Many people who receive Medicaid home care will not have to meet the new work requirement, but it depends on how their Medicaid is categorized. From January 1, 2027, some New York adults aged 19 to 64 must show 80 hours a month of work, school, job training or volunteering, or earn at least $580 a month. People 65 or older, people on Medicare and people enrolled in Medicaid with a disability are among those exempt.
The rule comes from a 2025 federal law known as H.R. 1. This page uses the federal CMS summary, the New York State of Health “Changes to Medicaid Coverage” page published on October 6, 2026, and a July 2026 letter from the NYC Health Department.
Do Medicaid home care recipients have work requirements in New York?
The federal rule applies to non-pregnant adults aged 19 to 64 who are not entitled to or enrolled in Medicare and who are in the Medicaid adult group. New York State of Health lists these people as not having to meet it:
- Anyone 18 or younger, or 65 or older.
- People entitled to or enrolled in Medicare Part A, or enrolled in Part B.
- People enrolled in Medicaid with a disability.
- People with a physical or mental health condition that makes it hard to work.
- A parent, guardian, caretaker relative or family caregiver of a disabled individual, or of a child under 14.
That list covers a large share of home care recipients, who are mostly older adults or people with disabilities. A person who is 19 to 64, has no Medicare and no disability finding is the one to watch. New York says it will mail a notice about the upcoming changes, and if you do not receive a notice, the requirements may not apply to you.
When do Medicaid work requirements start in New York?
Federal law says states must generally start by January 1, 2027. New York State of Health gives that same date for New York, and the rule is checked when someone applies or renews. The CMS rule was issued on June 1, 2026.
Here are the key facts in one place:
| Question | Answer |
|---|---|
| Start date | January 1, 2027, checked at application and renewal |
| Who is affected | Some adults aged 19 to 64 without Medicare, in the Medicaid adult group |
| What you must show | 80 hours a month of work, half-time school, job training or volunteering, or income of at least $580 a month |
| If the state cannot verify it | A notice and 30 calendar days to show you meet the rule or are exempt |
| If you lose coverage | You can reapply at any time |
| Renewals | Some adults 19 to 64 renew every 6 months instead of yearly; people with disabilities still renew once a year |
What counts toward the 80 hours or the $580?
You can meet the requirement with income, hours or a mix. New York State of Health gives an example: someone earning $380 a month has the equivalent of 52 hours at the federal minimum wage of $7.25, and would need 28 more hours of approved activities.
- Work: a full-time or part-time job, self-employment, gig work, internships and some unpaid work.
- School: at least half-time college, career and technical education, high school or GED programs, online or in person.
- Job training: programs run or approved by New York State, the federal government or local governments.
- Volunteering: with an organized public or nonprofit group, such as a food bank.
The $580 is based on household income. Taxable wages, Social Security, SSDI and retirement income count toward it, while SSI, child support and workers’ compensation do not.
Which exemptions matter most for people who need home care?
| Exemption | What the state says | Why it matters for home care |
|---|---|---|
| Age 65 or older | Not subject to the rule | Most older home care recipients are outside it |
| Medicare | Entitled to or enrolled in Part A, or enrolled in Part B | Covers many people who have both Medicare and Medicaid |
| Medicaid with a disability | Enrolled in Medicaid with a disability | Applies to many younger adults who use personal care or CDPAP |
| Health condition | A condition that makes it hard to work | The state is still working out which conditions qualify and how to check |
| Family caregiver | Parent, guardian, caretaker relative or caregiver of a disabled individual or a child under 14 | Covers relatives who provide regular care at home |
| Short-term exceptions | Hospital or nursing facility stay; travel for serious medical care; declared disaster; very high local unemployment | A hospital stay can count as an exception; give the details on your application |
You may need to show proof that you fit an exemption when you renew. For some exemptions the state says self-attestation will be allowed in 2027 and restricted in 2028 and beyond.
Do family caregivers and CDPAP personal assistants have to meet it?
A family caregiver of a disabled person may qualify for the caregiver exemption. The state says a caregiver can be the legal parent, a court-appointed guardian who provides care, or a relative or close person who provides regular care. If you are not related and do not live with the person, you must provide at least 80 hours of care a month. More than one caregiver in a household can qualify.
A paid job counts as work. A CDPAP personal assistant who is paid for a job is working, and the pay counts toward the $580. If you are a CDPAP caregiver who also receives Medicaid yourself, ask your enrollment assistor which category applies to you. Our guides to CDPAP eligibility and Medicaid home care coverage explain the care side.
Does the work requirement change the M11Q or the home care assessment?
We found nothing saying it does. The work requirement is an eligibility rule for Medicaid coverage. The home care assessment decides how much help a person needs. They run side by side.
For the assessment, the state’s October 2025 NYIAP FAQ says an adult can request an initial assessment by calling 855-222-8350. The practitioner order is completed for all initial assessments done by NYIAP, and the physician order form DOH-4359 is required before each reassessment. For children, assessments are done by the local social services district or the Medicaid plan, with a physician order on DOH-4359 or the HCSP-M11Q. Our M11q guide and the M11Q form explain the paperwork.
What should you do now to keep Medicaid?
- Update your contact information in your NY State of Health account or with your Local Department of Social Services. You can call NY State of Health at 1-855-329-8850.
- Open every notice from NY State of Health or your plan. The state said it would send notices by September 30, 2026.
- Wait for your renewal before taking action, unless a notice tells you otherwise. Details usually arrive around two months before renewal.
- Gather proof that you are exempt, such as disability documentation or records showing you care for a relative.
- Get help. In NYC, Health Department assistors can be reached at 347-665-0214 if you receive a notice of noncompliance.
- Keep getting care. Unless you are told your coverage has ended, your care stays covered.
The NYC Health Department also says the state is partnering with Truv so payroll data can verify compliance without extra steps. Opting in is optional.
We are a licensed home care agency in Brooklyn and Queens, licence #2572L001, New York State Department of Health. We cannot decide Medicaid eligibility, but we can help families understand how coverage and care hours fit together. Call (718) 232-2777 or use our contact page.
The rules are new and the state is still adding detail, especially for health-condition exemptions. Everything above was checked on 9 October 2026 against cms.gov, info.nystateofhealth.ny.gov, nyc.gov and health.ny.gov. Confirm your own situation with NY State of Health, your Local Department of Social Services or a Medicaid specialist. This is general information, not legal advice.
Frequently asked questions
Are there Medicaid work requirements for home care in New York?
There is a new work requirement from January 1, 2027 for some adults aged 19 to 64. People who are 65 or older, on Medicare, or enrolled in Medicaid with a disability are exempt, which includes many home care recipients.
How many hours do I have to work to keep Medicaid in New York?
If the rule applies to you, 80 hours a month of work, half-time school, job training or volunteering, or monthly income of at least $580. You can combine activities with income.
Are family caregivers exempt from Medicaid work requirements?
New York State of Health lists a parent, guardian, caretaker relative or family caregiver of a disabled individual, or of a child under 14, as an exception. Unrelated caregivers who do not live with the person must give at least 80 hours of care a month.
What happens if I do not meet the Medicaid work requirement?
The state must send a notice and give you 30 calendar days to show you meet the rule or are exempt. If you do not, your application may be denied or your coverage ended, and you can reapply at any time.
Will my Medicaid renewal change in 2027?
Some adults aged 19 to 64 will renew every 6 months instead of yearly. New York State of Health says people with disabilities will still renew once a year.
Does the new rule change the M11Q home care form?
We found nothing saying so. The M11Q and the assessment decide care needs, while the work requirement is a separate eligibility rule. The state’s FAQ says the M11Q is one option for the physician order on pediatric assessments.
How do I check that my home care aide is certified?
Search the New York State Home Care Registry on the Department of Health site by name or registry number, or call its help desk at 877-877-1827. See our registry guide for the steps.
