How Many Hours of Medicaid Home Care Can You Get in NYC?

Who Decides the Hours, and How

Since 2022, every new Medicaid home care case in New York goes through the New York Independent Assessor (NYIA). Two things happen: a nurse assessment of daily functioning, and a clinical exam that confirms the person is medically able to be cared for at home. Under current New York rules, most adults must need help with at least three activities of daily living (ADLs) to qualify for personal care, or two ADLs if there is a dementia or Alzheimer’s diagnosis. ADLs include bathing, dressing, toileting, transferring (getting in and out of bed or a chair), walking and eating.

Once eligibility is confirmed, the MLTC plan’s nurse builds a task-based plan of care: how many minutes each task takes, how often it is needed, and at what times of day. Those minutes add up to a weekly authorization, for example 28 hours a week (4 hours a day) or 56 hours a week (8 hours a day). The plan sends a written notice with the number.

The assessment measures need, not diagnosis or age. Two people with the same condition can be authorized very different hours depending on how much help they actually require.

What Typical Authorizations Look Like in NYC

These are common patterns families see, not guarantees.

Read more on the difference in our guide to 24-hour, overnight and live-in home care in NYC.

Live-In vs 24-Hour Split Shift: How Plans Decide

The plan looks at night-time need. If the person needs help at night only occasionally, and there is a separate bed and a place for the aide to rest, the plan authorizes live-in care (which is paid as 13 hours a day, with the aide entitled to 8 hours of sleep, 5 of them uninterrupted, and 3 hours of meal breaks). If records show the person needs turning, toileting or supervision many times a night, the case for split-shift becomes strong. Keep a simple night log for two weeks before the assessment: date, time, what help was needed. It is the single most useful document a family can bring.

Why Families Get Fewer Hours Than They Expected

• Under-reporting on assessment day. People often say “I manage” when they mean “I manage with my daughter’s help.” Describe the help actually given, by anyone, every day.
• Informal help counted. Plans may reduce hours when a family member is present and able to assist. Say clearly which hours family cannot cover (work, school, their own health).
• Good day at the assessment. Symptoms vary. Bring the night log, hospital discharge papers, physical therapy notes and a medication list so the record shows the typical day, not the best one.
• Tasks missing from the plan. Escorting to dialysis or chemotherapy, meal preparation for a special diet, and supervision for wandering are all authorizable tasks if they are documented.

How to Get More Hours

1. Ask the plan for a reassessment

Any change in condition, a fall, a hospitalization, a new diagnosis, or a caregiver who can no longer help, is grounds to request a new assessment. Put the request in writing to the plan’s care manager and ask for a written response.

2. Get the doctor’s documentation

A short letter from the treating physician describing functional limits and safety risks (“cannot be left alone due to fall risk and wandering”) carries weight the family’s description alone does not.

3. Appeal a denial or a cut

If the plan denies an increase or reduces hours, the notice tells you how to appeal. You have the right to a plan appeal and then a New York State fair hearing, and if you appeal a reduction quickly, hours usually continue at the old level while the appeal is decided (“aid continuing”). Our guide to what to do when home care hours are cut or denied in New York walks through the deadlines.

4. Check whether a waiver adds services

For some people, the NHTD waiver or the TBI waiver adds coordination, skills training and other supports alongside MLTC aide hours.

How Advantage Home Care Helps

We are a licensed home care agency serving all five boroughs from offices in Brooklyn (Sheepshead Bay) and the Bronx (East 149th Street). Our intake team helps families prepare for the NYIA assessment, works with every major NYC MLTC plan, staffs the authorized hours quickly with aides matched by language and neighborhood, and helps you request more hours when the need changes. Most of our clients pay nothing out of pocket.