If a hospital social worker, a relative, or an older checklist has told you to “get the doctor to fill out an M11Q,” you are in the right place. This page explains what the form is, the rules that apply to it, and, just as important, whether your family actually still needs it. For most adults applying for Medicaid home care today, the answer has changed.
What Is the M11Q Form?
The M11Q, officially the Medical Request for Home Care (HCSP-M11Q), is a New York City Human Resources Administration (HRA) form on which a physician describes a patient’s medical condition and confirms that they can safely receive care at home. It has long been part of applying for Medicaid-funded home care in the city. The state’s equivalent is the Physician’s Order for Personal Care/Consumer Directed Personal Assistance Services (DOH-4359).
Download the M11Q form (PDF, NYC HRA)
Do You Still Need an M11Q in 2026?
For most adults starting Medicaid home care, no. Since May 16, 2022, adults applying for Medicaid personal care or the Consumer Directed Personal Assistance Program (CDPAP) no longer begin the process with an M11Q. Instead, the New York Independent Assessor (NYIA) carries out a Community Health Assessment, followed by a clinical appointment with an independent practitioner, who completes a Practitioner Order. That order takes the place of the M11Q for the initial application.
A doctor’s order is still used in three situations:
- Children under 18. A physician’s order is still required for a child’s initial assessment.
- Reassessments. New York’s Department of Health requires a physician’s order (DOH-4359) before each reassessment of someone already receiving care.
- Immediate Need cases. When care is needed urgently, the county accepts either a Practitioner Statement of Need (DOH-5779) or a physician’s order such as the M11Q, together with a signed Attestation of Immediate Need (DOH-5786) and a Medicaid application if the person is not yet enrolled.
If you are not sure which applies to your family, ask the office or plan that requested the form, or call us and we will help you work it out.
M11Q Rules: Who Signs It and the 30-Day Rule
When an M11Q is required, these rules from the form itself apply:
- Who signs: a physician licensed in New York State, who must accurately describe the patient’s medical condition.
- The 30-day rule: the physician must sign within 30 days of examining the patient, and the completed form must be sent on within 30 calendar days of that examination. An older exam means a new appointment.
- No hours: the physician must not recommend or request a number of hours of care. Hours are decided through the assessment, not by the doctor.
- Complete details: incomplete forms are the most common cause of delay. The form asks for the patient’s name, address, and Social Security number, the date of the exam, and the physician’s New York registration number, NPI, and full business address.
Where Do You Send the M11Q?
The M11Q has no printed return address. The office that asks for it fills in where it should go, usually an HRA Home Care Services Program office in New York City. Send it back to the office or plan that gave it to you, within the 30-day window. Outside New York City, applications go through the county Department of Social Services, which will tell you which physician’s order form it wants.
What Most Families Need Instead: The NYIA Route
For an adult starting Medicaid home care, the steps are now:
- Medicaid. Make sure your loved one has active Medicaid, or apply. In New York City that is through HRA; on Long Island and in Westchester, through the county Department of Social Services.
- NYIA assessment. Call the New York Independent Assessor at 1-855-222-8350 to schedule the Community Health Assessment.
- Clinical appointment. An independent practitioner reviews the assessment, examines your loved one, and completes the Practitioner Order.
- Plan and care. Your loved one enrolls in a Managed Long Term Care plan, which authorizes the hours of care, and chooses a home care agency or CDPAP.
Our Medicaid home care family guide explains each of these steps in plain language, including how long the process usually takes. If you are hoping to have a family member paid as the caregiver, see Can I Get Paid to Take Care of My Parents in New York?
Need Care Quickly?
If your loved one is coming home from the hospital or cannot safely manage alone, ask about Immediate Need. Under state rules, once a complete application is received, the county has seven calendar days to decide Medicaid eligibility, and twelve calendar days to arrange the NYIA assessment and authorize personal care. Our guide to hospital discharge and home care in New York covers what to arrange before the discharge date. If you can pay privately while Medicaid is processed, private pay home care can start within days.
How Caring Professionals Can Help
Paperwork is where most families lose weeks. Caring Professionals has helped New York families through Medicaid home care since 1994: which form is needed, the NYIA assessment, choosing a plan, and matching a home health aide who speaks your family’s language. We serve Brooklyn, Queens, the Bronx, Manhattan, Staten Island, Westchester, and Long Island.
Call us at (718) 333-1400 or send us a message.
Frequently Asked Questions
What is an M11Q form?
The M11Q, or Medical Request for Home Care (HCSP-M11Q), is a New York City HRA form on which a New York-licensed physician describes a patient’s medical condition and confirms they can safely receive home care. It is used in applying for Medicaid-funded home care.
Is the M11Q still required in 2026?
Not for most adults starting Medicaid home care. Since May 16, 2022, adults applying for personal care or CDPAP go through the New York Independent Assessor, whose practitioner completes a Practitioner Order instead. A physician’s order is still used for children under 18, before reassessments, and can be used in Immediate Need cases.
Who can sign the M11Q?
A physician licensed in New York State. The physician must not recommend a number of hours of care.
What is the M11Q 30-day rule?
The physician must sign the M11Q within 30 days of examining the patient, and the completed form must be sent on within 30 calendar days of that examination.
Where do I send the M11Q form?
To the office or plan that requested it. The return address is filled in by that office, usually an HRA Home Care Services Program office in New York City.
What replaced the M11Q for adults?
The Practitioner Order completed by an independent practitioner during the New York Independent Assessor’s clinical appointment. To start, call NYIA at 1-855-222-8350.
Sources
- New York State Department of Health, 22 OHIP/ADM-01: New York Independent Assessor for PCS and CDPAS
- New York State Department of Health, NYIAP Frequently Asked Questions, October 2025
- New York State Department of Health, 16 ADM-02: Immediate Need for Personal Care Services
- New York State Department of Health, NYIA Immediate Need guidance
- NYC Human Resources Administration, Medical Request for Home Care (HCSP-M11Q)