Aid continuing and fair hearings when your home care hours are cut

If a notice says your CDPAP or personal care hours are being reduced, suspended, or ended, the most time-sensitive right you have is called aid continuing (the Department of Health also calls it aid to continue, and plan notices say "continuation of benefits"). It means your services stay at the current level while your appeal is decided. It is not automatic in every case, and the window is short, generally 10 days from the date of the notice, or until the effective date of the change if that is later.

So: find the date on the notice, find the effective date, and file your appeal before whichever of those two is later. Everything else can be sorted out afterward.

There are two tracks, and the first step differs.

Track A: you are in a Managed Long Term Care plan or other Medicaid managed care plan. The plan authorized the hours, so the plan hears the first appeal. Since April 2018, the Department of Health says enrollees generally must exhaust the plan's internal appeal before requesting a state fair hearing. The plan's notice will be titled something like "Initial Adverse Determination."

Track B: your hours are authorized by the local district (in New York City, HRA's Home Care Services Program, for people not enrolled in a plan). There is no plan appeal. You request a state fair hearing directly from the Office of Temporary and Disability Assistance (OTDA), and the district's "Notice of Intent" tells you how.

If you are not sure which track you are on, the letterhead on the notice tells you: a plan name means Track A, HRA or a county department of social services means Track B.

A different letter, an Intent to Disenroll letter from a plan or an Involuntary Disenrollment Confirmation Notice from New York Medicaid Choice, is about leaving the plan rather than a cut in hours. That process, and where its fair hearing right sits, is covered in MLTC Policy 26.01: involuntary disenrollment in New York.

The Department of Health's guidance for plans lays out the sequence:

1. File a plan appeal within 10 days. The plan must continue your services "immediately upon receipt of a Plan Appeal disputing the termination, suspension or reduction of a previously authorized service, filed verbally or in writing within 10 days of the date of the notice of adverse benefit determination, or the effective date of the action, whichever is later." The same rule applies when a plan reduces hours for a new authorization period of long term services and supports. You can file by phone; write down the date, time, and who you spoke to.
2. Wait for the plan's decision, called a Final Adverse Determination if the plan upholds the cut. If the plan misses its own deadlines or sends a defective notice, the Department says you may be "deemed to have exhausted" the plan appeal and go straight to a fair hearing.
3. Request a state fair hearing. You have at least 120 days from the plan's Final Adverse Determination to request one. But to keep aid continuing running, request the hearing within 10 days of that Final Adverse Determination; the Department says aid continuing ends if "the enrollee fails to request a fair hearing within 10 days of the plan's written adverse appeal resolution notice."
4. The hearing. OTDA's Office of Administrative Hearings schedules it. If you win, the Department says the plan must provide the disputed services no later than 72 hours after it receives the decision.

The Department of Health's August 2025 instruction to local districts on CDPAP aid to continue states the rule for district cases: "Generally, individuals have sixty (60) days from the date of the Notice of Intent to reduce or discontinue services to request a Fair Hearing." And, citing 18 NYCRR 358-3.6, individuals "have the right to continue their previously authorized services without interruption until a Fair Hearing decision is issued, as long as the individual requests a Fair Hearing prior to the effective date of a proposed action as contained in the notice of action or within 10 days of the mailing of the agency's notice of the action, whichever is later."

The same instruction says the statewide fiscal intermediary, PPL, "will accept and recognize the validity" of an aid-to-continue authorization from the district and will extend the authorization in its system. In other words, once aid continuing is granted, your personal assistant keeps being paid at the old hours through the intermediary.

The Department of Health's model notices (form DOH-5234, revised November 2024, and the MLTC Notice of Decision) print these channels, which come from OTDA:

• Phone: the statewide toll-free number 1-800-342-3334. Have the notice with you.
• Fax: (518) 473-6735, with a copy of the notice.
• Online: the fair hearing request form on otda.ny.gov.
• Mail: NYS Office of Temporary and Disability Assistance, Office of Administrative Hearings, P.O. Box 1930, Albany, New York 12201-1930 (as listed on the Department of Health's how-to-apply page).
• In person: OTDA lists walk-in locations in New York City and Albany on its site and on the notice.

Confirm all of these on otda.ny.gov/hearings before relying on them; this site could not load that page on September 28, 2026, so these channels come from the Department of Health's printed notices and its how-to-apply page.

When you request the hearing, say clearly that you want aid continuing. The Department of Health's notice form has a section for it. OTDA decides whether you get it; the plan or district then follows OTDA's direction.

Two honest cautions.

First, the Department's August 2025 instruction notes that under a federal waiver extended "through December 31, 2025," people who requested a hearing on time were granted Medicaid aid continuing automatically, even if they asked late for it, and that aid continuing granted before that date "is not subject to recoupment." Whether that waiver was extended past 2025 is something to confirm on health.ny.gov or with ICAN before assuming it still applies. Do not rely on it; file within 10 days.

Second, the Department's guidance for plans says that if the final decision upholds the cut, "the enrollee may be held liable for services" received under aid continuing. Outside any waiver, that is the trade-off: your hours continue, and if you lose, Medicaid may seek repayment for the difference. ICAN and legal services organizations can help you weigh that. This site does not name any law firm.

• The notice, both sides, and the envelope with the postmark.
• The prior authorization showing the old number of hours.
• Recent medical records, a doctor's letter about the person's needs, and notes on what has changed, if anything.
• A log of falls, hospital visits, or tasks the person cannot do alone.
• The names of everyone you spoke to at the plan, with dates.

Once the hearing is requested, the fair hearing prep checklist covers the evidence packet, what the plan or district has to show, witnesses, and hearing day.