Can I Change My Home Care Agency in Monroe County Without a Gap in Care?

OnNovember 7, 2026
InBlog

By the Priority Cares Home Services team · Updated October 28, 2026

Yes, you can change your home care agency in Monroe County, but it depends on your current plan and circumstances. Families can take steps like planning ahead and contacting New York Medicaid Choice to minimize any potential gaps in care.

Key fact: Under the federal Medicaid rule on free choice of providers, a beneficiary may obtain Medicaid services from any agency that is qualified to furnish them and willing to furnish them to that person, with exceptions that include the rules for Medicaid managed care plans. (Electronic Code of Federal Regulations, Medicaid free choice of providers rule)

What Are the Steps to Change Home Care Agencies in Monroe County?

To change home care agencies in Monroe County, start by understanding your current plan. If you are enrolled in a Managed Long-Term Care (MLTC) plan, you may need to follow specific rules, including a 90-day grace period and a nine-month lock-in period. If you are not in an MLTC plan, you can choose any qualified agency willing to serve you. Contacting New York Medicaid Choice can help determine if you have Good Cause to switch during a lock-in period. Monroe County’s Department of Human Services can also provide guidance on the process.

How Does the Good Cause Determination Work for Switching Agencies?

Good Cause determinations allow beneficiaries to switch MLTC plans during a lock-in period if specific conditions are met. These conditions include the current plan failing to provide appropriate care, moving out of the plan’s service area, or your current home care provider not having a contract with the plan. To request a Good Cause determination, contact New York Medicaid Choice. They will evaluate your situation and make a decision based on the information provided.

What Are the Potential Risks of Changing Home Care Agencies?

Changing home care agencies can come with risks, such as potential gaps in care. To mitigate these risks, plan ahead and communicate clearly with both the current and new agencies. Ensure that all necessary paperwork and approvals are in place before making the switch. Monroe County’s Department of Human Services and NY Connects can provide support and resources to help make the transition smoother and reduce the risk of interruptions in care.

How Can NY Connects Help Families in Monroe County with Home Care?

NY Connects, the Aging and Disability Resource Center for Monroe County, offers conflict-free, unbiased information and assistance for long-term services and supports. They can help families navigate the process of changing home care agencies, provide referrals to qualified agencies, and offer guidance on eligibility and services. NY Connects can be a valuable resource for families looking to make informed decisions about home care services in Rochester and Monroe County.

Frequently Asked Questions

Is there a grace period for switching MLTC plans?

Yes, for new enrollments since December 1, 2020, there is a 90-day grace period to switch MLTC plans. After that, you are locked in for nine months unless you can show Good Cause.

What services does Monroe County’s Department of Human Services offer?

Monroe County’s Department of Human Services oversees Medicaid home care programs, including Personal Care Assistance. They offer services like home health aide, personal care, emergency response systems, and housekeeping.

How can NY Medicaid Choice assist in switching agencies?

NY Medicaid Choice can help determine if you have Good Cause to switch MLTC plans during a lock-in period. They evaluate your situation and make a decision based on the information provided.

What happens if I need to change agencies urgently?

In urgent situations, contact your current agency and New York Medicaid Choice to expedite the process and minimize any potential gaps in care.

Sources

If you have questions about changing home care agencies in Rochester and Monroe County, our team is here to help. Call (585) 444-9245 or reach us at https://prioritycareshs.com/home-care-monroe-county-ny/.