Complete the form below to tell us about the person who needs care. Family Caregiver NY will review the information, explain possible Home Care options, and help suitable cases connect with a licensed partner agency for formal review.

  • Seeking Home Care for yourself or a loved one
  • Interested in becoming an eligible family caregiver or preferred caregiver
  • Need help understanding PCA, HHA, or OPWDD options
  • Do not have a family caregiver and may need a licensed agency aide

If the person who needs care cannot complete the form because of age, disability, or medical limitations, a family member or another trusted person may complete it on their behalf.

If no caregiver has been selected, submit the information for the person who needs care and leave the caregiver section blank. Depending on eligibility and agency availability, a licensed partner agency may be able to provide a qualified PCA or HHA.

What happens after submission? We review the basic details and contact you to discuss possible next steps. Final eligibility, approval, services, hours, caregiver acceptance, employment, and pay are determined by Medicaid, the applicable plan or program, and the licensed Home Care agency.

Need help with the form?
Call 929-660-2391
Email contact@familycaregiverny.com

Family Caregiver NY is an independent support and guidance service, not a licensed Home Care agency or government agency.

Where to Find the Medicaid CIN

Example showing where to find the Medicaid Client Identification Number on a New York State benefit card

The Medicaid Client Identification Number, or CIN, is generally the preferred method for verifying Medicaid information. It appears on the front of the New York State benefit card and is usually labeled “ID Number.”

If the CIN is unavailable and the secure form permits it, the patient’s Social Security number may be submitted for verification. Do not send a CIN, Social Security number, or other sensitive information by regular email or text message.

Information submitted through this form is used to review the case, communicate about possible Home Care options, and, when appropriate, coordinate formal review with a licensed partner agency.