New York Medicaid can pay for 24-hour home care, but only when an assessment shows the person needs frequent hands-on help during the day and the night. State rules recognize two kinds: live-in 24-hour care, with one aide who can sleep, and continuous care, with more than one aide for more than 16 hours a day. The hours come from the assessment, not from a family’s request, and Medicare does not pay for 24-hour care at home.
How does New York Medicaid decide how many hours of home care someone gets?
Neither the family nor the agency sets the hours. The state’s personal care regulation, 18 NYCRR 505.14, sets the process.
- Medicaid eligibility comes first. The regulation says eligibility, including financial eligibility, is established before services are authorized. See Medicaid spend-down if assets are the obstacle, and what Medicaid covers for home care.
- An independent nurse assesses the person. The person or an authorized representative calls the New York Independent Assessor Program (NYIAP) at 1-855-222-8350 (TTY 1-888-329-1541). According to the Department of Health’s NYIAP FAQ, most Community Health Assessments take 2 to 3 hours and can be in person or by video. A separate clinical appointment takes up to one hour and produces the practitioner order.
- The plan or the district writes the plan of care. For most people that is a Medicaid managed long term care (MLTC) plan. In New York City, people who are not in a plan are handled by HRA’s Home Care Services Program (718-557-1399, per HRA). The plan or district may evaluate the person directly. If it disagrees with a clinical finding, it can ask NYIAP for a new assessment, which the regulation says must be completed within 10 days.
- More than 12 hours a day goes to an independent review. Before more than 12 hours a day on average can be authorized, a panel of independent clinicians reviews the proposed plan. It may suggest changes but not a specific number of hours, and the plan need not follow it.
- The plan sends a written authorization. It must be based on the assessment, and no authorization can run longer than 12 months from the assessment or practitioner order, whichever came first.
The Department’s NYIAP page, last revised in November 2023, says NYIAP did not take over reassessments at that time, so plans and districts still do those. Ask your plan who will reassess you. Our NYIA guide covers the visit, and our ADL requirement page covers the threshold. The Department states it as at least limited assistance with physical maneuvering with more than two activities of daily living, or, with a dementia or Alzheimer’s diagnosis, at least supervision with more than one.
What is the difference between live-in 24-hour care and continuous care?
The regulation defines two categories, and which one applies depends mostly on what happens at night.
| Live-in 24-hour care | Continuous care | |
|---|---|---|
| Who provides it | One aide | More than one aide |
| Hours covered | One aide covers the whole 24-hour day | Uninterrupted care for more than 16 hours in a calendar day |
| Night-time need | Help is infrequent enough that the aide would likely get 5 hours of uninterrupted sleep in an 8-hour sleep period | Help is frequent enough that the aide would be unlikely to get those 5 hours |
| Help it is based on | Toileting, walking, transferring, turning and positioning, or feeding | |
| Sleeping space | The home must have sleeping accommodations for the aide | Must be authorized if the home has no sleeping space for an aide |
Families often call continuous care “split shifts” or “24/7 with two or three aides.” The regulation does not use those terms, so use its words when you talk to the plan. Note that continuous care means more than 16 hours of care, not necessarily 24.
Who qualifies for 24-hour care?
The person must first meet the basic personal care tests. After that, for a 24-hour authorization, the plan or district must document:
- that the practitioner’s order shows a medical condition causing frequent help during a day with toileting, walking, transferring, turning and positioning, or feeding
- which of those functions need help, and how often during a calendar day
- whether the person needs similar help while awake and while asleep, and if not, why not
- whether a live-in aide would be likely to get 5 uninterrupted hours of sleep
In plain terms, nights are the evidence. A person who needs turning every couple of hours or toileting several times a night points toward continuous care. A person who sleeps through most of the night fits the live-in definition better.
Other basics: the medical condition must be stable, and the person must be self-directing. The regulation says a person who is not self-directing and needs continuous supervision and direction generally does not receive personal care services, with exceptions where another person or an outside agency takes responsibility for those choices as part of the plan of care. It also says supervision and cueing alone are not a standalone service. For someone with dementia, how this applies is a question for the assessor and the plan, and an elder law attorney can advise on your situation. See also our dementia care guide.
What does the 13-hour rule for live-in aides mean?
It is a pay rule for the aide, not a limit on how much care a person can get. According to the New York State Department of Labor, home health aides are paid for 13 hours of each 24-hour shift, so long as they are provided eight hours of sleep, five of which are uninterrupted, and three uninterrupted meal breaks. A 2023 Department release adds that the aide must receive at least three hours of break time.
The sleep and meal exclusion is written into the state’s Minimum Wage Order (12 NYCRR Part 142), which applies it to a home care aide who works a shift of 24 hours or more.
For real prices, see what home care costs in New York. The table below is only arithmetic on the NYC home care aide minimum wage of $19.65 an hour, effective 1 January 2026 per the Labor Department’s fact sheet.
| Coverage for one day | Paid hours | Wage floor per day | Wage floor per 30 days |
|---|---|---|---|
| Live-in aide (13-hour rule met) | 13 | $255.45 | $7,663.50 |
| Aides working in shifts around the clock | 24 | $471.60 | $14,148.00 |
These are wages at the legal minimum only. They leave out overtime, which the Department says is owed after 40 hours a week (44 for residential employees), payroll taxes, insurance, nurse supervision and agency costs. They are a floor, not a quote.
Why do approved hours often come in below 24 hours, and what can a plan reduce?
The regulation requires the plan to consider other supports before it authorizes personal care, and it lets the plan cut hours for stated reasons. The reason must appear in the notice.
| What the plan may cite | What it means in practice | What to bring or ask |
|---|---|---|
| Equipment, adult day programs, telehealth or other programs can meet part of the need | The plan counts them if they are available, appropriate and cost-effective | Ask which service replaces which hours, and whether it works at night |
| Voluntary help from family or friends | The plan must confirm the caregiver is willing to do what the plan assigns | Say honestly what relatives can and cannot do, including on bad days |
| A change in condition, or a mistake in the earlier authorization | The notice must identify the specific change or mistake | Check it against the record and the doctor’s notes |
| Needs now exceed what a personal care aide may do, or the condition is no longer stable | The plan may deny or end the service | Ask what service is proposed instead, such as private duty nursing |
| More than 12 hours a day on average | Goes to the independent review before approval | Make sure night-time needs are documented |
What can you do if the plan cuts or denies 24-hour care?
The steps below follow the Department of Health’s model notice that managed care plans use for reductions. Your own letter controls, so check the dates on it.
- Read the notice. The regulation requires it to state the reasons for a reduction.
- Ask for a Plan Appeal within 60 calendar days. To keep services the same while it is decided, ask within 10 calendar days of the notice or by the date the decision takes effect, whichever is later. A relative, friend, doctor or lawyer can ask for you.
- Wait for the decision. The model notice gives 30 calendar days for a standard appeal and 72 hours for a fast-track one. Fast tracking applies, among other cases, when you ask for more of a service you already get.
- Ask for a State Fair Hearing if you lose. You have 120 days from the Final Adverse Determination. The notice gives 1-800-342-3334.
- Consider an External Appeal for medical necessity denials. You have 4 months from the Final Adverse Determination. The notice lists the Department of Financial Services at 1-800-400-8882.
- Use free help. The notice names the Independent Consumer Advocacy Network (ICAN) at 1-844-614-8800.
If your care comes directly through the local district, the regulation requires written notice of any reduction along with your right to a fair hearing under 18 NYCRR Part 358, and the district’s notice states the deadlines.
Does CDPAP pay for 24-hour care?
It can. 18 NYCRR 505.28 has the same two categories, live-in 24-hour and continuous consumer directed personal assistance, with the same five-hour sleep test, and the 12-hour independent review counts personal care and CDPAP hours together.
Under CDPAP the person, or a designated representative, hires, trains and supervises the assistants. The Department says this can be a friend or family member, except the person’s spouse, their designated representative or the parent of a consumer under 21. See CDPAP eligibility and paid family caregivers. The Department also says the consumer is responsible for arranging back-up coverage, so plan for nights and for days when an assistant is unavailable.
What are the options if Medicaid will not approve 24 hours?
| Option | What to know |
|---|---|
| Medicaid hours plus private pay | Pay privately for the gap, such as nights. See live-in care and private home care. |
| PACE | For ages 55 and over who need a nursing home level of care. The Department says it covers all medically necessary primary, acute and long term care. See PACE versus MLTC. |
| Adult day care | The regulation lists adult day health or social adult day care as a possible substitute for some hours. See adult day care. |
| Long Term Home Health Care Program | HRA describes it as medical, nursing and rehabilitative care at home for people eligible for nursing home placement, if it costs less than the local nursing home. |
| Nursing home | Compare it honestly with home care: home care versus a nursing home. |
| Medicare | Medicare.gov lists 24-hour-a-day care at home as not covered. |
How many hours will Medicaid approve? 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, licence #2572L001, New York State Department of Health. We can talk through what your family needs and which hours may need another solution. Call (718) 232-2777 or use our contact page.
Medicaid rules, wage rates and the assessment program change. Everything above was checked on 12 October 2026 against regs.health.ny.gov, health.ny.gov, nyc.gov, dol.ny.gov and medicare.gov. Confirm your own situation with your plan, HRA or the New York Independent Assessor Program. This page is general information, not legal or medical advice, and an elder law attorney can advise on your case.
Frequently asked questions
Will Medicaid pay for 24-hour home care in New York?
Yes, if the assessment shows the person needs frequent help day and night. The state recognizes live-in 24-hour care and continuous care, and anything above 12 hours a day on average goes to an independent review first.
How many hours of home care does New York Medicaid approve?
There is no fixed number. The plan or district authorizes only the hours the person actually needs, based on the assessment, and the authorization cannot run longer than 12 months.
Is live-in care the same as 24/7 care in shifts?
No. Live-in means one aide who can get 5 uninterrupted hours of sleep. Care in shifts is what the regulation calls continuous care: more than one aide, more than 16 hours a day, for people whose night-time needs are frequent.
Does the 13-hour rule limit how much care my parent can get?
No. It is how the state’s Labor Department says aides on 24-hour shifts are paid: 13 hours, when sleep and meal breaks are provided. It does not set the hours of care Medicaid approves.
How much does 24/7 home care cost per month in New York?
Agency prices vary and are set by the agency, so ask for a written quote. At the NYC home care aide minimum wage the wages alone are about $7,664 a month for a live-in aide under the 13-hour rule and about $14,148 for 24 paid hours, before overtime, taxes and agency costs.
Medicaid approved only a few hours a day but my parent needs more. What now?
Ask the plan for a reassessment and for the reasons in writing. If you disagree with the notice, appeal on time using the steps above. Describe night-time needs in detail and ask ICAN at 1-844-614-8800 for free help.
Does Medicaid cover in-home care at all?
Yes. The Department of Health says MLTC plans provide home health aide services, personal care, adult day health care, private duty nursing and CDPAP, for people who meet the requirements. See our guide to Medicaid home care coverage.
