Long Term Home Health Care Program in New York: Lombardi and MLTC

New York’s Long Term Home Health Care Program, the Medicaid waiver known as the Lombardi program or “Nursing Homes Without Walls,” no longer exists. It closed on May 27, 2016, after a multi-year transition that moved its participants into Managed Long Term Care plans.¹ If you or a family member needs the kind of care the LTHHCP once provided, nursing-home-level services delivered at home under Medicaid, MLTC is now the main way to get it.

What the Lombardi Program Was

Created in 1977 under Article 36 of the New York Public Health Law and championed by State Senator Tarky Lombardi Jr., the LTHHCP operated under a federal 1915(c) Medicaid home and community-based services waiver. It allowed New York to spend Medicaid dollars on home care for people who would otherwise have qualified for a nursing home, on the condition that the monthly cost of the home care plan did not exceed the local nursing home rate.²³

Participants received nursing, therapies, home health aide and personal care aide services, and case management by a registered nurse, along with waiver-only services such as respite care, home and vehicle modifications, home-delivered meals, personal emergency response systems, and social day care. A physician had to authorize the plan, and local social services districts approved it.⁴

Why the Program Ended

The closure was part of a statewide Medicaid redesign. The 2011–12 Enacted Budget amended Article 29-AA of the Public Health Law to require long-term care recipients to enroll in managed care, and on August 31, 2012, the federal Centers for Medicare and Medicaid Services approved New York’s plan to move community-based long-term care into MLTC.⁵⁶

Mandatory MLTC enrollment for dually eligible LTHHCP participants in New York City, Nassau, Suffolk, and Westchester counties began April 1, 2013. Referrals of new non-dual applicants stopped on May 15, 2013, and the program’s “front door” effectively closed on June 1, 2013.⁵⁷ Existing participants were given 60 days to pick an MLTC plan or be auto-assigned, and their existing care plans had to be honored for at least 90 days or until the new plan finished its own assessment, whichever came later.⁸ The waiver remained open briefly for participants who could not be placed, then closed for good on May 27, 2016.¹

Managed Long Term Care: The Successor Program

MLTC serves the same population the LTHHCP once did: adults who are chronically ill or disabled, need long-term services and supports, and want to remain at home. MLTC plans coordinate and pay for nursing, home health aide services, personal care, therapies, adult day health care, and the Consumer Directed Personal Assistance Program.⁹

Enrollment is mandatory for dually eligible adults (both Medicare and Medicaid) aged 21 and older who need community-based long-term care for more than 120 days, unless they qualify for an exemption or exclusion.¹⁰ Three forms are available:

Partial capitation, the standard MLTC plan, covers Medicaid long-term care services. Members keep their regular Medicare and Medicaid cards for doctor visits and hospital care.
Medicaid Advantage Plus (MAP) covers both Medicare and Medicaid services under one plan for adults 18 and older.
Program of All-Inclusive Care for the Elderly (PACE) is a fully integrated model for people 55 and older who meet nursing home level of care criteria.

Members do not lose their underlying Medicaid or Medicare benefits, but they generally use the plan’s provider network and follow a care plan developed with the plan.⁶

The Assessment Process

New applicants who are not already receiving home care must go through the New York Independent Assessor Program, run by Maximus under contract with the Department of Health. Call the NYIAP helpline at 855-222-8350 to schedule two appointments: a Community Health Assessment by a registered nurse using the Uniform Assessment System for New York, and a separate clinical exam by an independent practitioner with no prior relationship to you. Both must happen within 14 days of the initial call. The nurse visit typically takes two to three hours; the clinical exam takes up to an hour. In-person and telehealth options are available.¹¹¹²¹³

A physician order is required before the assessment, and the completed assessment and order are valid for 12 months. If a proposed care plan exceeds an average of 12 hours of services per day, an Independent Review Panel evaluates whether that level of care is safe and appropriate at home.¹¹

New Minimum Needs Rules

Since September 1, 2025, anyone newly seeking personal care services, CDPAP, or MLTC enrollment must be assessed as needing at least limited assistance with physical maneuvering for more than two activities of daily living. For applicants with a physician-confirmed diagnosis of dementia or Alzheimer’s disease, the threshold is at least supervision with more than one activity of daily living.¹⁴ The rule does not apply to PACE enrollees or to people who were already receiving services or continuously enrolled in an MLTC plan on September 1, 2025.¹⁵

Financial Eligibility

You must have Medicaid. For the aged, blind, and disabled population that typically uses long-term care, 2026 income limits are $1,836 per month for a household of one and $2,489 for a household of two (138% of the federal poverty level). Resource limits are $33,038 for one person and $44,796 for two.¹⁶ People with higher incomes can still qualify through a spend-down, and applicants may own a home, a car, and personal property.¹⁷ A 60-month lookback on financial transactions applies to those applying for nursing facility services.¹⁸

How to Apply

Get Medicaid first. In New York City, apply through the Human Resources Administration; elsewhere, apply through your local Department of Social Services. The standard application is the Access NY Health Insurance Application (DOH-4220) with Supplement A (DOH-5178A). You will need proof of identity, citizenship or immigration status, residence, income, resources, and Medicare status if it applies.¹⁸

If your need is urgent, an expedited track exists. File the Medicaid application together with a physician’s order and an Attestation of Immediate Need (DOH-5786). The agency must then request any missing information within 4 days, decide Medicaid eligibility within 7 days, and decide home care eligibility within 12 days.¹⁸

Once Medicaid is active, call NYIAP at 855-222-8350 to schedule the two assessments. If you are found eligible, choose an MLTC plan and the plan will build your care plan. Enrollment paperwork submitted to NY Medicaid Choice by the 18th of the month takes effect on the first of the following month.¹²

Other Home Care Options Worth Knowing

MLTC is the main path, but a few adjacent programs may fit certain situations:

The Consumer Directed Personal Assistance Program lets Medicaid recipients hire, train, and supervise their own aides, including family members in many cases. As of 2025 the program consolidated from roughly 600 fiscal intermediaries to a single statewide entity, Public Partnerships LLC.¹⁹
Certified Home Health Agency services provide short-term skilled nursing, therapy, and aide services for acute or unstable conditions, paid by Medicare, Medicaid, or private insurance. This is a different tool than long-term MLTC coverage.²⁰
The Nursing Home Transition and Diversion (NHTD) waiver serves seniors and adults with physical disabilities who need nursing home level of care but can live safely in the community. As of early 2026 it has hit its approved cap of 9,400 participants and is not taking new referrals.²¹
The Traumatic Brain Injury (TBI) waiver serves people with traumatic brain injuries. Enrollment in either the TBI or NHTD waiver exempts you from mandatory MLTC enrollment.²²

Your Rights If Care Is Denied or Cut

Home care recipients have real procedural protections. In managed care, the first step after a denial, reduction, or termination notice is a plan appeal, which must be filed within 60 days. If the plan denies the appeal, you can request a fair hearing before the Office of Temporary and Disability Assistance within 120 days. To keep your services running unchanged while you fight, file both the plan appeal and the fair hearing request within 10 days of the notice.²³

A separate protection comes from Varshavsky v. Perales, a 1992 class action order affirmed on appeal in 1994. Recipients with mental or physical disabilities who cannot travel to a hearing are entitled to a hearing at home. If a fully favorable decision on a request for increased home care hours is not issued within 45 days of the hearing request, the state must order the MLTC plan or local district to provide the additional hours on an interim basis until the home hearing is held and decided.²⁴ To use these protections, identify yourself as homebound on the hearing request form and submit medical documentation showing you cannot travel to a hearing by any means.

One more detail matters if you were enrolled before September 1, 2025. Being involuntarily disenrolled from MLTC for more than 30 days causes a loss of “Plan Legacy Status,” which means re-enrollment would require meeting the new minimum needs standards rather than the earlier ones. Service Legacy Status, for those who received personal care or CDPAP before that date, is preserved regardless of any gap in enrollment.²⁵

1
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2
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3
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4
New York State Department of Health. LTHHCP and AHCP Booklet
5
New York State Department of Health. Medicaid Update – LTHHCP Transition
6
New York State Department of Health. About MLTC
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LeadingAge New York. More Details on the Transition of the LTHHCP to MLTC
8
New York State Department of Health. MLTC Policy 13.13
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11
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Legal Services NYC. How Do I Enroll in a Managed Long Term Care Plan
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New York State Department of Health. Personal Care Services
15
LeadingAge New York. State Initiates Implementation of Revised Minimum Needs Requirement
16
NY Health Access. Medicaid Financial Eligibility
17
NYC Mayor’s Office. Medicaid Income Eligibility Chart
18
New York State Department of Health. How Do I Apply for Medicaid
19
New York Daily News. N.Y. CDPAP Change Has Been a Big Success
20
NY Health Access. Certified Home Health Agency Services
21
New York State Department of Health. NHTD Medicaid Waiver Program
22
NY Health Access. 1915(c) HCBS Waiver Programs
23
Legal Aid Society of NYC. What You Need to Know About Medicaid and Fair Hearings
24
NY Health Access. Varshavsky Fair Hearing Rights
25
NY Health Access. Involuntary Disenrollment From MLTC