Home Health Care in New York: Regulations, Payment & Workforce Guide

Home Health Agency Requirements in New York

New York requires home care agencies to be licensed or certified by the New York State Department of Health (NYSDOH). The Licensed Home Care Services Agency (LHCSA) license is the primary credential for agencies providing home care services.

LHCSA Licensing Overview

LHCSA licensure requires a Certificate of Need (CON) application demonstrating:

• Public need: New methodology includes rebuttable presumption of no need if five or more LHCSAs actively serve patients in the county
• Financial feasibility: Demonstrated ability to operate sustainably
• Character and competence: Review of operator qualifications

For a section-by-section walkthrough of Public Health Law Article 36, 10 NYCRR Parts 765 and 766, the Public Need Methodology, the application package exhibits, and the change-of-ownership exemption that bypasses public need, see our deep dive: New York LHCSA Licensure: Article 36, Public Need Methodology, and the Application Reality.

Recent Regulatory Changes (2025)

The Administrative Licensure Amendment (ALA) process was revised on August 6, 2025:

• County additions approved only when fewer than five LHCSAs actively serve patients in the requested county
• Written requests must be submitted on official letterhead to [email protected]
• Requests must include completed Attachment A: LHCSA Administrative Licensure Amendment Request Checklist

Key License Characteristics

• Non-transferrable: Change of ownership requires new application to DOH and PHHPC approval
• Registration required: Since January 1, 2019, LHCSAs must register to provide nursing, HHA, or personal care services and receive reimbursement (Public Health Law Section 3605-b)
• Statistical reporting: 2024 LHCSA Statistical Reports due by December 31, 2025

Contact Information

• Licensing questions: [email protected]
• Administrative amendments: [email protected]
• Official LHCSA page: health.ny.gov/facilities/home_care/lhcsa/

Certified Nursing Assistant (CNA) Certification

New York CNA programs must be approved by both the New York State Education Department (NYSED) and the New York State Department of Health. Training requirements exceed federal minimums.

Training Requirements

State-approved CNA training programs require:

• 120 hours total training (above 75-hour federal minimum)
• 90 hours of classroom instruction
• 30 hours of supervised clinical experience in a long-term care facility

Certification Process

1. Complete NYSED or NYSDOH-approved nurse aide training program (NATP)
2. Pass NYSDOH certified nurse assisting exam administered by Prometric:
   • Written knowledge test
   • Clinical skills demonstration
3. Complete criminal background check
4. Receive CNA certificate and registry listing

Additional Requirements

• Valid one-year medical clearance from NY State
• Drug screen completed within two weeks before class start

Continuing Education

Nurse aides must complete at least 6 hours of in-service education every six months (12 hours annually). In-service content should address areas of weakness identified in annual performance reviews.

Home Health Aide (HHA) Certification

New York maintains a separate Home Health Aide credential with multiple pathways to certification. HHA Training Programs must be approved by NYSDOH.

Training Pathways

Core Training (Full Program):

• Minimum 75 hours of training
• Competency evaluation upon completion

PCA Upgrade (35 hours):

• For Personal Care Aides with home care experience
• Builds on existing knowledge with additional HHA-specific content

CNA Transition:

• For CNAs with home or residential care experience
• Covers skills not included in nursing aide training
• Streamlined pathway to HHA certification

Program Cost

DOH-approved HHA training programs cannot charge tuition. NYSED-approved programs may charge tuition fees.

Maintaining Certification

• 12 hours of in-service training annually
• Employment with DOH-certified or licensed home health agency
• Nursing supervision from employing agency

Certification remains active as long as the HHA works for a qualifying agency that provides required supervision and training.

New York Medicaid and Long-Term Care Programs

New York delivers long-term care services through managed care programs under its 1115 Medicaid Demonstration waiver, with many traditional HCBS waivers incorporated into Managed Long-Term Services and Supports (MLTSS).

2026 Financial Eligibility

For HCBS waiver and MLTC programs:

• Income limit: $2,982 per month (300% of Federal Benefit Rate)
• Community Spouse Resource Allowance: 50% of couple's assets, up to $162,660

Unique New York Feature: No Look-Back Period

New York has no look-back period for Community Medicaid, the program through which long-term HCBS services are available. While the state plans to implement a 30-month look-back, the timeline remains unclear. This distinguishes New York from nearly all other states.

Managed Long Term Care (MLTC)

MLTC is New York's primary managed care program for seniors needing nursing home level of care who wish to remain at home or in assisted living.

Covered Services

• Personal care assistance
• Home health aide services
• Adult day health programs
• Meal delivery services
• Home modifications
• Medical transportation

Consumer Directed Personal Assistance Program (CDPAP)

CDPAP allows individuals to choose and manage their care services, including the ability to hire family members as caregivers.

2025 Program Changes

CDPAP underwent significant restructuring in 2025:

• Single Fiscal Intermediary: Program consolidated from 600+ intermediaries to Public Partnerships, LLC (PPL)
• Registration deadline: March 28, 2025 for consumers and Personal Assistants
• Legal challenges: A temporary restraining order placed on April 2, 2025 created program uncertainty

Agencies should monitor ongoing developments as the program continues evolving.

Other HCBS Waiver Programs

New York operates additional waiver programs serving specific populations.

Nursing Home Transition and Diversion (NHTD)

Helps nursing home residents transition to community living and prevents admission for at-risk individuals. Services include:

• Security deposit and utility set-up assistance
• Essential home furnishings
• Assistive technology and home modifications
• Personal care assistance
• Homemaker services

OPWDD HCBS Waiver

The Office for People With Developmental Disabilities operates a comprehensive 1915(c) HCBS waiver:

• Waiver renewal: Effective October 1, 2024 (supports nearly 100,000 people)
• Latest amendment: Approved by CMS effective April 1, 2025

Traumatic Brain Injury (TBI) Waiver

Provides specialized services for individuals with traumatic brain injuries, now incorporated into the 1115 Demonstration.

Electronic Visit Verification (EVV)

New York implements EVV requirements in compliance with the 21st Century Cures Act.

Required Data Elements

New York's EVV system captures:

• Type of service performed
• Individual receiving the service
• Date and location of service delivery
• Individual providing the service
• Time service begins and ends

Provider Responsibilities

Agencies must integrate EVV with scheduling and billing systems. Accurate documentation is essential for Medicaid reimbursement compliance.

Medicare Home Health in New York

Medicare-certified home health agencies in New York must maintain both federal certification and state LHCSA licensure.

Certification Requirements

Agencies must:

• Hold valid LHCSA license
• Meet all federal Conditions of Participation in 42 CFR Part 484
• Complete successful initial and periodic surveys
• Submit required statistical reports

PDGM Operations

New York agencies operate under the Patient-Driven Groupings Model (PDGM) with 30-day payment periods. Success requires accurate OASIS assessment, appropriate clinical coding, and efficient visit utilization.

New York Labor Laws for Home Care

New York provides nation-leading wage and benefit protections for home care workers through multiple laws and regulations.

Home Care Minimum Wage

Region	2025	2026
NYC, Long Island, Westchester	$19.10/hour	$19.65/hour
Rest of New York State	$18.10/hour	$18.65/hour

Home care aide minimum wages exceed general minimum wage rates and increase annually.

Overtime Requirements

• Non-live-in workers: 1.5x regular rate after 40 hours per week
• Live-in workers: 1.5x regular rate after 44 hours per week
• 2026 NYC overtime rate: Approximately $29.48/hour

Spread of Hours Pay

If a home care aide's workday exceeds 10 hours, they are entitled to additional daily pay equal to one hour at the minimum wage rate.

Wage Parity Law (Medicaid-Reimbursed Care)

The New York State Home Care Worker Wage Parity Law requires supplemental benefits for Medicaid-reimbursed home care workers:

Region	Required Benefits (per hour)
New York City	$4.09
Nassau, Suffolk, Westchester	$3.22

Benefits can be provided as wages, health insurance, other benefits, or a combination. Note: Wage parity applies only to Medicaid-reimbursed care; private-pay care requires only standard minimum wage rates.

Uniform Maintenance

Home care aides who clean their own uniforms may be entitled to additional weekly pay for uniform maintenance.

Domestic Workers' Bill of Rights

Initially passed in 2010 and updated in 2021, New York's Domestic Workers' Bill of Rights guarantees:

• Overtime pay protections
• Paid rest days
• Protection from discrimination and harassment

Employment Classification

Caregivers are employees under both federal and New York law—not independent contractors. Misclassification can result in significant penalties, back taxes, and legal liability.

Workforce Challenges and Strategies

New York agencies face unique workforce dynamics shaped by high wages, complex regulations, and competitive labor markets.

Key Challenges

• High labor costs: $19.65+ minimum wage plus $4.09 wage parity benefits in NYC creates substantial cost burden
• Complex compliance: LHCSA licensing, wage parity, spread of hours, and EVV require robust administrative systems
• CDPAP competition: Program allows consumers to hire family members directly
• County expansion limits: Five-LHCSA threshold restricts geographic growth
• Training investment: 120-hour CNA requirement exceeds federal standards

Effective Strategies

• Leverage DOH free training: DOH-approved HHA programs cannot charge tuition—develop employer-sponsored training pathways
• Optimize scheduling: Minimize spread of hours triggers and overtime through efficient care planning
• Wage parity compliance systems: Implement robust tracking for benefit calculations and documentation
• MLTC partnerships: Build relationships with managed care plans for referral streams
• Transition pathways: Streamline PCA-to-HHA and CNA-to-HHA conversions
• Regional wage strategy: Consider service areas outside NYC/Long Island/Westchester for lower wage floors

Retention Best Practices

• Competitive wages above minimums with transparent wage parity benefit communication
• Comprehensive benefits maximizing wage parity value
• Career advancement from HHA to LPN to RN
• Consistent scheduling minimizing unpredictable hours
• Recognition programs celebrating worker contributions

Resources and Links

• NY DOH LHCSA Information
• Home Care Professional Information
• NY DOL Home Care Aide Minimum Wage
• Wage Parity Information
• HHA Training Program FAQs
• OPWDD HCBS Waiver

The Bottom Line

New York's home health care environment combines nation-leading worker protections with complex regulatory requirements. The $19.65 minimum wage (2026) plus $4.09 wage parity benefits create the highest home care compensation in the country, while LHCSA licensing limits and CDPAP restructuring shape market competition. Success in the Empire State requires mastering wage parity compliance, building efficient training pipelines through free DOH-approved programs, and navigating the evolving managed care landscape. The absence of a Medicaid look-back period and substantial OPWDD waiver serving nearly 100,000 people represent significant market opportunities for agencies prepared to meet New York's high standards.