New York Medicaid pays for in-home personal care and related services through 3 programs, including the Nursing Home Transition and Diversion (NHTD) Waiver and the Traumatic Brain Injury (TBI) Waiver. New York's CDPAP can be used in combination with the NHTD or TBI waiver — Local Departments of Social Services must assess and provide PCSP or CDPAP services to Medicaid recipients transitioning from nursing homes through these waivers. Individuals eligible for NHTD or TBI continue to combine waiver and state plan services.
Which New York waivers can a home care agency bill?
Each waiver below lists who it covers, the services it pays for, and how providers bill.
Nursing Home Transition and Diversion (NHTD) Waiver
Population
Medicaid-eligible seniors and people with physical disabilities who would otherwise require nursing home placement
Services covered
service coordination
personal care services
consumer-directed personal assistance (CDPAP)
home and community support services
assistive technology
environmental modifications
Billing format
Fee-for-service; EVV via provider's chosen EVV system (NY Choice Model); aggregated via eMedNY
To bill Medicaid for home care you need a state license, a Type 2 NPI, state Medicaid enrollment and screening, waiver or managed care contracts, EVV and authorizations.
Private pay means higher rates and fast payment; Medicaid means steady volume at state-set rates with authorizations and EVV. Compare rates, cash timing and admin before you mix them.
Track units remaining, the end date and the service code for every client, and check them before each schedule change. Hours over the cap are unbillable.
Four units equal one hour. How to convert units to hours, the common HCPCS codes, how states round partial units, and how to stay inside the authorization.
These free tools are made by the team behind Caregiver Scheduling,
caregiver scheduling software for home care agencies.
Simple pricing
From$199/month
Up to 10 caregivers on Starter, 50 on Growth.
More than 50 caregivers? We'll put together a custom Scale plan for your agency.
