Healthfirst · New York Only · MLTC Medicaid · Senior Home Care · CompleteCare D-SNP · 65 Plus Plan
Healthfirst’s Senior Health Partners is a Managed Long-Term Care (MLTC) Medicaid plan — not a traditional insurance plan. It is specifically designed for New Yorkers who need home care, personal aides, or adult day services to stay out of a nursing home. Understanding what it does and doesn’t cover — and how laboratory tests fit into the picture — requires understanding how MLTC works alongside Medicare, not instead of it.
🌿 What Healthfirst Senior Health Partners Actually Is — The Plain Explanation
Healthfirst’s Senior Health Partners is a Managed Long-Term Care (MLTC) Medicaid plan — a state program run through Healthfirst that coordinates home care services for eligible New Yorkers who have Medicaid and need long-term support to remain in their community. It is not a health insurance plan that replaces your doctor visits. It does not replace your Medicare coverage. What it provides is the support layer that Medicare and most insurance plans do not: personal care services (help with bathing, dressing, eating, toileting), home health aide services, adult day healthcare, private duty nursing, physical and occupational therapy at home, and care coordination from a Registered Nurse or Licensed Social Worker who builds and manages your personal care plan. If you also have Medicare — either traditional or Medicare Advantage — your medical benefits, doctor visits, hospitalizations, and laboratory tests remain covered through your Medicare plan, not through Senior Health Partners. The MLTC plan fills the long-term care gap that Medicare specifically excludes.
📋 Key Facts — What Every Senior Should Know About Healthfirst MLTC
Straight answers to the most-searched questions about Healthfirst Senior Health Partners and related plans in New York.
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Does the Senior Health Partners plan cover laboratory tests? No — lab tests are not a benefit of the MLTC Senior Health Partners plan · Laboratory testing is covered by your Medicare plan (original or Medicare Advantage) or your Medicaid fee-for-service coverage · MLTC covers home care services, not medical proceduresThis is the most commonly misunderstood aspect of Senior Health Partners. As an MLTC plan, it covers long-term community-based services — personal care, home health aides, adult day healthcare, therapy at home — not medical services like blood draws, urinalysis, imaging, or diagnostic tests. Those fall under your Medicare coverage. If you have Original Medicare (Parts A and B), lab tests ordered by your doctor are covered under Medicare Part B at 20% coinsurance after the annual deductible, with no copay for preventive labs. If you have a Healthfirst Medicare Advantage plan (like CompleteCare or the 65 Plus Plan), your labs are covered according to that plan’s benefits. If you receive Medicaid but not Medicare, Medicaid fee-for-service covers laboratory tests ordered by enrolled providers. The bottom line: your lab coverage is in your health insurance plan — not in Senior Health Partners. If you are unsure which plan to present at the lab, call the number on your health insurance card, not your MLTC plan.
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Is Healthfirst Medicaid or Medicare? Healthfirst offers both: Medicaid plans (including Senior Health Partners MLTC and Essential Plans) AND Medicare Advantage plans (65 Plus Plan, CompleteCare D-SNP, Signature, Connection) · They are separate products and can be held simultaneouslyHealthfirst is a nonprofit insurer based in New York that administers both Medicaid-funded and Medicare-funded plans. They are entirely separate products. The Senior Health Partners MLTC is funded by New York State Medicaid — it is a Medicaid plan. The Healthfirst 65 Plus Plan, CompleteCare, and Signature are Medicare Advantage plans — they are Medicare plans. The CompleteCare plan is specifically a Dual-Eligible Special Needs Plan (D-SNP), meaning it is designed for people who have both Medicare and Medicaid simultaneously. If you have both Medicare and Medicaid, you can hold a Healthfirst Medicare Advantage plan and the Senior Health Partners MLTC plan at the same time — in fact, that is a common and well-supported combination. The Medicare plan handles your medical and prescription drug coverage; Senior Health Partners handles your home care and long-term services.
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Who qualifies for Healthfirst Senior Health Partners? Must: have Medicaid · reside in NYC (Manhattan, Bronx, Brooklyn, Queens, Staten Island), Nassau, or Westchester · be assessed as needing nursing home level of care · require at least two ADLs with hands-on help (new requirement for first-time enrollees since Sept 1, 2025) · need CBLTSS for more than 120 continuous daysSenior Health Partners is available in a specific geographic footprint only: the five NYC boroughs (Manhattan, Bronx, Brooklyn, Queens, Staten Island), Nassau County, and Westchester County. You must have active Medicaid coverage and be assessed as needing nursing home level of care — meaning your medical and functional needs are significant enough that without community-based support, a nursing facility placement would be appropriate. For new enrollees applying after September 1, 2025, you must be assessed as needing hands-on physical assistance (not just supervision) with at least two Activities of Daily Living such as bathing, dressing, eating, toileting, transferring, and walking. The long-term care services must be expected to be needed for a continuous period of more than 120 days. Assessment is conducted by the New York Independent Assessor Program (NYIAP) — call 1-855-222-8350 to initiate an eligibility assessment. Individuals already enrolled before September 1, 2025 are not subject to the new minimum needs criteria at reassessment, as long as they remain continuously enrolled.
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What home care services does Senior Health Partners cover? Personal care services · Home health aide services · Private duty nursing · Skilled nursing visits at home · Physical, occupational, and speech therapy at home · Adult day healthcare · Consumer Directed Personal Assistance Services (CDPAS) · Care coordination by RN or Licensed Social WorkerThe core of what Senior Health Partners provides is the support system that allows someone to remain at home — or in the community — instead of entering a nursing facility. Personal care services include help with activities of daily living: bathing, dressing, grooming, preparing meals, and moving safely around the home. Home health aide services add a health monitoring component alongside the personal care. For those who prefer to direct their own care, Consumer Directed Personal Assistance Services (CDPAS) allows members to hire and manage their own personal assistants, including family members in some cases, through a fiscal intermediary. Adult day healthcare provides a structured daytime program outside the home with health monitoring, socialization, meals, and activities. Skilled nursing visits, physical therapy, occupational therapy, and speech therapy can be provided in the home for members whose functional goals are appropriate for these services. A dedicated Care Team — typically a Registered Nurse or Licensed Social Worker — develops your personal care plan based on your goals and coordinates all services on your behalf.
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What is the Healthfirst CompleteCare plan and how is it different from Senior Health Partners? CompleteCare is a Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP) — it combines Medicare Parts A, B, and D coverage with long-term care services in one integrated plan · Includes a $252/month OTC Plus allowance for qualifying chronic conditions · Available to people with both Medicare and MedicaidCompleteCare (HMO D-SNP) is Healthfirst’s most comprehensive plan for seniors who have both Medicare and Medicaid — what’s called “dual eligibility.” It bundles Medicare Parts A and B (hospital and doctor coverage), Part D (prescriptions), and long-term care services into one plan with one care team. The difference from Senior Health Partners: Senior Health Partners is a Medicaid-only MLTC plan — it requires you to maintain separate Medicare coverage. CompleteCare integrates both into one plan. For qualifying members with certain chronic conditions (cardiovascular disease, diabetes, lung disorders, disabling mental health condition, or obesity), CompleteCare includes a $252/month OTC Plus allowance that can be used for over-the-counter medications, healthy foods, fitness equipment, and home utilities including gas, electric, internet, and water bills. CompleteCare covers laboratory tests through the Medicare portion of the plan. If you currently have Senior Health Partners and also have Medicare, transitioning to CompleteCare is worth evaluating during the Annual Enrollment Period — it may simplify your coverage and add benefits.
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What is the Healthfirst Essential Plan for New York? $0 monthly premium · $0 copays for dental and vision · For income-eligible New Yorkers who don’t qualify for Medicaid but earn within 200% of the federal poverty level · Not a senior-specific plan · Does not provide long-term care services · Covers medical, prescriptions, dental, vision, mental healthThe Healthfirst Essential Plan is a separate product from Senior Health Partners — it is a commercial health plan for lower-income New Yorkers who earn too much for Medicaid but still have limited income. Essential Plans 1–4 provide different levels of cost-sharing based on income, with Essential Plan 1 (for those at or below 100% of the federal poverty level) offering $0 premiums and $0 copays for most services including dental and vision. The Essential Plan covers medical visits, prescriptions, behavioral health, dental, and vision — it includes laboratory test coverage. It does not provide home care services, personal care aides, adult day care, or any long-term care benefits. Seniors who are 65 and older in New York and have limited income generally qualify for Medicare and Medicaid before they would qualify for an Essential Plan, which is why the Essential Plan is more relevant to younger working-age New Yorkers than to most seniors. If you are not yet 65 or have not yet enrolled in Medicare, an Essential Plan may bridge the gap.
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Does Healthfirst cover IVF in New York? Yes — New York State law requires most health plans including Healthfirst to cover medically necessary fertility treatments including IVF for eligible members · Applies to commercial and some Medicaid plans · Specific coverage details depend on your plan type · Not relevant to Senior Health Partners MLTC which is a long-term care planNew York has one of the strongest state fertility coverage mandates in the country. Under New York Insurance Law, fully insured health plans — including Healthfirst commercial plans like the Essential Plan — must cover medically necessary diagnosis and treatment of infertility, including IVF. This applies primarily to working-age adults. For seniors on Medicare Advantage plans through Healthfirst, fertility coverage is not applicable under Medicare. The Senior Health Partners MLTC plan — being a long-term care coordination plan — does not cover fertility treatments; they are outside the scope of MLTC services entirely. If you are asking on behalf of a younger family member who has a Healthfirst commercial plan, confirm coverage and any prior authorization requirements directly with Healthfirst at 1-888-260-1010, as specific in-network fertility providers and coverage limits apply.
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How do I get blood work covered by insurance — what do I need to know? Order from your doctor: physician-ordered labs are covered by Medicare Part B or your Medicare Advantage plan · Preventive labs (cholesterol, blood sugar, etc.): $0 copay under Medicare · Diagnostic labs: 20% coinsurance under Original Medicare after deductible · In-network lab required for lowest cost under Medicare AdvantageFor seniors on Medicare, blood work and laboratory testing coverage works as follows. Under Original Medicare Part B, diagnostic lab tests ordered by your physician are covered at 80% (you pay 20% coinsurance) after the Part B annual deductible ($283 in 2026). Preventive laboratory tests — such as annual cholesterol screening, diabetes screening, and certain cancer screenings ordered as part of your annual wellness visit — are covered at 100% with no copay under Medicare. Under a Medicare Advantage plan (including Healthfirst’s 65 Plus, CompleteCare, or Signature plans), labs are covered according to your plan’s specific copay structure — typically $0–$15 for in-network lab draws. The critical requirement: the lab must be in your plan’s network and the test must be ordered by an in-network physician. Walk-in labs without a doctor’s order are generally not covered. Quest Diagnostics and LabCorp are both in-network with most Healthfirst Medicare Advantage plans — confirm with your specific plan before your appointment. To get blood work covered at no or low cost: request the lab as part of your Annual Wellness Visit, which is entirely free under Medicare once per year.
📊 Healthfirst Plans at a Glance — Which One Is Right for Your Situation
🏠 Senior Health Partners MLTC
Long-Term Home Care
Medicaid-funded · Covers personal care aides, home health aides, adult day healthcare, therapy at home, CDPAS · Requires Medicaid + nursing home level of care assessment · NYC + Nassau + Westchester only · Does NOT cover medical care or lab tests
🌟 CompleteCare (D-SNP)
Medicare + Medicaid Combined
Dual-eligible members only (Medicare + Medicaid) · Includes long-term care + medical + prescriptions in one plan · $252/mo OTC Plus allowance for chronic condition members · Covers lab tests via Medicare portion
👴 65 Plus Plan (HMO)
Medicare Advantage for NY Seniors
Age 65+ · Medicare Advantage HMO · Dental, vision, prescriptions · SilverSneakers fitness benefit · Covers doctor visits, lab tests, hospitalizations · Separate from MLTC; can be held alongside Senior Health Partners
💚 Essential Plans (1–4)
$0 Premium for Eligible NY Residents
For income-eligible non-Medicaid, non-Medicare New Yorkers · $0 premium + $0 copays on EP1 · Covers medical, dental, vision, labs, prescriptions · No long-term care services · More relevant to under-65 adults
💊 Signature (HMO)
Medicare Advantage — Comprehensive
Medicare Advantage HMO · Higher-tier benefits · Dental, vision, hearing included · Covers labs at low or $0 copay in-network · Available in select NY counties · Annual Enrollment Period Oct 15–Dec 7
📞 Not Sure Which Plan?
Call for Free Help
Healthfirst: 1-888-260-1010 · NY MLTC eligibility assessment (NYIAP): 1-855-222-8350 · Free NY SHIP counseling: shiphelp.org · 1-800-MEDICARE: 1-800-633-4227
🔍 Your Real Questions — Answered Plainly
My parent is in Senior Health Partners but their home care hours were reduced — what can we do?
CARE HOURS REDUCED · APPEAL RIGHTS
A reduction in authorized home care hours is one of the most common and most frustrating problems for MLTC members and their families — and it is not final until the appeals process is exhausted. When Healthfirst reduces, suspends, or terminates home care services, they are required to send a written Notice of Action explaining the reason and your rights. You have the right to request an internal appeal with Healthfirst and, separately, a fair hearing with the New York State Office of Administrative Hearings. Critically: if you request a fair hearing before the effective date of the reduction and request “aid continuing,” the services must continue at the current authorized level while the hearing is pending. Do not miss this window — the request must be made promptly, typically within 10 days of the notice. For complex cases, the Legal Aid Society in New York City and other legal aid organizations assist Medicaid recipients with MLTC appeals at no cost. The New York State Department of Health maintains the MLTC Involuntary Disenrollment Process document (updated April 2026) that outlines protections for members. Contact your Care Team immediately if you receive a reduction notice.
📋 Request fair hearing: before effective date + request “aid continuing”
⏰ Deadline: typically 10 days from notice — don’t wait
🏛️ Free legal help: Legal Aid Society NYC · legalaidnyc.org
📞 NY State fair hearing: 1-800-342-3334
My mother has Medicare and Medicaid — should she be in Senior Health Partners or CompleteCare?
DUAL ELIGIBLE · CHOOSING A PLAN
The honest answer depends on how much home care she needs and whether she wants one integrated plan or separate coordination. Healthfirst CompleteCare (HMO D-SNP) combines Medicare and Medicaid benefits into a single plan — one Care Team, one ID card, one point of contact. It includes personal care and home care services alongside Medicare medical coverage and prescriptions. For qualifying members with chronic conditions, it adds a $252/month OTC Plus allowance. Senior Health Partners MLTC, by contrast, covers home care services only — your mother would need to also enroll in a Medicare plan (like the Healthfirst 65 Plus Plan or another Medicare Advantage plan) separately for her medical coverage. The argument for CompleteCare: simplicity, integration, and the OTC allowance. The argument for keeping plans separate: more flexibility in choosing a Medicare plan with better coverage for specific doctors or drugs, and the ability to switch Medicare plans annually without affecting MLTC enrollment. If her home care needs are high and she has a qualifying chronic condition, CompleteCare’s integrated approach typically wins. If her primary concern is keeping specific doctors or a specific drug formulary, separate plans may be the better fit. Call Healthfirst at 1-888-260-1010 or consult a free SHIP counselor to compare both options side by side for her specific situation.
💡 CompleteCare: one plan, one Care Team, $252/mo OTC Plus (if qualifying)
🔄 Separate plans: more Medicare plan flexibility, easier to switch annually
📞 Healthfirst: 1-888-260-1010 for side-by-side comparison
🏛️ Free unbiased help: NY SHIP counselor at shiphelp.org
What type of insurance is Healthfirst New York, and is it a good plan?
WHAT TYPE · REVIEW
Healthfirst is a not-for-profit, hospital-sponsored health insurer founded in 1993 and headquartered in New York City. It was created by a coalition of major New York City hospital systems — including NYC Health + Hospitals, the public system — specifically to serve Medicaid and Medicare patients in the city. It operates exclusively in New York. As of 2026, Healthfirst serves over 1.8 million members across Medicaid, Medicare Advantage, Essential Plan, Child Health Plus, and qualified health plan products. For seniors, the main Healthfirst products are Medicare Advantage plans (65 Plus, CompleteCare, Signature, Connection) and the Senior Health Partners MLTC. In CMS star ratings, Healthfirst Medicare plans typically earn 3 to 4 stars, with some plans rated higher in certain counties. The 65 Plus Plan has strong community ties and is widely accepted at NYC Health + Hospitals — important for seniors who receive much of their care at the public hospital system. The plan is generally well-regarded by members for its local focus, multilingual support (English, Spanish, Mandarin, Russian, and others), and understanding of the specific challenges faced by low-income New Yorkers.
🏥 Founded by NYC hospital systems · not-for-profit · 1.8M+ members
⭐ CMS star ratings: 3–4 stars depending on plan and county
🗣️ Multilingual: English, Spanish, Mandarin, Russian + more
🏛️ Strong at NYC Health + Hospitals and major NYC medical centers
How do I apply for Healthfirst Senior Health Partners — what is the process?
HOW TO APPLY · STEP BY STEP
The process for enrolling in Senior Health Partners MLTC involves an independent eligibility assessment first — you cannot simply call Healthfirst and sign up without completing this step. Here is the correct sequence. First, confirm you have active Medicaid. If not, apply at your local Department of Social Services or at access.ny.gov. Second, contact the New York Independent Assessor Program (NYIAP) at 1-855-222-8350 to request a needs assessment. An independent assessor (unaffiliated with any MLTC plan) will visit your home and evaluate your functional needs, medical history, and Activities of Daily Living. Third, if assessed as eligible, you will be informed of your MLTC options and can choose Senior Health Partners. Fourth, once enrolled, a Healthfirst Care Team member — a Registered Nurse or Licensed Social Worker — contacts you to develop your Personal Care Plan based on your goals and assessed needs. Services are then authorized and arranged. If you are calling for a family member who needs help or lives in a nursing facility and wants to return home, the process is the same — NYIAP assessment first. Services cannot begin until the assessment and enrollment are complete.
✅ Step 1: confirm active Medicaid (access.ny.gov if needed)
📞 Step 2: call NYIAP at 1-855-222-8350 for eligibility assessment
📋 Step 3: choose Senior Health Partners after assessment confirms eligibility
🏠 Step 4: Care Team develops Personal Care Plan and arranges services
Can I use CDPAS — can my family member be my paid home care aide?
CDPAS · FAMILY AIDE
Consumer Directed Personal Assistance Services (CDPAS) allows MLTC members to hire, direct, and in many cases, pay a family member as their personal assistant — and this is one of the most valuable and underused features of the Senior Health Partners plan. Under CDPAS, the member (or a designated representative) acts as the employer, setting the hours, tasks, and schedule for their personal assistant. The assistant can be a family member, friend, or neighbor — with the main exception being that in most cases a legal spouse or designated representative who manages the program on the member’s behalf cannot also be the paid assistant. Adult children, siblings, and other relatives are generally eligible to serve as paid assistants. A fiscal intermediary (a contracted organization) handles payroll, taxes, and benefits for the assistant. The CDPAS program gives members maximum control over their care compared to agency-based services, where the agency assigns workers. To enroll in CDPAS through Senior Health Partners, speak with your Care Team. They will assess whether CDPAS is appropriate for your functional needs and help connect you with a fiscal intermediary. Not all members are eligible for CDPAS — you need to be capable of directing your own care (or have a designated representative who can do so on your behalf).
👨👩👧 Family members can be paid aides under CDPAS (except spouse in most cases)
🏢 Fiscal intermediary handles payroll + taxes for your hired assistant
💡 You or a representative must be able to direct care for CDPAS eligibility
📞 Ask your Care Team: request CDPAS enrollment through Senior Health Partners
What happens if I need to go to a nursing home — does Senior Health Partners cover that?
NURSING HOME · COVERAGE LIMITS
Senior Health Partners MLTC is specifically designed to prevent nursing home placement by providing community-based alternatives — it does not cover long-term nursing home care. The entire purpose of the MLTC program, as defined by New York State policy, is to support people who are at nursing home level of care but capable of remaining safely at home with services. If a member’s needs escalate to the point where they can no longer safely remain at home even with maximum home care hours, a transition to a nursing facility may become necessary — and at that point, coverage shifts. Short-term skilled nursing facility care (rehabilitation after a hospitalization) is covered by Medicare Part A for up to 100 days per benefit period. Long-term custodial nursing home care for people with Medicaid is covered by Medicaid, not by the MLTC plan — typically through nursing home Medicaid (full Medicaid in a facility). If transitioning to nursing home care, notify your Senior Health Partners Care Team — they can help coordinate the transition. If your goal is eventually returning home from a nursing facility, the MLTC program can re-enroll you when you are ready and assessed as eligible to return to the community.
🏠 MLTC purpose: keep you at home — not cover nursing home stays
⏱️ Rehab after hospital: covered by Medicare Part A (up to 100 days)
🏥 Long-term nursing home: covered by Medicaid (separate from MLTC)
📞 Transitioning? Call Care Team — they coordinate nursing home and return-to-home planning
📍 Find Healthfirst Offices & Help Near You
Use the buttons below to find Healthfirst community offices, free Medicare counseling, Medicaid offices, and home care resources near your location in New York.
🔑 Quick Reference — Healthfirst Key Numbers & Links
🌿 Healthfirst member services: 1-888-260-1010 · TTY 1-888-542-3821
🏠 Senior Health Partners: healthfirst.org/senior-health-partners-plan
📞 NYIAP eligibility assessment: 1-855-222-8350 · M–F 8:30am–8pm, Sat 10am–6pm
💊 CompleteCare (D-SNP): healthfirst.org/completecare-plan
👴 65 Plus Medicare Advantage: healthfirst.org/65-plus-plan
📋 Member Handbook & documents: healthfirst.org/documents
🏛️ Free NY SHIP counseling: shiphelp.org · 1-800-701-0501
📞 NY Medicaid fair hearings: 1-800-342-3334
💚 Apply for Medicaid: access.ny.gov
🏥 NY MLTC state information: health.ny.gov → MLTC
✅ 5-Step Checklist for Healthfirst Senior Health Partners
- Step 1 — Check eligibility: Confirm you have active Medicaid, live in the service area (NYC boroughs, Nassau, or Westchester), and are assessed at nursing home level of care. Call NYIAP at 1-855-222-8350 to initiate a free home assessment — this is required before enrollment.
- Step 2 — Understand what’s NOT covered: Senior Health Partners does not cover doctor visits, hospitalizations, prescriptions, or laboratory tests. Those remain under your Medicare plan. Make sure your Medicare coverage is active and up to date before relying on MLTC alone.
- Step 3 — Evaluate CompleteCare if you have both Medicare and Medicaid: Healthfirst CompleteCare (D-SNP) combines both programs with a care team that manages everything together. For qualifying members with chronic conditions, it also provides a $252/month OTC Plus allowance for food, medications, and utilities. Call 1-888-260-1010 to compare it with keeping plans separate.
- Step 4 — Know your appeal rights: If your care hours are reduced, you have the right to appeal and to continue receiving current services while the appeal is pending (“aid continuing”) if requested before the reduction effective date. Contact the Legal Aid Society (legalaidnyc.org) for free help with MLTC appeals.
- Step 5 — Ask about CDPAS: If you would prefer a trusted family member or friend as your aide, ask your Care Team about Consumer Directed Personal Assistance Services. In many cases, adult children and other relatives can be paid directly as your personal assistant through this program.
Healthfirst plan benefits, eligibility requirements, service areas, and coverage details change annually and are subject to New York State contract requirements. Senior Health Partners MLTC is provided by Healthfirst PHSP, Inc. and funded through New York State Medicaid. Medicare Advantage plans are provided by Healthfirst Health Plan, Inc. under contract with the federal government. Benefits vary by plan and enrollment requirements. Minimum Needs eligibility criteria for new MLTC enrollees took effect September 1, 2025 — existing enrolled members are not subject to new criteria as long as they remain continuously enrolled. This page has no affiliation with Healthfirst or the New York State Department of Health. This content is for informational purposes only and is not a substitute for professional enrollment counseling. Always contact Healthfirst or a free SHIP counselor to verify current benefits and eligibility before making enrollment decisions.