Consumer Guide to Community-Based Long Term Care

What are long term care services?

Long term care services may include the medical, social, housekeeping, or rehabilitation services a person needs over months or years in order to improve or maintain function or health. Such services are provided not only in nursing homes, but also in patients' homes or in community-based settings such as assisted-living facilities.

New York State has many services and programs as alternatives to nursing home care. Both medical and non-medical care may be received at home or in residential settings, and can range from simple (light housekeeping) to complex (nursing care or physical therapy) services.

Who can receive which services?

You may be able to receive a service or participate in a program through your private health insurance, a managed care agency, Medicaid or Medicare - depending on whether you are financially and medically eligible and meet the criteria of the service or program you are interested in - or by paying for it yourself.

  • Some services are available to persons who are eligible for Medicaid, have Medicare coverage, use their own funds ("private pay"), or have private health or long term care insurance.
  • Some services are available only to persons who are eligible for Medicaid.

What is Medicare and what does it do?

Medicare is a federal health insurance program for:

  • people 65 years of age and older
  • some people under 65 who have disabilities
  • people with end-stage renal disease

Medicare helps pay for hospital care, skilled nursing facilities, hospice care, some home health care, doctors' services, outpatient hospital care, and some other medical services.

To find out whether you are eligible for Medicare, or whether the service you need is covered by Medicare, call 1-800-MEDICARE (1-800-633-4227), or 1-877-486-2048 or go to www.medicare.gov.

Visit the following sites for more information about Medicare:

What is Medicaid and what does it pay for?

Medicaid is a health insurance plan for New Yorkers who cannot afford medical care.

You may be eligible for Medicaid if you receive Supplemental Security Income (SSI) or meet certain income, resource, age, or disability requirements.

Medicaid can pay for a variety of medical services that can help you continue to live in your home, or for special services available to participants in waivers. Some of the covered services are: doctor and clinic services, prescription and non-prescription drugs, home care, personal care aides, adult day care, lab tests, transportation to medical care, physical, occupational and speech therapy, mental health services, x-rays, durable medical equipment such as wheelchairs, orthotic and prosthetic appliances.

You can make an appointment to apply for Medicaid at your county Department of Social Services.

For more information on Medicaid call:

The NYS Medicaid Helpline
1-800-541-2831 (Monday - Friday 8:00 am - 5:00 pm)

In New York City, residents of the 5 Boroughs may call the Human Resources Administration toll free
at 718-577-1399.

Other Payment Sources

If you will be using private insurance or a managed care organization, contact your insurance carrier.

Veterans may wish to contact the Veterans' Administration Health Benefits Service Center at 1-877-222-VETS or go to www.va.gov/elig/.

You can find other useful information on the website of the New York State Office for the Aging.

How to Find Services:

In this web page you will find broad descriptions of some long term care services and programs that may help you remain at home. The page contains general information on services certified, operated or overseen by the NYS Department of Health and points you toward other sources that offer services and information you may be interested in.

Please note that the information provided is general in nature and may not apply to your specific circumstances.

You may be medically and financially eligible for some of the services. In determining this, you may need to undergo an assessment and authorization process which may include orders from your health-care provider.

Generally, a person must meet several criteria in order to be eligible for a service or program. For example, the fact that you may need personal care or occupational therapy does not mean you qualify for all programs that provide those services.

The following links contain information on some services and programs. This is not a comprehensive list, since other services or programs may be available from other government agencies or from private organizations.

If you need help with meals or housekeeping:

If you need personal care (such as help with dressing, bathing or getting into bed):

If you need respite care:

If you need skilled nursing care at home:

If you need services for an elderly person:

If you need transportation:

If you need occupational therapy:

If you need physical therapy:

If you need case management or referral coordination:

If you need residential facilities:

If you've suffered a brain injury and want to receive services in the community:

If you've been diagnosed with HIV or AIDS and need help getting access to doctors and home health care, or paying for prescriptions:

If you're over age 65 and you need help paying for prescriptions:

If your child is between the ages of 5 and 17 and has a serious mental health disability:

For someone who has a developmental disability and wants to receive services at home:

If you need your home modified to be accessible:

Additional Links and Resources