Medicaid members in New York can get FREE long-term care. 

NYIA uses a two-step process. There is a Community Health Assessment provided remotely through Zoom or in-person by a NYIA approved nurse, and then a second Clinical Assessment (medical assessment) performed by an Independent Practitioner Panel (IPP) health care provider remotely through Zoom or in-person. 

You must require assistance with daily living activities that are considered everyday tasks needed to live independently. This may include: 

• Bathing – Can you take a shower or bath, brush your teeth, comb your hair, etc.? 
• Dressing – Can you put on and take off your clothes? Can you put on socks, tie your shoes, button your coat, etc.? 

• Mobility – This is also called “transferring.” Can you get in and out of a chair or couch, can you get out of bed to walk to the bathroom and get up from the toilet yourself, etc.? 
• Toiletings – This includes toilet control and hygiene. Can you go to the toilet when you need to and can you clean up yourself afterwards? 
• Eating – Can you pick up a fork and bring the food to your mouth? Can you hold a plate or glass without spilling, etc.? 

NYIA assessments are broken into two parts: Community and Clinical. These are two different assessments performed at two different times. The assessments can be in-person or handled remotely through Zoom.

NYIA assessments are used by your health plan to determine how much assistance you may need. The health plan creates a plan of care (POC) with this information. The health plan POC is what assigns how many hours of assistance you’ll have to use. 

Assessment 1 

A NYIA approved nurse performs the Community Health Assessment remotely through Zoom or in-person where they ask about daily activities from the last 3 days that are hard for you, or that you can no longer do on your own. Only assistance provided by paid help or help provided by family members in the last 3 days is recorded – they will not record what you can do for yourself or what amount of assistance you believe is needed. 

It is important to be clear and honest during assessments. Cover any items that you have been assisted with, big or small, for home and health care help. This includes items you may be used to, such as using a cane or walker. You may be denied your care request if you have not needed help in the last 3 days. 

Assessment 2 

A second Clinical Assessment (medical assessment) is performed by an Independent Practitioner Panel (IPP) health care provider remotely through Zoom or in-person to verify the needed assistance. This cannot be performed by your personal doctor. 

In some cases, if the care plan is for over 12 hours per day, a 3rd assessment through an Independent Review Panel is required through NYIA. 

You will receive a letter with the NYIA assessment result within 14 days (about 2 weeks) of the second assessment. 

Schedule a NYIA assessment by calling 1-855-222-8350 (TTY 1-888-329-1541). You must have your Medicaid number and should follow the prompts for scheduling a long-term care assessment. Assessments can be done in-person or over Zoom. 

Call the same number you used to schedule the appointment, 1-855-222-8350 (TTY 1-888-329-1541). You must have your Medicaid number and should follow the prompts for scheduling a long-term care assessment to ask for an update on the scheduled appointment. 

When you receive a favorable Outcome Notice, the next step is to notify your existing plan, or contact a health plan to enroll. 

For MMC plans, you MUST fax your outcome notice to the plan before they will schedule the Plan of Care (POC) assessment.  

For new MLTC plans, you must be completely enrolled with the plan, including the Plan of Care (POC) assessment, by the 18th of the month for the plan to start on the 1st of the next month. For example, complete enrollment in an MLTC plan by February 18th to begin care with the plan on March 1st. 

All plans require a Plan of Care (POC) assessment. A POC is the plan’s version of an assessment to determine the exact number of hours granted for your health care each week. The plan uses the NYIA assessment information as part of their decision. You will receive a notice from your plan 28-30 days after the POC visit with the number of weekly health care hours you’ve been granted. 

A favorable NYIA assessment for services is good for 1 year if you do not immediately start services with a plan. Once you start services with a plan, you do not need to go through the NYIA process again. 

If you have been approved by NYIA and are currently using the assigned care time, nothing new is needed for a switch between insurance plans. If you have been approved by NYIA and did not use the assigned care time, you will need to be re-assessed if more than 1 year has passed. 

If you are approved by NYIA, but require more hours of care assistance, you can request a change directly with your health plan. 

If you receive an unfavorable Outcome Notice, the most common NYIA rejections are because NYIA determines you do not need their list of daily living assistance for more than 120 days, and are not qualified to enroll in a Managed Long-Term Care (MLTC) health plan. In this case, you may be approved instead for short-term care or home health care to assist you for the period less than the 120 days. For example, this may occur if you need assistance after surgery. Short-term care is handled through your insurance. 

On more rare occasions, NYIA may determine your condition is not stable enough to receive personal care services at home. This may mean you are not able to handle your daily living needs even with home health assistance. 

Decide whether the stated rejection is correct. If not, you can request a new NYIA assessment. If you are rejected a second time, you may file a formal complaint. 

Patients frustrated with NYIA are encouraged to email their complaints to [email protected]. This is often more responsive than calling. 

Send the complaint to both the Department of Health (DOH) and the NYIA program. 

• Email [email protected] for NYIA complaints 
• Select the correct complaint unit for the DOH: 

• MLTC DOH complaints / DSS complaints: [email protected] or 1-866-712-7197 
• MMC DOH complaints: [email protected] or 1-800-206-8125 

A request for a fair hearing or an expedited fair hearing is possible within a 60-day window from receiving the Outcome Notice. The Outcome Notice should indicate the 60-day date. You must submit your complaint before this date has passed. Get a Request Evidence Packet for a fair hearing at [email protected]. 

An Immediate Need Request is also available from [email protected]. An Immediate Need Request can be made if your condition deteriorates, or a new issue occurs that requires immediate care. A temporary home assistant can be assigned through your insurance until you can complete the NYIA and POC processes. 

A Department of Social Services (DSS) Housekeeping request may be an option for those approved for short-term care (8 hours weekly/Personal Care Service (PCS) Level 1). This provides assistance for light home help needs, such as laundry, dishes, etc. that are not CDPAP level needs. 

If you are a Designated Representative (DR) for a loved one, NYIA requires you submit a form indicating you represent your loved one’s interests. NYIA will not allow you to schedule any appointments for the patient until this form has been submitted and filed. Anyone 18 and over can submit a form as a DR. 

FreedomCare is happy to help to forward this form if you’d like assistance in submitting it, or you can fax the form directly to NYIA at 917-228-8601.