What licenses regulate home care in New York?

New York has three primary home care licenses, all issued by the New York State Department of Health (NYSDOH): the Licensed Home Care Services Agency (LHCSA) for personal care and home health aide services; the Certified Home Health Agency (CHHA) for skilled, Medicare/Medicaid-certified home health; and the Long Term Home Health Care Program (LTHHCP), now largely transitioned. Hospice agencies are licensed separately under Article 40 of the Public Health Law. CHHAs are governed by Certificate of Need (CON) and effectively cannot be created from scratch.

Is New York a CON state for home health?

Yes. New York requires Certificate of Need approval to establish a Certified Home Health Agency (CHHA), and the state has not granted new CHHA licenses in most regions for many years. This makes existing CHHAs scarce and high-value assets — they trade at meaningful premiums to non-CON markets. LHCSAs are licensed but were subject to a moratorium and limited-needs methodology that has constrained new licensure.

How does the New York MLTSS market affect home care valuation?

New York operates one of the largest Managed Long-Term Care (MLTC) programs in the country. Most Medicaid-funded personal care and CDPAS hours are administered through MLTC plans rather than fee-for-service. Agencies with strong MLTC plan contracts, diversified plan mix, and demonstrated authorization-to-claims efficiency trade at premium multiples. Heavy concentration with a single MLTC plan is a valuation negative.

What is happening with CDPAS in New York and how does it affect M&A?

Consumer Directed Personal Assistance Services (CDPAS) underwent a major restructuring in 2024–2025, transitioning to a single statewide fiscal intermediary model. This significantly affected agencies that operated as fiscal intermediaries (FIs). Buyer appetite for traditional LHCSA-only personal care agencies — without FI revenue dependence — has remained strong; agencies historically dependent on FI revenue face structural headwinds in valuation.

What are typical EBITDA multiples for New York home care agencies in 2026?

CHHAs (CON-protected): 9x–13x for sub-$3M EBITDA, 11x–14x+ for larger platforms. LHCSAs with strong MLTC contracts: 5.5x–8.5x for $1M–$3M EBITDA, 7.5x–10.5x for $3M+ EBITDA platforms. Hospice agencies: 9x–13x. Pediatric private duty nursing: 9x–12.5x. Premium pricing applies to agencies with diversified payer mix, strong compliance, and verifiable workforce stability.

Selling a Home Care Agency in New York 2026

New York is one of the largest and most strategically valuable home-based care markets in the United States — and one of the most regulated. The combination of CON-protected CHHA licensure, a massive Managed Long-Term Care population, and a structurally constrained LHCSA pipeline produces some of the highest valuation multiples in the country for the right asset. It also produces some of the most complex transactions.

This guide covers what New York agency owners should understand about selling in 2026: license structure, the impact of CON and MLTSS, the CDPAS restructuring aftermath, buyer landscape, and valuation context.

Why New York Is a High-Value M&A Market

Population and demographics. New York’s 65+ population is among the largest in the country, with high-need, high-acuity demographics in NYC, Long Island, Westchester, and the Hudson Valley.

CON-protected CHHA scarcity. Existing Certified Home Health Agencies are scarce and effectively cannot be replicated. This is the single most important valuation driver in the New York Medicare-certified home health market.

Managed care concentration. Most Medicaid home care flows through MLTC plans (Centers Plan, VillageCareMAX, Healthfirst, Fidelis, GuildNet/successor entities, EmblemHealth, etc.). Strong contract relationships are durable economic value.

Buyer demand. New York attracts national platforms specifically because of CON scarcity and population density. Buyers include national strategic operators (BAYADA, Centene-related, BrightSpring portfolio, others) and a deep PE-backed platform set.

Hospice concentration is lower. New York hospice penetration is below the national average, which both creates growth opportunity for buyers and sustains hospice multiples.

License Structures You Need to Understand

New York’s licensing framework is more complex than most states. Buyers will scrutinize each license closely.

LHCSA — Licensed Home Care Services Agency

Personal care, home health aide, and homemaker services
Issued by NYSDOH
Subject to a multi-year moratorium and need methodology that effectively halted most new LHCSA approvals
Existing LHCSAs in needed regions trade at a premium to states with open licensure

CHHA — Certified Home Health Agency

Skilled home health (nursing, therapy, social work, home health aide)
Medicare and Medicaid certified
Subject to CON — new CHHA approval is exceptionally rare
Existing CHHAs are the highest-multiple home care assets in New York

Hospice (Article 40)

Separate licensure under Public Health Law Article 40
Subject to CON in most regions
Trades at high multiples consistent with national hospice premiums

Pediatric and Private Duty Nursing

Often delivered through LHCSA, CHHA, or specialty pediatric programs
Pediatric agencies serving Medicaid Waiver populations command premium multiples in NY

CDPAS Fiscal Intermediary (FI)

Consumer Directed Personal Assistance Services
2024–2025 transition consolidated FI services to a single statewide intermediary (Public Partnerships LLC)
Agencies that derived material revenue from FI services face structural headwinds; buyer appetite is constrained

The MLTSS Market and What Buyers Care About

New York Medicaid home care is overwhelmingly delivered through Managed Long-Term Care (MLTC) plans. Buyer diligence on a New York LHCSA focuses heavily on:

MLTC plan contract portfolio — number of plans contracted, breadth, exclusivity
Authorization volume by plan — concentration risk
Authorization-to-claim conversion rate — operational efficiency proxy
Rate negotiation history — ability to secure favorable contract terms
MLTC accounts receivable aging — collection quality varies meaningfully by plan
Compliance history with plan audits — recoupment exposure

Sellers who can produce a clean, well-organized MLTC contract and revenue analysis materially compress diligence and protect valuation. Sellers who cannot face buyer-led restatement of revenue quality.

CON and Why It Matters for Valuation

New York is one of the most restrictive Certificate of Need states in the country for home health and hospice. The implications for sellers:

Existing licenses are durable economic moats. A CHHA in a needed region cannot be replicated; the buyer is paying for the license as much as the operating business.
Buyer set is broader. National platforms specifically pursue CON-protected NY CHHAs because organic entry is impossible.
CHOW timing matters. CHHA CHOW approvals can take 9–18 months in some cases. Deal calendars must accommodate this.
Premium multiples apply. CHHAs in needed regions trade at 11x–14x+ EBITDA — meaningfully above non-CON market benchmarks.

The CDPAS Transition and Its Aftermath

The 2024–2025 CDPAS Single Fiscal Intermediary transition fundamentally changed the New York personal care market.

For agencies that were FIs: The FI revenue line is gone. Agencies are revaluing as LHCSAs only. Buyers underwrite to post-transition LHCSA economics, not historical pre-transition financials.

For LHCSA-only agencies: The CDPAS transition created an opportunity. With FI economics no longer available to competitors, LHCSAs that built strong MLTC and direct-care economics remain competitively positioned. Buyer appetite for clean LHCSAs has remained strong.

For sellers contemplating exit: The right CIM positions the post-transition reality clearly and avoids buyer surprise during diligence. Sellers who attempt to present pre-transition financials as forward run-rate will be discounted aggressively.

Typical New York Home Care Valuation Ranges (Q2 2026)

Asset Type	EBITDA Size	Multiple Range
LHCSA (strong MLTC mix)	$1M–$3M	5.5x–8.5x
LHCSA (strong MLTC mix)	$3M–$10M	7.5x–10.5x
LHCSA (large platform)	$10M+	9.5x–12x
CHHA (CON-protected)	sub-$3M	9x–13x
CHHA (CON-protected)	$3M+	11x–14x+
Hospice (CON region)	all sizes	10x–14x+
Pediatric / PDN	$1M–$5M	9x–12.5x
Behavioral health (NY)	$2M–$10M	8x–12x

Premiums apply for: diversified MLTC plan mix, strong STAR ratings (CHHA), low caregiver turnover, proven compliance with NYSDOH and managed care plan audits, geographic coverage of needed regions, and clean post-CDPAS-transition financials.

Buyer Landscape for New York Sellers

Strategic Buyers Active in New York

BAYADA Home Health Care — Nationwide presence including New York
Centene-affiliated and managed care-affiliated buyers
BrightSpring Health Services — Home care, pharmacy, behavioral health
National hospice platforms with NY presence
Regional NY operators consolidating outer-borough and Long Island markets

PE Platforms with Active NY Mandates

Multiple platforms backed by Alpine, Blue Wolf, Webster, Audax, Vistria, and Linden
Independent sponsors targeting NYC and downstate LHCSAs
Family offices targeting CHHAs and CON-protected hospice

The buyer pool for a quality New York agency is meaningfully deeper than for most other states — but only if the seller’s process is structured to reach all of it.

Common New York Seller Mistakes

1. Underestimating CDPAS impact in the CIM. Sellers who attempt to present pre-transition FI revenue as continuing run-rate forfeit credibility immediately.

2. Single-buyer conversations. NY’s deep buyer pool is exactly what makes competitive process so valuable here. Sellers who respond to a single inbound forfeit material value.

3. Underweighting CHOW timing. A CHHA transaction with insufficient calendar runway will fail or close at unfavorable terms when the deal slips past exclusivity.

4. Disorganized MLTC contract documentation. Buyer diligence into MLTC plan economics is intensive. Disorganization costs both time and price.

5. Ignoring NY-specific compliance exposure. NY has aggressive labor and wage enforcement, prevailing wage exposure for some contracts, and active Office of the Medicaid Inspector General audit activity. Pre-sale compliance audit is non-optional in New York.

How to Prepare a New York Agency for Sale

The 12–18 months before sale are when New York agencies create — or destroy — value at exit.

Do early:

Sell-side Quality of Earnings — particularly for MLTC revenue recognition
MLTC contract portfolio review with renegotiation where possible
Wage-and-hour compliance audit
OMIG and DOH audit history reconciliation
Caregiver retention metric documentation
Post-CDPAS-transition financial presentation framework

Engage early:

M&A advisor with active New York deal experience
New York healthcare regulatory counsel
Tax advisor familiar with NY State and NYC tax dynamics

Working With Hendon Partners in New York

Hendon Partners advises New York LHCSA, CHHA, hospice, pediatric, and behavioral health agency owners through every stage of preparation, sale process, and close. Our approach combines national PE buyer network access with deep familiarity in New York’s licensing structure, MLTC dynamics, and CON considerations.

For a New York seller, the right advisor is the difference between trading at the bottom and trading at the top of the multiple range — particularly in CON-protected and MLTC-leveraged assets where buyer-specific demand is the primary value driver.

Schedule a confidential New York-focused conversation with Hendon Partners →

Hendon Partners is a sell-side only home care M&A advisory firm. We have advised on home-based care transactions across New York including LHCSAs, CHHAs, hospice, and pediatric agencies in NYC, Long Island, Westchester, the Hudson Valley, and upstate markets.

Selling a Home Care Agency in New York: 2026 Market Guide