Beginning September 1, 2025, New York State will implement new rules that change how residents qualify for Medicaid home-care services. If you or a loved one is considering applying, it’s important to understand these changes now so you can make informed decisions and protect your benefits.
New York’s Updated Medicaid Home-Care Rules
Starting September 1, 2025, the minimum needs requirements for certain Medicaid-covered home-care services will change. These updates affect initial applications for:
- Personal Care Services (PCS)
- Consumer Directed Personal Assistance Program (CDPAP)
- Managed Long-Term Care (MLTC)
Key changes:
- Applicants will be assessed under updated functional need standards, focusing on Activities of Daily Living (ADLs) such as bathing, dressing, walking, and using the bathroom.
- The state will use revised criteria for determining eligibility during the initial and subsequent assessments.
- Legacy Status: If you are already authorized for PCS or CDPAP, or enrolled in MLTC before September 1, 2025, you will generally be “grandfathered in” under the old rules—unless your coverage lapses or ends.
Federal Law Changes That May Affect Medicaid
In addition to New York’s rule changes, recent federal legislation—the One Big Beautiful Bill Act (H.R.1 / Public Law No. 119-21)—will introduce new Medicaid requirements nationwide.
Key provisions include:
- Work or community engagement requirements for certain adult enrollees without dependents.
- More frequent eligibility renewals for some populations, which could increase the risk of losing coverage due to missed paperwork.
- Changes to immigrant eligibility that may affect some lawfully present immigrants and Essential Plan enrollees.
Analysts expect these changes to result in coverage losses for some individuals and increased administrative steps for many Medicaid recipients.
What You Should Do Now
- Consider applying before September 1, 2025 if you a re close to needing home care.
- Document your ADLs with your doctor so they are clearly noted in your medical record.
- If you are an immigrant or Essential Plan enrollee, seek guidance on how the federal law changes may impact your coverage.
We’re Here to Help
Medicaid planning can feel overwhelming—especially when the rules are changing at both the state and federal levels. Our team at Monteleon Law can help you:
- Review your current eligibility status
- Prepare documentation for assessments
- Understand how new laws may affect your benefits
Contact us today to learn how we can work with you.
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