LHCSA vs CHHA in New York: Home Care Agency Types Explained

Two Types of Home Care Agencies, Two Very Different Roles

New York regulates home care through two distinct agency categories, and confusing them leads families down the wrong enrollment path. A Licensed Home Care Services Agency (LHCSA) provides long-term custodial care — the daily bathing, dressing, feeding, and housekeeping help that keeps your parent living at home. A Certified Home Health Agency (CHHA) provides short-term clinical care — skilled nursing, wound care, physical therapy, and occupational therapy ordered by a physician.

The distinction matters because they serve different needs, accept different funding, and send different types of workers to your parent's home.

What a LHCSA Does

An LHCSA is licensed by the New York State Department of Health to employ and deploy personal care aides (PCAs) and home health aides (HHAs) for non-medical, custodial assistance. This is the agency type that families interact with when a parent receives Medicaid home care through a Managed Long Term Care plan.

LHCSA services include:

• Hands-on help with Activities of Daily Living — bathing, dressing, grooming, toileting, transfers, and eating
• Light housekeeping, laundry, and meal preparation
• Medication reminders (though not administration of injections or complex clinical tasks)
• Companionship and safety supervision

When your parent enrolls in an MLTC plan after receiving Medicaid approval and completing the NYIA assessment, the plan assigns care hours and your parent selects a LHCSA from the plan's contracted provider network. The LHCSA then schedules aides to cover the authorized hours.

New York maintains a state directory of licensed home-care agencies, but your parent can only choose from agencies that hold contracts with their specific MLTC plan. This is one of the most common frustrations families encounter — a well-reviewed agency two blocks away may not be in-network for your parent's plan.

What a CHHA Does

A Certified Home Health Agency operates under a higher level of state and federal certification. CHHAs employ registered nurses, licensed practical nurses, physical therapists, occupational therapists, speech-language pathologists, and medical social workers. They provide skilled, clinical services that require professional licensure.

CHHA services are funded primarily by Medicare (not Medicaid) and are available only when:

• A physician orders the services
• The patient is certified as "homebound" under Medicare guidelines
• The patient requires intermittent skilled nursing care or therapy

Medicare home health through a CHHA is inherently temporary. Once your parent no longer needs skilled clinical care — the wound has healed, the rehabilitation goals are met, the therapy has plateaued — Medicare coverage ends. A CHHA will not provide ongoing custodial care.

Home Health Aide vs Personal Care Aide

The worker titles compound the confusion. Both LHCSAs and CHHAs can employ Home Health Aides, but the HHA role differs by context:

Personal Care Aide (PCA): The entry-level custodial worker deployed by LHCSAs. PCAs complete a state-approved training program (typically 40 hours) and provide non-medical assistance with daily living activities. They cannot perform any clinical tasks.

Home Health Aide (HHA): Completes a longer training program (typically 75+ hours) that includes basic clinical skills like taking vital signs, simple wound dressing changes, and assisting with prescribed exercises. When deployed by a CHHA under Medicare, an HHA works under nursing supervision on clinical tasks. When deployed by a LHCSA under Medicaid, an HHA performs the same custodial duties as a PCA but commands a slightly higher hourly rate.

Registered Nurse / Licensed Practical Nurse: CHHAs employ these clinicians for skilled clinical visits — medication management, IV therapy, complex wound care, and clinical assessments. LHCSAs may also employ nurses for supervision and care coordination.

For most families arranging long-term home care, the day-to-day caregiver is a PCA or HHA from a LHCSA, not a clinical professional from a CHHA.

How This Plays Out in Practice

Here's the typical sequence: Your parent is discharged from the hospital after a fall. Medicare sends a CHHA nurse and physical therapist for a few weeks of skilled recovery care. That coverage ends once the clinical goals are met. Your parent still needs daily help with bathing, dressing, and meals — but Medicare won't pay for it.

This is when families apply for Medicaid home care, enroll in an MLTC plan, and select a LHCSA to provide ongoing custodial care. The CHHA and the LHCSA may or may not be affiliated with each other. The handoff between the two is where many families lose continuity — the CHHA therapist's last visit and the LHCSA aide's first visit need to overlap or at minimum share care plan documentation.

If your parent is in this transition, ask the CHHA discharge planner to provide the care summary directly to the MLTC plan's care manager, who coordinates the LHCSA assignment.

Choosing the Right LHCSA

Once your parent has Medicaid authorization and an MLTC plan, selecting a quality LHCSA within the plan's network is the next critical decision. Key questions to ask:

• What is your minimum shift length? Some agencies require 4-hour minimums, which may not align with your parent's authorized hours.
• Do you provide consistent aide assignments? Rotating different aides every shift undermines trust and care quality, especially for parents with cognitive decline.
• What is your backup staffing protocol? When the assigned aide calls out sick, does the agency send a trained replacement or leave your parent without coverage?
• Do your aides have specialized dementia training? Standard PCA training does not include dementia-specific care techniques.

The Aging in Place in New York guide includes a provider evaluation worksheet and explains the continuity-of-care rules that protect your parent's right to keep their existing caregiver for 90–120 days when switching between MLTC plans.

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