Medicaid “immediate need” is a fast track for people who need personal care or CDPAP right away and have no other way to get it. In New York City, you give HRA a signed attestation of immediate need (DOH-5786), a statement from a doctor, nurse practitioner or physician assistant (DOH-5779), and, if you do not have the right Medicaid yet, a completed Medicaid application. The independent assessment is then due within six calendar days, and HRA has up to 12 calendar days from receiving your papers to authorize services.
What counts as an immediate need for Medicaid home care?
It is not a separate program. The state’s 16 OHIP/ADM-02 directive says the rules do not create a new “immediate needs” program, they require faster Medicaid eligibility decisions and faster assessments for people who need personal care services or CDPAP now. It covers people with no Medicaid, people whose Medicaid does not include long-term care services, and Medicaid members who need an expedited assessment.
To be considered, you sign an attestation. The state’s 2022 directive says it continues to require you to attest to five things:
- you need assistance;
- you have no willing and available informal supports, meaning family or friends;
- you are not currently served by a home care agency;
- adaptive or assistive devices are not meeting, and cannot meet, your needs;
- you have no third-party insurance or Medicare available to pay for the assistance.
Read these carefully before signing. If a family member can realistically provide care, the attestation may not be accurate for you, and the state may ask for documentation if its information conflicts with what you attested.
What do you need to submit? Step by step
HRA’s long term care page lists the forms by name, including the Attestation of Immediate Need for Personal Care Services/Consumer Directed Personal Assistance Services, the Immediate Need Transmittal to the Home Care Services Program and the Access NY Health Care Medicaid Application. Here is the order the directives describe:
- Get the practitioner statement. A doctor, nurse practitioner or physician assistant who knows your condition completes the Practitioner Statement of Need (DOH-5779). If you already have a physician’s order, HRA is told to accept it.
- Sign the attestation (DOH-5786, formerly OHIP-0103).
- Apply for Medicaid if you do not already have coverage that includes these services. See our guide on how to apply for Medicaid home care in NYC.
- HRA refers you to the Independent Assessor. HRA completes the web-based Expedited/Immediate Need Request Form and starts a three-way call with the New York Independent Assessor’s operations unit and you.
- The assessment. The nurse assessment and the clinical appointment are scheduled to be completed within six calendar days.
- Care plan and authorization. HRA reviews the outcome, builds the plan of care and authorizes services. If you are not exempt from managed care, HRA provides services until you can be enrolled in a plan.
One catch: you cannot go around HRA. The state’s 2022 message says that if you call the Independent Assessor yourself, or a hospital discharge planner does, the representative will direct you to contact HRA for immediate need processing. If you are in the hospital, ask the discharge planner to help you start with HRA.
How fast is it? The official deadlines
| Step | Deadline in the state directives |
|---|---|
| HRA checks that your Medicaid application is complete | As soon as possible, no later than four calendar days after receiving the application, the order and the attestation (16 OHIP/ADM-02) |
| Medicaid eligibility decision | Within seven calendar days of a complete application (16 OHIP/ADM-02) |
| Independent assessment and clinical appointment | Scheduled to be completed within six calendar days (22 OHIP/ADM-01) |
| Everything on HRA’s side for an immediate need case | No more than 12 calendar days from receiving the attestation and the practitioner statement (and the Medicaid application, if needed) to refer you, review the result, develop the plan and authorize services (22 OHIP/ADM-01) |
You may see “7 days for the assessment plus 5 for the decision” elsewhere online. We could not find that split in any state directive. The numbers above are the official ones, and they are deadlines on paper, not a promise of what you will experience. If you are SSI-related, the 2016 directive lets you attest to the current value of real property and bank accounts instead of providing every document up front, which can shorten the paperwork stage.
What if you already had an independent assessment?
You may not need another one. A state message to local districts dated April 10, 2024 says that if you already have a Community Health Assessment and a clinical exam resulting in a practitioner order from the standard process, you do not have to repeat the expedited three-way call assessment. HRA may use those results to build your plan. If HRA does not believe they reflect your current condition, it can ask you to go through the expedited process again.
What about children under 18?
The independent assessment changes apply to adults. For children, the state’s GIS 22 MA/09 says the local district keeps doing the assessment and a physician’s order (DOH-4359 or HCSP-M11Q) is required with the attestation. Our M11q guide explains that form.
| Question | Adults (18 and over) | Children (under 18) |
|---|---|---|
| Medical paper | Practitioner Statement of Need (DOH-5779); an existing physician’s order is also accepted | Physician’s order (DOH-4359 or HCSP-M11Q) |
| Attestation of immediate need (DOH-5786) | Required | Required |
| Who assesses | The independent assessor, arranged by HRA through a three-way call | The local district (HRA) |
What can you do while you wait?
Immediate need speeds up the paperwork, but a hospital discharge or a fall does not wait for deadlines. Two options families use in the gap are help from family or friends, and private-pay care. For private-pay care, we usually match an HHA or PCA in 24 to 48 hours when staff are available, and care can often start within 48 hours. With Medicaid, the start date also depends on the assessment and authorization. Our pages on private home care and home care after surgery explain the options, and our Medicaid home care guide covers what comes after approval.
Before things reach a crisis: a note from our nurse director
Anna Klyauzova, RN, MSN, MPA, Director of Patient Services at ProLife Home Care, on what she sees in practice:
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.
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.
We are a licensed home care agency in Brooklyn and Queens, licence #2572L001, New York State Department of Health. We do not file Medicaid applications or run the assessment. To talk through your options, call (718) 232-2777 or use our contact page.
Medicaid rules and deadlines change. Everything above was checked against nyc.gov and the New York State Department of Health directives and messages cited (16 OHIP/ADM-02, 22 OHIP/ADM-01, GIS 22 MA/09 and GIS 24 MA/02) on 9 October 2026. These are the most recent state documents we found on the immediate need process. Confirm the current steps with HRA or the Independent Assessor at 1-855-222-8350.
Frequently asked questions
How fast can I get home care through Medicaid immediate need in NYC?
The independent assessment is scheduled within six calendar days, and HRA has up to 12 calendar days from receiving your attestation and practitioner statement to authorize services. Actual start dates can differ, so plan a bridge.
Do I need to have Medicaid already to use immediate need?
No. People without Medicaid, or with Medicaid that does not cover long-term care services, can apply for Medicaid together with the immediate need request. HRA must decide eligibility within seven calendar days of a complete application.
What forms do I need for immediate need?
For adults, a signed attestation of immediate need (DOH-5786, formerly OHIP-0103) and a Practitioner Statement of Need (DOH-5779), plus a Medicaid application if you do not already have coverage. For children under 18, a physician’s order (DOH-4359 or HCSP-M11Q) goes with the attestation.
Can I call the Independent Assessor myself for an immediate need?
No. The state says immediate need requests go through HRA, and if you call the assessor directly the representative will send you back to HRA.
I already had an assessment. Do I have to do it again?
Not necessarily. A 2024 state message says HRA may use an existing assessment and practitioner order from the standard process, unless it does not reflect your current condition.
Why might I not qualify for immediate need?
The attestation says you have no willing and available informal supports, no home care agency, no devices that can meet your needs, and no Medicare or other insurance to pay for help. If any of those is not true for you, ask HRA about the standard process instead.
