NY State of Health is New York's official health-plan marketplace, and for Alzheimer's caregivers it is the entry point for Medicaid for most adults under 65. If the person with dementia is 65 or older, blind, disabled, or needs nursing-home or personal-care services, the family generally applies through the local social-services district instead.
NY State of Health accepts Medicaid applications year-round, including by phone at 855-355-5777. Marketplace approval alone does not grant home-care hours. Caregivers still need the correct financial decision, then a separate clinical assessment for long-term services.
Medical information disclaimer: This article is for general educational purposes only and does not provide medical advice, diagnosis, or treatment. Always consult a physician or other qualified health professional about symptoms, medications, tests, or treatment decisions.
Official resource:
- Request an Alzheimer's home-care assessment and diagnosis form — Official Independent Assessor page shows how to submit dementia diagnosis verification and schedule the eligibility assessment.
Table of Contents
- Which application door should you use?
- What income and asset rules apply?
- What long-term services can Medicaid cover?
- How does New York decide home-care hours?
- Can you hire a family member to provide care?
Which application door should you use?
Use NY State of Health when you seek income-based Medicaid for an adult under 65 without a disability-related care need. The marketplace also handles Child Health Plus applications. It keeps enrollment open through the year. Use the local social-services district when the applicant is 65 or older, blind, or disabled.
The NY Department of Health gives this direction in its how-to-apply guidance for Medicaid. The same local route applies when someone needs nursing-home care or personal-care services. Pick the right door first. A filing in the wrong place can delay financial approval and push back the home-care assessment.
What income and asset rules apply?
For 2026, income-based Medicaid covers adults under 65 with income up to 138% of the poverty level. That is about $22,025 per year for one person. No asset test applies in that category.
Aged, blind, and disabled community Medicaid uses different limits. The figure is about $1,836 per month in income plus a $33,038 asset limit. Check household size and current chart figures before you apply, because exact limits change with family size.
What long-term services can Medicaid cover?
Medicaid Managed Long Term Care, called MLTC, serves adults with chronic illness or disability who need ongoing help. According to the NY Department of Health in its overview of Managed Long Term Care, covered services include nursing, therapies, medical equipment, transportation, and adult day care. The goal is to support the person safely at home and delay nursing-home placement.
For an Alzheimer's family, that can mean scheduled nursing visits, physical or occupational therapy, personal-care help, and rides to medical or day programs. New MLTC enrollment generally requires a need for community-based long-term care for more than 120 days. Most adults must need limited help with more than two daily-living activities, such as bathing, dressing, eating, toileting, transferring, or walking. A diagnosis of dementia or Alzheimer's lowers the bar to needing supervision with more than one such activity.
How does New York decide home-care hours?
Financial approval does not set hours. Clinical eligibility for personal care, consumer-directed care, or MLTC comes from the state-contracted New York Independent Assessor. It uses a conflict-free Community Health Assessment.
Expect an in-person evaluation of memory, safety, mobility, and daily tasks. The assessor records how much supervision or hands-on help the person needs. That finding shapes the care plan and authorized hours.
- File the correct Medicaid financial application first.
- Request the independent assessment after financial eligibility is established.
- Keep a list of daily tasks, falls, wandering, medication problems, and nighttime needs.
- Ask for free counseling from NY Connects or the Alzheimer's Association 24/7 Helpline at 800-272-3900.
Can you hire a family member to provide care?
The Consumer Directed Personal Assistance Program lets an eligible Medicaid member hire a friend or family member as the aide. The worker can help with personal care, housekeeping tied to care, and health-related tasks under the care plan. A spouse cannot serve as the paid aide.
A designated representative and a parent of a consumer under 21 also cannot serve. These limits matter when families plan around work schedules. The Alzheimer's Association New York City Chapter notes in its care-consultation resource that caregivers should treat marketplace approval as step one, then pursue the independent assessment and counseling. Call the 24/7 Helpline at 800-272-3900 for help choosing the next step.
