Overview of New York’s Personal Care Services Program
The New York State Plan Personal Care Services (PCS) Program provides frail elders and persons with disabilities with in-home assistance. Intended to help these persons in living independently, personal care aides (caregivers) provide assistance with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). These activities include bathing, dressing, mobility, eating, cooking, light housecleaning, medication management, and laundry.
Program participants can reside in their own home or the home of a friend or relative. While they can also reside in an assisted living residence or an adult foster care home, they cannot already be receiving personal care services.
The services offered under this program may be provided by licensed home care workers, or program participants enrolled in a managed care health plan have the option to self-direct their personal care services via the Consumer Directed Personal Assistance Program (CDPAP). CDPAP is an option that allows the hiring of a relative or friend to provide care. Relatives, such as adult children, can be hired to provide care, but spouses cannot. A fiscal intermediary handles the financial aspects of employment responsibilities, such as tax withholding and caregiver payments.
The Personal Care Services Program is part of New York’s State Plan Medicaid. PCS are an entitlement, which means meeting eligibility requirements guarantees one will receive benefits. Put differently, there is never a wait list to receive PCS. This benefit is available via NY’s Regular Medicaid Program (which is covered on this page) and the state’s Managed Long Term Care Program.
Benefits of the Personal Care Services Program
For the PCS Program, assistance is broken into two levels. The level of care, and the number of hours, for which one can receive assistance is determined based on one’s care plan. For persons who require only Level I services, assistance cannot exceed 8 hours per week. For those that require Level 2 services, even live-in assistance (24-hour) may be possible.
Level 1 – Housekeeping Services
Includes assistance with laundry, changing bedding, shopping for groceries, dusting, vacuuming, dishwashing, light cleaning, paying bills, and meal preparation.
Level 2 – Personal Care Services
Includes assistance with bathing, personal hygiene / grooming, toileting, dressing, mobility / wheelchair use, eating, medication administration, meal preparation with special diets, routine skin care, and turning / positioning (for bedbound persons). Also includes all Level 1 services: assistance with laundry, changing bedding, shopping for groceries, dusting, vacuuming, dishwashing, light cleaning, paying bills, and meal preparation.
Eligibility Requirements for Personal Care Services Program
PCS is for New York residents who are eligible for NY’s State Plan Medicaid. One must have a stable medical condition (not expected to get worse or better), be able to live safely at home with personal care assistance, and be self-directing (can make decisions about their daily living activities, understand the impact, and take responsibility for the outcome). Persons who cannot self-direct may be able to have someone do so on their behalf. Additional eligibility criteria follows and is relevant for the elderly (65+ years of age) and persons who are disabled.
Financial Criteria: Income, Assets & Home Ownership
Income
In 2024, the individual applicant income limit is $1,732 / month. For married couples, regardless of if one spouse or both are applicants, the income limit is $2,351.
Assets
In 2024, the asset limit is $31,175 for a single applicant. For married couples, regardless of whether one spouse or both are applicants, the asset limit is $42,312.
Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.
Assets should not be given away or sold under fair market value prior to applying for long-term care Medicaid. This is because NY Medicaid is implementing a 30-month Look-Back Rule for applicants of home and community based services. Once implemented, violating this rule will result in a Penalty Period of Medicaid ineligibility. The earliest the state plans to implement the “look back” is sometime in 2025.
Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take it. For eligibility purposes, New York Medicaid considers the home exempt (non-countable) in the following circumstances.
– The applicant lives in the home or has Intent to Return, and in 2024, their home equity interest is no greater than $1,071,000. Home equity is the current value of the home minus any outstanding mortgage. Equity interest is the portion of the home’s equity value that is owned by the applicant.
– A non-applicant spouse lives in the home.
– The applicant has a disabled child living in the home.
– The applicant has a minor child (under 21 years old) living in the home.
Learn more about the potential of Medicaid taking the home.
Medical Criteria: Functional Need
Many long-term care Medicaid programs require an applicant need a Nursing Facility Level of Care (NFLOC), but the Personal Care Services Program does not. However, PCS must be medically necessary and the need for assistance must be ordered by a nurse practitioner or doctor. Furthermore, a nursing assessment and social assessment will be completed. Generally, a need for assistance with daily living activities (i.e., bathing, dressing, mobility, preparing meals) is indicative that the need for assistance is medically necessary. While persons with Alzheimer’s Disease or a related dementia may receive assistance, a diagnosis in and of itself does not mean one will meet the functional need.
Qualifying When Over the Limits
Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for Medicaid. There are a variety of planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.
When persons have income over the limit, Pooled Income Trusts can help. “Excess” income is deposited into the trust, no longer counting as income. NY also has a Medicaid Spend-Down Program that permits applicants to spend “excess” income on medical bills each month to meet the income limit. The amount that must be paid can be thought of as a deductible. Once one’s “deductible” has been paid for the month, New York Medicaid will pay for Personal Care Services.
When persons have assets over the limits, one option is to “spend down” assets. Examples include paying off debt, making home improvements, such as updating heating and plumbing, and purchasing pre-paid funeral and burial expense trusts called Irrevocable Funeral Trusts. Medicaid Asset Protection Trusts are another option in which assets are placed in trusts and are no longer considered countable assets. There are many other options when the applicant has assets exceeding the limit.
Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid Planners are educated in the planning strategies available in New York to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. There are also planning strategies that not only help one meet Medicaid’s financial criteria, but also protects assets from Medicaid’s Estate Recovery Program, preserving them for family as inheritance. Historically, NY has not had a Medicaid Look-Back Period for Medicaid home and community based services. However, the state is in the process of implementing a 30-month Look-Back Period, and certain planning strategies will violate this rule. Therefore, these strategies should be implemented well in advance of the need for long-term care. However, there are some workarounds, and Medicaid Planners are aware of them. For these reasons, it is highly suggested one consult a Medicaid Planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s).
How to Apply for New York’s Personal Care Services Program
Before You Apply
Prior to submitting an application for the PCS Program, applicants need to ensure they meet the New York Medicaid eligibility criteria. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria.
As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security and Medicare cards, previous bank statements, proof of income, copies of life insurance policies, property deeds, and pre-need burial contracts. A common reason applications are held up is required documentation is missing or not submitted in a timely manner.
Application Process
To apply for State Plan Personal Care Services, applicants must be eligible for New York Medicaid. Seniors can apply via their Local Department of Social Services (LDSS) office. A Health Insurance for Older Adults, People with Disabilities and Certain Other Populations Application can be found here. Certain persons, including those 65+ years old, must also submit Supplement A. Persons can also apply via phone by calling the Medicaid Helpline at 1-800-541-2831. A Facilitated Enroller can provide application assistance.
Persons already enrolled in NY Medicaid can call NYIAP (NY Independent Assessor Program) at 855-222-8350 to schedule a functional needs assessment for Personal Care Services. Persons enrolled in a Medicaid managed health care plan can call their health plan.
Learn more about the Personal Care Services Program.
The New York State Department of Health (DOH) administers the state’s Medicaid program and the Department of Social Services (DSS) office determines eligibility.
Approval Process & Timing
The Medicaid application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed. Based on federal law, Medicaid offices have up to 45 days to review and approve or deny one’s application (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further.