Protecting New Yorkers’ Ability to Age at Home
New York is undergoing a historic demographic shift. Today, one in five New Yorkers is age 65 or older—the highest share in our state’s history—and the number of residents over 65 now exceeds those under 18. This milestone reflects a positive reality: people are living longer, healthier lives and want to remain active in their communities.
But it also presents both a challenge and an opportunity. As our population ages, New York must strengthen the systems that allow older adults to remain independent while supporting their families and caregivers.
For most New Yorkers, independence means aging at home rather than in an institution. Achieving that goal requires thoughtful policies and sustained investment in the home care workforce and infrastructure that make aging in place possible.
The New York State Association of Health Care Providers (HCP) represents licensed home care services agencies (LHCSAs) across the state. These agencies provide regulated personal care and home health services to hundreds of thousands of older adults and people with disabilities under Article 36 of the Public Health Law. Their services include assistance with daily activities such as bathing, dressing, meal preparation, mobility, medication reminders, and household tasks—helping individuals remain safe, independent, and connected to their communities.
Licensed home care service agencies deliver the majority of Medicaid-funded personal care services in New York, making them a central pillar of the state’s long-term care system.
For decades, New York has made the smart policy choice to prioritize home care as a cost-effective alternative to institutional care. As a result, the state has built one of the largest home care workforces in the country. Home health and personal care aides now represent the single largest occupational category in New York State.
This workforce is diverse and dedicated, made up of home health aides, personal care aides, licensed practical nurses, and registered nurses. Immigrants make up a significant portion of this workforce, particularly in the metropolitan region. Article 36 imposes strict regulatory standards, including comprehensive training, nurse supervision, background checks, Electronic Visit Verification (EVV), and detailed documentation requirements. These safeguards help ensure that high-quality, accountable care is delivered safely in private homes.
Home care not only preserves dignity and independence for recipients—it also relieves pressure on families and the broader health care system. It is significantly more cost-effective than institutional care. In New York, the annual cost of nursing home care can exceed $150,000 per resident, while home care services typically cost a fraction of that amount depending on the level of care required. By preventing unnecessary emergency room visits, hospitalizations, and nursing home placements, home care saves taxpayers far more than it costs.
New York’s home care system is a policy success story. Demand continues to grow as people live longer, and policymakers rightly emphasize community-based care.
Yet serious challenges threaten this progress.
Managed Long Term Care (MLTC) plans often reimburse providers at rates that fail to cover mandated wage increases and rising operating costs. At the same time, staffing shortages and high turnover make it increasingly difficult to recruit and retain workers. The result can be delayed care, reduced hours for patients, and burnout among caregivers—placing tremendous strain on agencies trying to meet growing demand.
If these pressures continue unchecked, we risk pushing vulnerable patients toward a dangerous alternative: an expanding “gray market” of unregulated, cash-based care that lacks the oversight and safeguards patients deserve.
Recent federal scrutiny has added another layer of concern. In a March 3, 2026 letter, the Centers for Medicare & Medicaid Services (CMS) raised concerns about potential fraud in New York’s Medicaid personal care and home health programs. Fraud must be addressed wherever it exists. But broad accusations risk unfairly casting suspicion on an entire sector that serves hundreds of thousands of New Yorkers responsibly every day.
Much of the growth in home care services reflects legitimate demand driven by our aging population and New York’s long-standing commitment to community-based care.
This moment should be about strengthening oversight while ensuring the stability of a system that millions depend on—not undermining it through sweeping assumptions.
Federal and state policymakers must distinguish between genuine wrongdoing and the necessary expansion of services to meet the needs of a rapidly aging population. That means improving oversight, supporting the workforce, and ensuring fair reimbursement so providers can continue delivering high-quality care.
New Yorkers deserve the opportunity to age with dignity, independence, and trusted support in their own homes.
With thoughtful policy and sustained commitment, we can preserve home care as one of New York’s greatest health care achievements.
But we must act now.
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