New Minimum Needs Requirement for Community Medicaid

As of September 1, 2025, individuals seeking Personal Care Services (PCS), Consumer Directed Personal Assistance Program (CDPAP) or Managed Long Term Care plan (MLTC) enrollees must now require assistance with at least 3 Activities of Daily Living (ADLs) to qualify for services. Previously, the criteria was a minimum of 2 ADLs.

Exception

The only exception to the additional requirement is for new enrollees diagnosed with Alzheimer’s or dementia if they require supervision with at least 2 ADLs.

What counts as an ADL?

Typical ADLs include bathing, dressing, feeding, toileting, transferring, personal hygiene and assistance with incontinence.

The Good News

This change is only for new enrollees. All participants who enroll before Sept 1, 2025, retain eligibility under the previous standards. They are “grandfathered” in.

Tip

If your Medicaid application has been approved, schedule your New York Independent Assessor Program (NYIAP) medical assessments as soon as possible. If your medical assessments are conducted before Sept 1, 2025, you can obtain “legacy status” under the prior 2 ADL standard. However, you must enroll in an MLTC within 1 year of the assessments.

The stricter ADL requirement raises the bar for Medicaid home care access in New York. Therefore, for families and individuals close to the old thresholds, acting before September 1^st  is crucial!

If you need help navigating the application process or have questions regarding this program change, please do not hesitate to contact our office at 1 (800) 680-1717. We look forward to the opportunity to work with you.

Disclaimer: The information provided above is for general informational purposes only and is not legal advice.