NYIA, formally the New York Independent Assessor Program (NYIAP), is the state’s independent assessment for Medicaid members who want personal care services, CDPAP or enrollment in a Managed Long Term Care (MLTC) plan. You schedule it by calling 1-855-222-8350. It has two parts: a nurse’s community health assessment and a short clinical exam.
The program is run for the Department of Health (DOH) by Maximus. NYIA does not provide care and does not decide your Medicaid financial eligibility. It decides whether you meet the clinical requirements, and your plan or local social services office then builds the plan of care. This page explains who has to go through it, what happens at each appointment, and how to prepare.
What is NYIA and who runs it?
A 2020 state law (Chapter 56) authorized DOH to hire an independent entity to assess people seeking community-based long-term services, as described on the DOH NYIAP page. State regulations (18 NYCRR 505.14 for personal care and 505.28 for CDPAP) now require an independent assessment and a practitioner’s order from an independent clinician who has no prior relationship with you. DOH contracted with Maximus Health Services, which runs NYIAP.
The two assessments are a Community Health Assessment, done by a registered nurse, and a clinical exam by a doctor, nurse practitioner or physician assistant. For high-need cases, where the proposed plan of care averages more than 12 hours a day, there is a third step: an Independent Review Panel checks that the plan is appropriate and safe.
Who has to go through an NYIA assessment?
Anyone 18 or older who has Medicaid, or Medicaid and Medicare, and wants personal care, CDPAP or an MLTC plan can be assessed. Medicaid comes first: people who do not have it should contact their local department of social services (HRA in New York City). The table below shows how common situations work.
| Your situation | Do you call NYIAP? |
|---|---|
| Adult with Medicaid asking for new personal care or CDPAP | Yes. Call 1-855-222-8350 |
| Adult who wants to join an MLTC plan | Yes, same number |
| Child under 18 | No. DOH says pediatric assessments are done by the local district or the Medicaid managed care plan |
| No Medicaid yet | Apply for Medicaid first through HRA or your local district |
| Urgent need after a sudden change in health | Contact your plan or local district. DOH says they call NYIAP with you on the line |
| Already receiving care, annual review or more hours | Ask your plan or HRA first. See the note below |
On reviews, DOH announced in November 2023 that NYIAP would not take over routine or non-routine reassessments at that time. Legal-aid advocates at the New York Legal Assistance Group (NYLAG) reported in an article updated on 27 August 2026 that, as of April 2026, annual reassessments and requests for more hours are still handled by the MLTC plan or local district. Rollout dates can change, so confirm with your plan.
How does the NYIA process work, step by step?
- Call to schedule. The helpline is 1-855-222-8350 (TTY 1-888-329-1541), Monday to Friday 8:30 a.m. to 8 p.m. and Saturday 10 a.m. to 6 p.m., closed on state holidays. An authorized representative can call for you if they are on file with NYIAP.
- Choose in-person or video. DOH’s NYIAP FAQ says you can pick either for both appointments.
- Have the nurse assessment. A nurse assessor completes the Community Health Assessment, usually 2 to 3 hours.
- Have the clinical appointment. A licensed clinician examines you, about an hour, and completes the practitioner’s order.
- Wait for the outcome notice. NYIAP mails the result. If you qualify, your plan or local district arranges services.
| Community Health Assessment | Clinical appointment | |
|---|---|---|
| Who | NYIAP registered nurse | Doctor, nurse practitioner or physician assistant |
| Length | Most take 2 to 3 hours | Up to about 1 hour |
| Where | Your home, another care setting, or by video | In person or by video |
| Purpose | Health, medicines, daily tasks, equipment, family support | Medical history and whether you can direct your care or have someone who can |
The DOH and NYIAP pages do not publish how long the whole process takes. The wait for an appointment is usually the slowest part, so schedule as soon as you know you need care.
What does the nurse ask during the assessment?
The nurse asks about your current health and the medicines you take. She asks how you manage everyday tasks, such as getting around your home, dressing and bathing, whether you need equipment like a wheelchair or special bed, and what help you already get from family or friends. If the visit is in person, it takes place at your home or wherever you would receive care, so the nurse can see your living arrangement.
At the clinical appointment, the clinician reviews your medical history and current care, and can talk with your doctor if needed. For adults, the practitioner’s order is completed by NYIAP’s clinician, so your own doctor does not usually need to fill out an M11q for an initial assessment. See our M11q guide for when that form still comes up.
What is the minimum needs requirement for personal care and CDPAP?
Since 1 September 2025, New York applies a clinical threshold. DOH states it covers Medicaid recipients 21 and older seeking personal care or CDPAP, and anyone 18 and older enrolling in an MLTC or Medicaid Advantage plan. Details are on the DOH CDPAP page.
| Person | Assessed need required |
|---|---|
| Most adults | At least limited assistance with physical maneuvering with more than two activities of daily living (ADLs) |
| Alzheimer’s disease or dementia diagnosis | At least supervision with more than one ADL |
| Authorized or enrolled before 1 September 2025 | Continue under the previous criteria |
| PACE enrollment | Requirement does not apply |
For a dementia diagnosis, NYIAP asks your provider to complete the Alzheimer’s Disease and Dementia Diagnosis Verification Form (DOH-5821). Fax it to 917-228-8601 before the assessment or bring a copy to the appointments. NYIAP says that without the form, the diagnosis cannot be considered in your results. Our pages on CDPAP eligibility and dementia care at home go further.
How do you prepare for the NYIA assessment?
The NYIAP website lists what to have ready for both appointments.
- Photo ID or a Medicaid card.
- Your doctor’s name and phone number.
- Your medicine bottles, or a list of medicines and how often you take them.
- Paperwork from a recent doctor’s visit or hospital discharge.
- The Information Sharing Consent Form, completed online, naming at least one provider who may share records with the clinician.
- An authorized representative form, if someone will speak for you. NYLAG notes that a power of attorney or health care proxy can also be faxed to NYIAP. See our POA and guardianship guide.
Advice from our nurse director on describing your day
Anna Klyauzova, RN, MSN, MPA, Director of Patient Services at ProLife Home Care, on what she sees in practice:
At the needs assessment, someone asks, “Can your mother shower, dress and use the toilet on her own?” and the family says, “Yes, basically.” Meanwhile she is afraid of falling in the shower, has trouble getting out of bed and forgets her pills. Describe how the person really manages, bad days included. How well she handles daily activities affects eligibility, so the details count.
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.
What happens after the assessment, and can you challenge the result?
You receive an outcome notice by mail. If you meet the requirements, your plan or local social services office arranges the services and sets the hours; NYIAP itself does not schedule aides. For hours, see how Medicaid covers home care in New York and personal care services.
The New York Legal Assistance Group (NYLAG) explains in its NY Health Access article that if the notice finds you not eligible for MLTC, you may request a Fair Hearing. Treat the dates on any notice as firm deadlines. For problems with the assessor program, DOH lists independent.assessor@health.ny.gov. A Medicaid spend-down is a separate financial question handled by HRA, not NYIAP.
ProLife Home Care is a licensed home care agency serving Brooklyn and Queens (New York State DOH licence #2572L001). We do not run NYIAP and cannot schedule or change your assessment, but we can help you think through what home care you need. Call (718) 232-2777 or use our contact page.
Program details change, and parts of this process are still being phased in. Everything above was checked on 9 October 2026 against the DOH NYIAP and CDPAP pages, the DOH NYIAP FAQ (October 2025), the official NYIAP site and NYLAG’s NY Health Access article. Confirm your own steps with NYIAP at 1-855-222-8350 or your Medicaid plan.
Frequently asked questions
What does NYIA stand for?
The New York Independent Assessor Program, often shortened to NYIA or NYIAP. It conducts assessments for New York Medicaid members seeking personal care, CDPAP or Managed Long Term Care enrollment.
How do I schedule an NYIA assessment?
Call 1-855-222-8350 (TTY 1-888-329-1541). Lines are open Monday to Friday 8:30 a.m. to 8 p.m. and Saturday 10 a.m. to 6 p.m. An authorized representative on file with NYIAP can call for you.
Is the NYIA assessment done at home or by video?
Either. DOH says you can choose in person or video for the community health assessment and the clinical appointment. In-person assessments take place where you live or would receive services.
How long is the NYIA assessment?
Most community health assessments take 2 to 3 hours, and the clinical appointment takes up to about 1 hour, according to the DOH FAQ.
Is NYIA required for CDPAP?
For new CDPAP or personal care requests from Medicaid members, yes. Children are excluded, and urgent cases go through your plan or local district first, which schedules NYIAP with you on the call.
Does NYIA decide whether I qualify for Medicaid?
No. You must already have Medicaid. NYIAP assesses your clinical need for services, and your Medicaid financial eligibility is handled by HRA or your local district.
What if I have dementia?
Ask your provider to complete form DOH-5821 and fax it to 917-228-8601 before your appointments, or bring a copy. Without it, NYIAP says the diagnosis cannot be considered when your results are determined.
