supplements were reduced from their prior levels (NYC from $4.09, Long Island/Westchester from $3.22) when the 2024 legislation raised the base wage. The total compensation threshold adjusts annually. Agencies must be able to produce per-worker compliance documentation for any audit period — tracking aggregate payroll averages is not sufficient.
The compliance requirement is an operational documentation problem as much as a payroll problem. Agencies paying cash in lieu of benefits must document the cash amounts per worker per hour and cannot count overtime premiums, bonuses, or other compensation elements toward the benefit threshold. Agencies that can't produce this documentation face material audit exposure even if the wages paid were in fact compliant — because compliance without documentation is indistinguishable from non-compliance in an audit.
Agencies outside the four covered counties must comply with the statewide minimum wage. For New York City, Long Island, and Westchester, the 2025 minimum was $16.50/hour. Upstate regions follow a different rate. Check NYDOL for current figures as these adjust each calendar year.
New York requires EVV for Medicaid-funded personal care and home health aide services under the 21st Century Cures Act. HHAeXchange is the primary EVV platform for MLTC member services. Six federally required EVV data elements must be captured per visit: type of service, individual receiving service, date of service, location, individual providing service, and start and end times. Missing or unmatched EVV records hold claims.
| Program / Payer | Where Claims Go | EVV Platform | Critical Operational Note |
|---|---|---|---|
| MLTC Partial Capitation | Directly to the MLTC plan | HHAeXchange | Each plan has its own timely filing window, prior authorization format, and claims submission process. Verify requirements with each contracted plan. |
| MAP / PACE | Directly to the plan | Plan-specific (typically HHAeXchange) | Full capitation — all services plan-authorized. Out-of-network requires explicit approval. Separate credentialing process from Partial Capitation. |
| Fee-for-Service Medicaid | eMedNY (via ePACES portal) | HHAeXchange | Always verify MLTC enrollment status through ePACES first. Claims sent to eMedNY for MLTC-enrolled members will be denied. CMS-1500 format. |
| CDPAP (PPL) | PPL handles all payroll and fiscal functions | Time4Care app (PPL-managed) | LHCSAs are not in the CDPAP billing chain post-August 2025. PPL manages all EVV and fiscal functions for CDPAP participants. |
All CDPAP consumers and personal assistants transitioned to Public Partnerships LLC as sole statewide fiscal intermediary. Final deadline extended to August 1, 2025 after a late registration window was opened in April. PPL operates 8 offices statewide and employed 2,500+ team members to support the transition.
Agency impact: LHCSAs are out of the CDPAP revenue chain. Agencies formerly operating as FIs have permanently lost that revenue stream and need to serve that capacity through PCS MLTC contracts.
New eligibility criteria for MLTCP and MAP enrollment: new members must demonstrate 2+ ADL assistance needs, or Alzheimer's/dementia with 1+ ADL supervision — in addition to the existing 120-day CBLTSS requirement. PACE enrollment is not affected by these criteria.
Legacy status: Members enrolled before September 1, 2025 retain legacy criteria for reassessment as long as continuously enrolled. Impacts new referrals assessed after the date, not existing caseloads unless a gap in enrollment occurs.
As of August 6, 2025, NYSDOH approves LHCSA county expansion only where fewer than 5 active LHCSAs serve patients. This is a material restriction — most NYC metro, suburban, and mid-size upstate markets already exceed the threshold.
Action: Agencies with current expansion plans should assess county LHCSA density through NYSDOH's public provider list before preparing CON applications for additional counties.
The Wage Parity threshold adjusts annually. Monitor NYDOL announcements for the next effective date. Payroll systems and employee benefit structures need to be reviewed before the new threshold takes effect, not after — retroactive adjustments to benefit cash-in-lieu payments are administratively complex.
Build the annual Wage Parity adjustment into your operations calendar the same way you'd build in a license renewal date — it happens every year and the documentation requirement is the same.
Managed Long-Term Care (MLTC) is how most Medicaid home care gets delivered in New York. Eligible members — mostly dual-eligible individuals age 21+ who need community-based long-term services for 120+ days — are mandatorily enrolled in an MLTC plan before they can access services. The plan authorizes care and pays the agency. Being a Medicaid provider means you're eligible to participate. Being contracted with the plans active in your counties means you actually get referrals and payments. Many agencies have active Medicaid enrollment but minimal revenue because they haven't built MLTC plan contracts in their service area.
If you employ home care workers in New York City, Nassau County, Suffolk County, or Westchester County, yes. The 2026 thresholds are: NYC — $19.65 base + $2.54 supplement = $22.19/hour total; Nassau, Suffolk, and Westchester — $19.65 base + $1.67 supplement = $21.32/hour total. The supplement rates differ because the 2024 legislation that raised the base wage simultaneously reduced the supplement amounts, with a larger supplement reduction in NYC than in the surrounding counties. Supplemental benefits can be health insurance, retirement contributions, PTO value, or cash in lieu. Agencies in other parts of the state comply with the statewide minimum wage instead. Regardless of geography, documentation matters as much as actual compliance — per-worker records for every covered worker must be producible on audit demand.
CDPAP consolidated from 600+ fiscal intermediaries to a single statewide FI (PPL) by August 1, 2025. CDPAP still exists as a consumer-directed option — the fiscal structure changed, not the program. For traditional LHCSA agencies delivering Personal Care Services through MLTC plans, CDPAP doesn't directly affect daily operations. If your agency previously operated as a CDPAP fiscal intermediary, that revenue stream ended with the transition and needs to be replaced through PCS contracts.
Getting an initial LHCSA license requires a Certificate of Need (CON) — a full review of public need, financial feasibility, and owner qualifications. Processing takes 6 to 12+ months for approved applications. As of August 6, 2025, county additions to an existing LHCSA license are approved only when fewer than 5 LHCSAs actively serve patients in that county. Most metro and suburban counties exceed this threshold, making county expansion effectively unavailable in large parts of the state without waiting for existing LHCSAs to go inactive.
New York stacks multiple simultaneous compliance obligations: MLTC plan-specific authorization and billing workflows, Wage Parity documentation per worker, HHAeXchange EVV requirements, and ePACES eligibility verification before each FFS billing cycle. CareBravo manages all of these as delivered operational functions — scheduling, EVV compliance, billing across multiple MLTC plan formats, and payroll with Wage Parity documentation built in — rather than requiring your office staff to manage them separately across disconnected tools.
MLTC plan contracts, Wage Parity documentation across two different county-level thresholds, LHCSA CON restrictions, HHAeXchange EVV — each demands separate operational attention. The CareDrain Diagnostic shows what your current gaps are costing in monthly revenue terms, before you decide what to fix first.