No type of New York Medicaid is better for everyone, and the state does not rank them. Which one you are in depends on your age, whether you also have Medicare, your income rules and whether you need long-term care at home. Most people with both Medicare and Medicaid cannot join mainstream managed care, and an adult with both who needs community-based care at home for more than 120 days must generally join Managed Long Term Care (MLTC).
What is the difference between Medicaid fee-for-service and managed care in New York?
In fee-for-service Medicaid, the state pays each provider directly for each covered service. In managed care, the state pays a health plan, and the plan arranges and pays for your care. The Department of Health describes managed care as a plan or system that coordinates the provision, quality and cost of care for its members, and says that when you enroll in a plan you select a regular doctor, called a primary care practitioner.
New York has three main setups. Which one applies is decided by your category, not by preference alone.
| Type | How it works | For home care |
|---|---|---|
| Fee-for-service Medicaid | The state pays doctors, hospitals and other providers directly. People excluded from mainstream managed care stay here. | Personal care and CDPAP still require a state-approved assessment of your need. |
| Mainstream Medicaid managed care | You join a health plan and choose a primary care practitioner. Since 1 April 2023 the plans’ pharmacy benefit is covered by NYRx, the state Medicaid drug program. | The plan is your main health coverage. Long-term home care may instead run through MLTC; the rules differ depending on whether you also have Medicare (see below). |
| Managed Long Term Care (MLTC) | A plan that provides long-term services for chronically ill or disabled people who want to stay at home. The plan types are partially capitated plans, Medicaid Advantage Plus (MAP) and PACE. | Covers services such as personal care (PCS) or CDPAP, home health aide services, nursing, therapies, adult day health care and private duty nursing. |
One detail from the Department of Health’s pharmacy page: the 2023 move to NYRx did not apply to members of Managed Long-Term Care plans (including PACE and MAP), the Essential Plan or Child Health Plus.
Who has to join a managed care plan, and who is excluded?
The Department of Health publishes a chart of people who are excluded from mainstream Medicaid managed care (they cannot join) and people who are exempt (they do not have to join but may choose to). Examples from the chart:
| Excluded from mainstream managed care | Exempt (may choose to join) |
|---|---|
| People who have both Medicare and Medicaid. They can enroll in an Integrated Benefits for Dually Eligible Enrollees (IB-Dual) program or in MLTC. | People eligible for services through the Office for People With Developmental Disabilities (OPWDD) |
| People with a Medicaid spend-down (excess income) | People in the Nursing Home Transition and Diversion or Traumatic Brain Injury waivers |
| People receiving hospice care when they enroll | People with a chronic condition treated by a specialist outside every plan’s network (limited to 6 months) |
| People expected to be eligible for Medicaid for under 6 months, with an exception for pregnancy | Native Americans and Alaska Natives, and residents of certain long-term chemical dependence programs |
| People with comprehensive private health insurance |
If you receive Medicaid through a spend-down, our spend-down guide and pooled trust guide explain your options. The chart is a summary, so the exact rule for your case depends on your Medicaid record.
Who needs MLTC for home care, and what is the Minimum Needs Requirement?
According to the Department of Health’s MLTC overview, dual eligible adults age 21 and older who receive community-based long-term care for more than 120 days must enroll in MLTC to keep receiving it, unless excluded. These people may enroll voluntarily:
- dual eligible individuals age 18 to 20 who need community-based care for more than 120 days and are assessed as eligible for nursing home level of care;
- non-dual individuals age 18 and older with the same need and nursing home level of care.
To qualify, the person must be eligible for Medicaid, be found eligible for MLTC by the New York Independent Assessor Program using the Community Health Assessment, be able to stay at home safely, and be expected to need at least one covered service for more than 120 days. The listed services include nursing in the home, therapies, home health aide services, personal care (Level 2), adult day health care, private duty nursing and CDPAP. A person assessed as needing only Level 1 services does not qualify. For home care, the state’s Minimum Needs Requirement also applies. Anyone 18 or older joining MLTC or a Medicaid Advantage Plan must be assessed as needing at least limited assistance with physical maneuvering for more than two activities of daily living, or supervision with more than one if they have dementia, unless they were already authorized or enrolled on 1 September 2025. It does not apply to PACE.
Our guides to what Medicaid covers for home care and CDPAP eligibility go through the assessment step by step.
How do I choose a plan, and who can I call?
The Department of Health’s enrollee page lists the questions to ask: is your doctor in the plan, how close is the doctor’s office to your home, and does the plan have special services that you and your family need? It also publishes regional consumer quality guides for MLTC plans and suggests talking with friends, your doctor and local social services counselors before deciding.
- Find out which category you are in. Check your Medicaid notices, or ask your county office (HRA in New York City).
- Call New York Medicaid Choice. The enrollment contractor, New York Medicaid Choice, lists 1-800-505-5678 and, for long term care customer service, 1-888-401-6582 (TTY 1-888-329-1541).
- Get the assessment. For MLTC, the New York Independent Assessor Program must find you eligible first.
- Compare plans on your own priorities: your doctors, language, how the plan handles hours, and quality guides.
- Know where to complain. For problems with an MLTC plan, the Department says you can call 1-866-712-7197 or email mltccomplaints@health.ny.gov without filing with your plan first.
What is the hourly pay for home care aides in NYC in 2026?
The New York State Department of Labor sets a minimum wage for home care aides that is higher than the general minimum wage. Under Public Health Law section 3614-f, a home care aide includes home health aides, personal care aides, home attendants and personal assistants whose primary job is in-home help with daily living activities. These are the Department of Labor’s figures from its fact sheet P105 and its home care aide minimum wage page.
| Date | New York City, Long Island, Westchester | Rest of New York State |
|---|---|---|
| January 1, 2024 | $18.55 | $17.55 |
| January 1, 2025 | $19.10 | $18.10 |
| January 1, 2026 | $19.65 | $18.65 |
| January 1, 2027 | $20.00 | $19.00 |
Home care aides must be paid time and a half for weekly hours over 40 (or over 44 for residential employees), and may be owed call-in pay, spread-of-hours pay and uniform maintenance pay. A separate wage parity law applies to Medicaid-reimbursed home care in New York City, Nassau, Suffolk and Westchester. The Labor Department’s wage parity page currently lists a required benefit of $4.09 an hour in New York City and $3.22 in Nassau, Suffolk and Westchester, with the base wage being the state minimum wage. How these requirements combine for a given aide depends on the agency’s pay structure, so ask the agency, or call the Labor Department at 888-525-2267 with questions.
These are what aides must be paid, not what a family pays an agency for private care. For prices, see our guide to the cost of home care in New York. If you are an aide looking for work, see HHA jobs in NYC.
How many hours of Medicaid home care will be approved? Advice from our nurse director
Anna Klyauzova, RN, MSN, MPA, Director of Patient Services at ProLife Home Care, on what she sees in practice:
I never promise a family a number of hours before the assessment. Two people with the same diagnosis can need very different amounts of help. The assessment looks at how they manage daily activities, their cognitive state and other individual needs. If the approved hours still look too low, ask for a reassessment.
Don’t wait for a hospital stay or a fall to start looking at Medicaid and home care programs. It is far easier to arrange safe care before things reach a crisis.
We are a licensed home care agency in Brooklyn and Queens, New York State Department of Health licence #2572L001. We are not a Medicaid plan or an enrollment broker, but we can help you understand what care at home could look like and where private care fits alongside Medicaid. Call (718) 232-2777 or use our contact page.
Program rules and wage rates change. Everything above was checked on 9 October 2026 against the Department of Health’s MLTC, managed care exclusions and exemptions, NYRx and CDPAP pages, New York Medicaid Choice’s site and the Department of Labor’s home care aide pages. The state’s own page on who must enroll in managed care blocked our automated access, so use the chart above and confirm your category with your Medicaid office or New York Medicaid Choice.
Frequently asked questions
What is the primary difference between Medicaid managed care and fee-for-service in New York?
In fee-for-service the state pays providers directly. In managed care a health plan arranges and pays for your care and you choose a primary care practitioner. Some groups, such as people with Medicare and Medicaid, cannot join mainstream managed care.
Is Medicaid managed care or fee-for-service better for home care?
Neither is better for everyone. Dual eligible adults who need long-term care at home for more than 120 days must generally join MLTC, other adults may choose it, and the Minimum Needs Requirement applies to new MLTC enrollees 18 and older. Ask your Medicaid office which route you are in.
Who must enroll in MLTC in New York?
Dual eligible adults 21 and older who receive community-based long-term care for more than 120 days must enroll, unless they are excluded. Dual eligible 18 to 20-year-olds and non-dual adults 18 and older may enroll voluntarily if assessed at a nursing home level of care.
What is the hourly pay for home care aides in NYC in 2026?
The state minimum wage for home care aides is $19.65 an hour in New York City, Long Island and Westchester from January 1, 2026, according to the Department of Labor. It rises to $20.00 on January 1, 2027. Overtime is time and a half after 40 hours a week.
Does Medicaid managed care cover prescriptions?
Since April 1, 2023, pharmacy benefits for members of mainstream managed care plans, HARPs and HIV special needs plans are covered by NYRx, the state Medicaid drug program. MLTC plan members, including PACE and MAP, were not part of that change.
Can I switch Medicaid plans if I am unhappy?
You can contact New York Medicaid Choice at 1-800-505-5678 (or 1-888-401-6582 for long term care) to ask about your options. For complaints about an MLTC plan, the Department of Health takes calls at 1-866-712-7197.
