When Medicaid home care hours are cut in New York

The one thing to do today

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 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.

First, read the notice

The letterhead tells you which track you are on. A plan name means the plan authorized the hours and hears the first appeal. HRA or a county department of social services means the local district authorized them and you go straight to a state fair hearing. Look for the notice date, the effective date, the reason given, and the section on how to appeal and how to ask for aid continuing. Keep the envelope with the postmark.

One letter that is not a reduction notice: a plan contacting you because a single personal assistant is working very long weeks. That is a review of the consumer’s duty to hire enough assistants, not a cut by itself, and it is explained in the excessive-hours review. Any actual change in hours still has to come with a notice and appeal rights.

Another letter that is not a reduction notice: an Intent to Disenroll letter from your plan, or an Involuntary Disenrollment Confirmation Notice from New York Medicaid Choice. Those are about whether you stay in the plan at all, under MLTC Policy 26.01, and the fair hearing right attaches to the notice from New York Medicaid Choice. That process is explained in MLTC Policy 26.01: involuntary disenrollment in New York.

Track A: you are in a Managed Long Term Care or other Medicaid managed care plan

1. File a plan appeal within 10 days. The Department’s guidance says 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.” You can file by phone; write down the date, time, and who you spoke to. Since April 2018, enrollees generally must exhaust the plan’s internal appeal before requesting a state fair hearing.
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. To keep aid continuing running, request the hearing within 10 days of that decision; 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.

Track B: your hours are authorized by the local district

For people not enrolled in a plan (in New York City, HRA’s Home Care Services Program), there is no plan appeal. The Department’s August 2025 instruction to local districts states the rule: “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 it in its system. Once aid continuing is granted, the personal assistant keeps being paid at the old hours through the intermediary. PPL does not decide appeals; what it does and does not handle is laid out in the fiscal intermediary explained.

How to request a fair hearing

The Department of Health’s model notices (form DOH-5234, revised November 2024, and the MLTC Notice of Decision) print OTDA’s request channels: a statewide toll-free phone line (1-800-342-3334), a fax number ((518) 473-6735), the online request form on otda.ny.gov, mail to the Fair Hearing Section, New York State Office of Temporary and Disability Assistance, P.O. Box 1930, Albany, New York 12201, and walk-in locations in New York City and Albany. Re-confirm all of these on otda.ny.gov before relying on them; this site could not load that page directly on the date below and is citing the Department of Health’s printed notices. When you request the hearing, say clearly that you want aid continuing. OTDA decides whether you get it; the plan or district then follows OTDA’s direction.

Official page: otda.ny.gov/hearings.

What aid continuing does, and the risk

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 (under section 1902(e)(14)) 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.

Where ICAN fits

ICAN, the Independent Consumer Advocacy Network, is New York’s ombudsprogram for people with Medicaid who need long term care. It is free, statewide, and focused on exactly this: plan problems, appeals, and fair hearings. Call 1-844-614-8800 (TTY 711) with the notice in front of you. New York Medicaid Choice (1-800-505-5678) answers plan enrollment questions, not appeals.

What to gather

• 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 weeks before it matter. The fair hearing prep checklist covers the evidence packet, what the plan or district has to show, witnesses, and hearing day.

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