If you or a loved one rely on CDPAP services in New York, receiving a denial or reduction notice can feel overwhelming. The good news? You have the right to appeal—and many New Yorkers successfully do.

Understanding how the Medicaid appeals process works in New York can help you act quickly, protect your care, and improve your chances of approval.

What Does a Medicaid Denial or Reduction Mean?

A denial or reduction (also called an “adverse determination”) happens when Medicaid or your Managed Long-Term Care (MLTC) plan decides to:

• Deny your CDPAP eligibility
• Reduce your approved care hours
• Terminate your existing services

In New York, these decisions are typically based on assessments conducted through your MLTC plan or local Medicaid office—but they don’t always reflect your true daily care needs.

If you’re unsure how CDPAP eligibility works, start here

Your Right to Appeal in New York (And Why It Matters)

If you receive a denial or reduction, you have the legal right to challenge it through New York’s Medicaid appeals process.

In New York:

• You can request a Fair Hearing through the New York State Office of Temporary and Disability Assistance (OTDA)
• Most cases require an internal appeal first through your MLTC plan
• You can have a family member, caregiver, or representative assist you

Many CDPAP appeals in New York are successful—especially when supported by strong medical documentation.

Key Deadlines for Medicaid Appeals in New York

Timing is critical. Missing a deadline can mean losing your right to appeal.

Internal Appeal (MLTC Plan)

• File within 10 days to keep your current services active (aid continuing)

Fair Hearing Request

• You typically have up to 120 days from the notice date to request a hearing in New York

Expedited Appeals

• If your health is at risk, you may qualify for a faster decision—sometimes within 72 hours

Can You Keep Your CDPAP Services During an Appeal?

Yes—this is called “aid continuing” in New York.

If you request your appeal quickly (usually within 10 days of your notice):

• Your current CDPAP hours can continue during the appeal process
• This helps prevent dangerous gaps in care

Step-by-Step: How to Appeal a CDPAP Decision in New York

Step 1: Review Your Notice Carefully

Your notice will explain:

• Why your services were denied or reduced
• Your appeal rights under New York Medicaid
• Exact deadlines to respond

Step 2: File an Internal Appeal with Your MLTC Plan

In New York, most CDPAP participants are enrolled in an MLTC plan, which means:

• You must first appeal directly with your plan
• Appeals can be submitted by phone or in writing
• You can authorize someone to act on your behalf

Step 3: Request a Fair Hearing

If your internal appeal is denied—or delayed—you can request a Fair Hearing through the New York State Office of Temporary and Disability Assistance.

You can:

• Request online
• Call 1-800-342-3334
• Submit by mail or fax

A Fair Hearing gives you the opportunity to present your case to an administrative law judge in New York.

Step 4: Gather Strong Documentation

This is one of the most important parts of your appeal.

Helpful documentation includes:

• Physician statements detailing your care needs
• Medical records and diagnoses
• A daily care schedule showing assistance required
• Caregiver or family statements

The goal is to clearly show that your requested CDPAP hours are medically necessary.

Step 5: Prepare for Your Hearing

During your New York Fair Hearing:

• You explain why your care hours should not be reduced
• Your MLTC plan presents its reasoning
• A judge reviews the evidence and makes a decision

Decisions are typically issued within several weeks to a few months.

Expert Tips to Strengthen Your Appeal

Act Quickly

Deadlines in New York Medicaid appeals are strict—don’t delay.

Be Specific About Daily Needs

Break down tasks like bathing, dressing, mobility, and supervision.

Get Support

Working with a CDPAP provider or Medicaid expert can improve your chances.

Request a Reassessment

If your condition has changed, a new evaluation can support increased hours.

Common Reasons CDPAP Appeals Win in New York

Many appeals succeed because:

• Initial assessments underestimate care needs
• Medical documentation was incomplete
• Conditions worsened after evaluation
• MLTC plans made administrative or procedural errors

When to Get Help

If your care is essential—or your case feels complex—getting guidance can make a major difference.

Navigating New York’s Medicaid system can be confusing, but you don’t have to do it alone.

A denial or reduction in CDPAP services in New York is not the end of the road.

With the right strategy, documentation, and timing, you can successfully appeal and protect the care you need to live safely at home.

Need Help with CDPAP or Medicaid Appeals in New York?

Our team supports individuals and families across New York with:

• CDPAP eligibility and enrollment
• Medicaid application guidance
• Appeals and increasing care hours

Get the support you need—and take the next step with confidence.