Home Care Agency Insurance in New York

Grandbay Financial Services places home care agency insurance for New York businesses from its New York office at 1140 Avenue of the Americas. This page covers the LHCSA licensing framework, the absence of a published state liability minimum, the contract-driven requirements that fill that gap, and the workers compensation, wage parity, and background check obligations that shape coverage and cost for New York home care operators.

What New York requires

A Licensed Home Care Services Agency requires a license under Public Health Law Section 3605 and 10 NYCRR Part 765, approved by the Public Health and Health Planning Council on public need and character and competence. The application fee is $2,000, per the DOH LHCSA application form.

Public need is a real barrier. Under 10 NYCRR 765-1.16, where five or more LHCSAs are actively serving patients in a county, there is a presumption that no more are needed. Since August 2025, under DAL DHCBS 25-03, the Department approves adding a county only where fewer than five LHCSAs are actively serving there. Operators seeking to expand into new counties must confirm current availability before applying.

Annual LHCSA registration is required under Public Health Law Section 3605-b. The late fee is $500 per month, and two missed registrations lead to revocation proceedings.

New York publishes no statutory or regulatory liability insurance minimum for home care agencies. Public Health Law 3605, 10 NYCRR Parts 765 and 766, and the DOH application were checked and no minimum appears. Limits come from MLTC plan contracts, local social services district agreements, and hospital and facility contracts. Each contracting entity may specify different limits and endorsement requirements.

Background checks are required on two tracks. Under 10 NYCRR Part 402, a fingerprint Criminal History Record Check is required before a direct-care hire, with supervised provisional employment permitted while results are pending. Under Public Health Law Section 3613 and 10 NYCRR Part 403, a Home Care Registry check must be completed before the first shift, and the aide must be entered in the registry within 10 business days of hire.

Training requirements under 10 NYCRR 766.11 are: home health aides, 75 hours (59 classroom and 16 supervised practical); personal care aides, 40 hours; annual in-service of 12 hours for HHAs, 6 hours for PCAs, and 18 hours for advanced HHAs.

MLTC plans may contract with a limited number of LHCSAs: 1 per 100 enrollees downstate and 1 per 60 in the rest of the state, per the DOH MLTC LHCSA contract guidance. Operators dependent on MLTC revenue should understand that this cap limits their ability to add MLTC contracts as they grow.

Coverage a New York home care agency program needs

A complete New York home care agency insurance program typically includes the following lines. Coverage depends on the policy wording and endorsements, and the specific limits required by each contract must be confirmed with the contracting entity.

Workers compensation, disability benefits, and Paid Family Leave. Required of virtually all New York employers under Workers' Compensation Law Sections 2 and 3. Workers compensation is typically the largest single line for home care agencies because direct care work carries high injury rates. The 24-hour live-in shift rule under the Court of Appeals decision in Andryeyeva v. New York Health Care and 12 NYCRR 142-2.1(b) affects payroll calculation, which in turn affects workers compensation premium.
Professional liability. Covers claims arising from the professional services provided by aides and clinicians, including errors in care delivery and supervision. Whether professional liability is required by your MLTC or facility contracts must be confirmed with each contracting entity. Coverage depends on the policy wording and endorsements.
Commercial general liability. Covers premises and operations exposures. MLTC plans and facility contracts typically require general liability with specific limits and additional insured endorsements. The required limits and endorsement forms must be confirmed with each contracting entity.
Hired and non-owned auto. There is no DOH rule on aides driving clients; it is an insurance question, not a licensing one. A hired and non-owned auto endorsement on the agency's commercial auto policy typically addresses the gap when aides use personal vehicles to transport clients. Coverage depends on the policy wording and endorsements.
Employment practices liability. Wage parity violations and misclassification claims are a significant exposure for New York home care agencies. The New York Attorney General's December 2025 enforcement action resulted in a $45 million wage settlement and $10 million to Medicaid over wage parity violations at a home care agency. Employment practices liability coverage depends on the policy wording and endorsements and typically does not cover wage and hour claims without a specific endorsement.
Umbrella or excess liability. Provides limits above the primary professional liability, general liability, and auto policies. The appropriate umbrella limit depends on census, contract requirements, and the agency's risk profile.

What underwriters ask New York home care agency operators

Background check compliance. Underwriters ask whether all direct-care hires have cleared the fingerprint Criminal History Record Check under 10 NYCRR Part 402 and the Home Care Registry check under 10 NYCRR Part 403 before the first shift. Gaps in background check compliance are a significant underwriting concern for professional liability and abuse and molestation coverage.
Training records. Under 10 NYCRR 766.11, HHAs must complete 75 hours of initial training and 12 hours of annual in-service. Underwriters ask for evidence that training records are current for all aides.
Aide classification. Underwriters ask whether aides are classified as employees or independent contractors. Given the DOL guidance on supervision, direction, and control, and the LHCSA supervision requirement under 10 NYCRR Part 766, misclassification is both a regulatory and a coverage risk. Workers compensation underwriters in particular scrutinize classification.
Wage parity compliance. The home care aide minimum wage under Public Health Law 3614-f is $19.65 per hour in New York City, Long Island, and Westchester, and $18.65 elsewhere, effective January 1, 2026. Wage parity under Public Health Law 3614-c on Medicaid work adds a benefit portion of $2.54 per hour in New York City and $1.67 in Nassau, Suffolk, and Westchester, with an annual LS300 compliance statement and LS301 audited statement, and records kept for 10 years. Underwriters ask whether the agency is current on wage parity filings and whether the LS300 and LS301 statements are up to date.
MLTC contract status. Underwriters ask whether the agency is currently in good standing with its MLTC plans and whether there have been any contract terminations, corrective action plans, or licensing actions in the prior three years.
24-hour shift practices. Underwriters ask how the agency handles 24-hour live-in shifts and whether it has documented procedures for tracking sleep and meal break conditions under the Andryeyeva rule. Agencies that pay for 13 hours without documenting the required conditions face both wage liability and workers compensation exposure.

New York laws that shape claims and costs

Public Health Law Section 3605 and 10 NYCRR Parts 765 and 766. The LHCSA licensing framework requires supervision of aides, which is itself direction and control under the DOL independent contractor test. Agencies that attempt to use 1099 aides to avoid workers compensation and wage parity obligations face regulatory and coverage risk.

Court of Appeals, Andryeyeva v. New York Health Care (March 26, 2019) and 12 NYCRR 142-2.1(b). An aide on a 24-hour live-in shift may be paid for 13 hours only if the aide receives 8 hours of sleep (5 of them uninterrupted) and 3 hours of meal breaks. If those conditions are not met, all 24 hours are payable. This rule affects workers compensation premium calculation because premium is based on payroll, and it affects wage parity compliance because the benefit portion applies to all compensable hours.

Public Health Law Section 3614-f (home care aide minimum wage) and Section 3614-c (wage parity). Effective January 1, 2026, the minimum wage for home care aides is $19.65 per hour in New York City, Long Island, and Westchester, and $18.65 elsewhere. Wage parity on Medicaid work adds a benefit portion of $2.54 per hour in New York City and $1.67 in Nassau, Suffolk, and Westchester. Annual LS300 and LS301 filings are required, and records must be kept for 10 years. The December 2025 Attorney General enforcement action, which resulted in a $45 million wage settlement and $10 million to Medicaid, illustrates the scale of exposure for agencies that fall out of compliance.

Workers' Compensation Law Sections 2 and 3. Workers compensation, disability benefits, and Paid Family Leave are required of virtually all New York employers. For home care agencies, workers compensation is typically the largest single insurance line because direct care work carries high injury rates.

Requirements at a glance

Requirement	Who sets it	Where it is written
LHCSA license; application fee $2,000; PHHPC approval on public need and character and competence	NYS Department of Health	Public Health Law Section 3605; 10 NYCRR Part 765
Annual registration; late fee $500/month; two missed registrations lead to revocation	NYS Department of Health	Public Health Law Section 3605-b
No published liability insurance minimum in licensing rules	N/A	PHL 3605; 10 NYCRR Parts 765 and 766 (checked; no minimum found)
Fingerprint Criminal History Record Check before direct-care hire; supervised provisional employment permitted pending results	NYS Department of Health	10 NYCRR Part 402
Home Care Registry check before first shift; registry entry within 10 business days	NYS Department of Health	Public Health Law Section 3613; 10 NYCRR Part 403
HHA training: 75 hours initial (59 classroom, 16 practical); 12 hours annual in-service. PCA: 40 hours initial; 6 hours annual. Advanced HHA: 18 hours annual.	NYS Department of Health	10 NYCRR 766.11
Home care aide minimum wage: $19.65/hour (NYC, Long Island, Westchester); $18.65 elsewhere (effective January 1, 2026)	NYS Legislature	Public Health Law Section 3614-f
Wage parity benefit portion: $2.54/hour (NYC); $1.67/hour (Nassau, Suffolk, Westchester) on Medicaid work; annual LS300 and LS301 filings; records 10 years	NYS Legislature / NYS DOL	Public Health Law Section 3614-c
Workers compensation, disability benefits, and Paid Family Leave	NYS Workers' Compensation Board	Workers' Compensation Law Sections 2 and 3
24-hour live-in shift: pay for 13 hours only if aide receives 8 hours sleep (5 uninterrupted) and 3 hours meal breaks; otherwise all 24 hours payable	NYS Court of Appeals / NYS DOL	Andryeyeva v. New York Health Care (2019); 12 NYCRR 142-2.1(b)

What changed in 2024 to 2026

CDPAP moved to a single statewide fiscal intermediary (April 1, 2025). The Consumer Directed Personal Assistance Program moved to Public Partnerships LLC as the single statewide fiscal intermediary on April 1, 2025, per the NYS Department of Health. Agencies that previously served as fiscal intermediaries for CDPAP lost that revenue stream, and the transition affected the financial profile of many home care operators.
DAL DHCBS 25-03: county expansion restricted (August 2025). Since August 2025, under DAL DHCBS 25-03, the Department approves adding a county only where fewer than five LHCSAs are actively serving there. This tightened the public need standard and makes county expansion harder for existing operators.
Home care aide minimum wage increase (January 1, 2026). Under Public Health Law Section 3614-f, the minimum wage for home care aides increased to $19.65 per hour in New York City, Long Island, and Westchester, and $18.65 elsewhere, effective January 1, 2026. This increase affects payroll, workers compensation premium, and wage parity calculations.
Attorney General wage enforcement action (December 2025). The New York Attorney General announced on December 18, 2025 that a home care agency agreed to pay $45 million in unpaid wages and $10 million to Medicaid over wage parity violations. This enforcement action signals continued scrutiny of wage parity compliance across the industry.

Frequently asked questions

What insurance does a LHCSA need in New York?▼

New York publishes no statutory or regulatory liability insurance minimum for LHCSAs under Public Health Law 3605, 10 NYCRR 765, or 766. The practical limits come from MLTC plan contracts, local social services district agreements, and hospital and facility contracts. Workers compensation, disability benefits, and Paid Family Leave are required of virtually all employers under Workers' Compensation Law Sections 2 and 3. Professional liability and general liability are typically required by contracting entities, but the specific limits must be confirmed with each contracting party.

Does New York require a minimum liability limit for home care agencies?▼

No. Public Health Law 3605, 10 NYCRR Parts 765 and 766, and the DOH LHCSA application do not state a liability insurance minimum. Limits are set by MLTC plans, local social services districts, hospitals, and other contracting entities. Because each contract may specify different limits and endorsement requirements, operators should review every active contract before placing or renewing coverage.

Can I pay my aides as 1099 contractors in New York?▼

It is difficult to do so lawfully. Under NYS Department of Labor guidance, independent contractor status turns on freedom from supervision, direction, and control. A licensed LHCSA must supervise its aides under 10 NYCRR Part 766, which is itself direction and control. Agencies that misclassify aides as independent contractors face workers compensation exposure, wage parity liability, and regulatory risk. The New York Attorney General's December 2025 enforcement action, which resulted in a $45 million wage settlement and $10 million to Medicaid, arose from wage parity violations at a home care agency.

How are 24-hour live-in shifts paid in New York?▼

Under the New York Court of Appeals decision in Andryeyeva v. New York Health Care (March 26, 2019) and 12 NYCRR 142-2.1(b), an aide on a 24-hour live-in shift may be paid for 13 hours only if the aide receives 8 hours of sleep (5 of them uninterrupted) and 3 hours of meal breaks. If those conditions are not met, all 24 hours are payable. This affects workers compensation premium calculation and wage parity compliance.

What background checks must a New York home care agency run?▼

Under 10 NYCRR Part 402, a fingerprint Criminal History Record Check is required before a direct-care hire, with supervised provisional employment permitted while results are pending. Under Public Health Law 3613 and 10 NYCRR Part 403, a Home Care Registry check must be completed before the first shift, and the aide must be entered in the registry within 10 business days of hire. Both checks are required; neither substitutes for the other.

Sources

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