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For updates about the transition to the new NYS "Single Fiscal Intermediary" (FI) and NYLAG's lawsuit challenging it - please see
Download NYLAG PowerPoint about the Single FI Transition - dated March 10, 2025, here. In this article:
The Consumer Directed Personal Assistance Program (CDPAP) is a statewide Medicaid program that provides an alternative way of receiving home care services, where the consumer has more control over who provides their care and how it is provided. Rather than assigning a home care vendor or agency that controls selection, training, and scheduling of aides, the "consumer" or the family member, friend or guardian directing his/her care performs all these functions usually done by a vendor. All counties, all mainstream Managed Care and Managed Long Term Care plans are required to have a CDPAP program. To be eligible, one must be eligible for services provided by a certified home health agency AIDS home care program, or personal care (home attendant) and meet other eligibility criteria here. Another special benefit of CDPAP is that CDPAP aides may perform "skilled" care that otherwise may only be performed by a nurse - suctioning tracheostomies, insulin injections, administration of oxygen or medications where the consumer cannot self-administer. See N.Y. Educ. Law § 6908(1)(a) . Tasks that could not otherwise be performed by home health aides or personal care aides are indicated in the scope of tasks for personal care and home health aides.
2. March 28, 2025 Deadline for Consumers and Personal Assistants to Switch to a "Single" Fiscal Intermediary - PPL
INFORMATION ON THE CHANGES to A SINGLE FI - see here
3. ELIGIBILITY FOR CDPAP - Stricter Rules Started Sept. 1, 2025Eligibility Criteria - 18 NYCRR Sec. 505.28(c)
Also, new Independent Assessor procedures (NYIAP) to assess the need for CDPAP, personal care, and MLTC enrollment started May 1, 2022. See more about the Independent Assessor here. 4. WHO CAN BE HIRED AS THE CDPAP AIDE - expanded in 2016 and clarified in 2021The consumer may hire almost anyone, including any adult family members except his or spouse. Since April 2016, because of a change in State law, parents of disabled ADULT children -- have been able to serve as the CDPAP personal assistant (PA) if they are not also the recipient's designated representative. Likewise, an adult son or daughter, son-in-law or daughter-in-law may now be the aides for their parent. See this article in Democrat & Chronicle, Nov. 25, 2015. Social Services Law §365-f, subd. 3, as amended by L. 2015 Ch. 511, enacting Senate bill S05712-A (Sen. Simcha Felder). A "legally responsible" adult may not be the aide. Spouses are always legally responsible for their spouse. Parents are always legally responsible for their children under age 21. They still may not be the CDPAP aide for those relatives.
Changes to the CDPAP state regulation effective Nov. 8, 2021 removed the ban that did not allow a family member to be hired as the personal assistant if they lived with the consumer. 18 NYCRR 505.28(b)(4). A "designated representative" (DR) of a CDPAP consumer may not be the Personal Assistant (PA), but a legal Guardian for the consumer may be the PA - if someone else serves as D.R. State regulations provide, "...A person legally responsible for the consumer's care and support, a consumer's spouse, or the consumer's designated representative may not be the consumer directed personal assistant for that consumer; however, a consumer directed personal assistant may include any other adult relative of the consumer. 18 NYCRR 505.28(b)(4). The state regulation defines "designated representative" as "an adult to whom a self-directing consumer has delegated authority to instruct, supervise and direct the consumer directed personal assistant and to perform the consumer's responsibilities specified in subdivision (h) of this section [505.28] and who is willing and able to perform these responsibilities. With respect to a non self-directing consumer, a designated representative means the consumer's parent, legal guardian or, subject to the social services district's approval, a responsible adult surrogate who is willing and able to perform such responsibilities on the consumer's behalf. The designated representative may not be the consumer directed personal assistant or a fiscal intermediary employee, representative or affiliated person. 18 NYCRR 505.28(b)(5)
Immigrants must have a valid work authorization. The aide need not be "certified" - training is done by the consumer and family. However, one of the changes coming in 2025 with the Single FI is a training requirement. Stay tuned. See above. 5. How Do You Obtain CDPAP - Managed Care/MLTC Plan or local Medicaid agency (HRA or local DSS)There are different procedures to apply depending on whether the consumer has Medicaid only and is enrolled in a Medicaid Managed Care plan, or whether the individual has both Medicare and Medicaid, or has Medicaid but not Medicare and is not enrolled in a Medicaid Managed care plan.. See NYC HRA MICSA Medicaid Alert dated Oct. 26, 2012 on CDPAP and Managed Care. Also, children under 18 have different procedures.
6. How Many Hours of CDPAP Should be Authorized?The New York State Department of Health (NYSDOH) has issued guidelines for enrollees to use in requesting services from their plans. NYSDOH Guidelines for Personal Care Services in Medicaid managed care. THese guidelines should apply to CDPAP as well as personal care. See the article on Personal Care for the guidelines and standards for determining the number of hours - especially these sections i the article: 5. How Much Personal Care? How are Hours Determined? A.. Standards for 24-Hour Care - Definition of Live-in and Split Shift B. Standards for Assessing Need and Determining Amount of Care 7. Help with Understanding and Using CDPAPThe Consumer-Directed Personal Assistance Association of NYS (CDPAANYS) has lots of resources on its website. Concepts of Independence - had been the largest and oldest fiscal intermediary, now is a Facilitator for the single FI PPL, has tutorials and other info. on its website 7. CDPAP Laws, Regulations, State Policy Directives & History of CDPAPThis article explains the CDPAP program in NYS, with cites to state statutes (some have been amended since). Note that this article pre-dates mandatory MLTC. Laws. The statutes establishing the CDPAP program include Section 365-f of the Social Services Law and N.Y. Educ. Law § 6908(1)(a) (also known as the Nurse Practice Act, which creates an exception that allows CDPAP aides, along with family and other unpaid informal caregivers, to perform tasks that otherwise may only be performed by licensed nurses. The State published final regulations, effective April 20, 2011, creating a new section 28 to 18 NYCRR Part 505. See New York State Register April 20, 2011/Volume XXXIII, Issue 16 (pp. 7-8)
See December 2015 NYS Dept. of Health GIS 15 MA/024 - Changes to the Regulations for the Personal Care Services Program (PCS) and the Consumer Directed Personal Assistance Program (CDPAP) (PDF) NOTICE OF ADOPTION
State Dept. of Health guidance for MLTC and managed care plans plans to provide CDPAP services -- on the Medicaid Redesign Team page, scroll down to MRT 90 - MLTC and then to CDPAS Final MLTC Documents (posted around 10/1/12)
The following directives have been issued since the above article was written in 2003:
State Managed Long Term Care Contracts, Guidelines re CDPAP (Posted Oct. 1, 2012, eff. 11/1/2012)
NYC Directives
HISTORY For a history of the development of the consumer-directed program in New York City, which was a national leader in launching this form of service 33 years ago, see this article., along with:
8. ARCHIVES: RATE CUTS and LITIGATION 2019On October 11, 2019, the Albany County Supreme Court enjoined NYS DOH from implementing a new reimbursement methodology for Consumer-Directed Personal Assistance (CDPAP) which would have drastically cut reimbursement rates. See court decision here.
The lawsuit was previously reported about in Crain's NY Business on Aug. 14, 2019 and Spectrum News on August 1, 2019. The first round of cuts directly effect CDPAP services provided on a Fee-for-Service basis through local district Medicaid programs, not those enrolled in Medicaid managed care or MLTC plans. However, advocates and the CDPAP association contend that the cuts will force many CDPAP provider agencies, called Fiscal Intermediaries (“FI”), to close - resulting in reduced access to this service across the state for the 90,000 consumers who rely on CDPAP services, in MLTC plans and managed care plans as well. Also, many consumers choose CDPAP because they have “skilled” needs that traditional personal care aides may not perform, such as suctioning a tracheostomy, operating a ventilator, or directly administering insulin or other medications. See Scope of Tasks of various types of aides. While they may be eligible for Medicaid Private Duty Nursing services, managed care and MLTC plans resist authorizing these services because they are so expensive. These consumers, and others facing reduced access to care when the FIs close, may well be forced into nursing homes. The July 2019 DOH guidance implementing the CDPAP rate cuts -- Managed Care Policy 19.01 –provides for transition rights to ensure “a smooth transition of consumers to a different FI in the event that an FI no longer provides services or leaves a service area.” Advocates warn that the transition rights are insufficient. In comments to a Workgroup convened by State DOH, The Legal Aid Society warned that “these transition rights only apply to CDPAP enrollees transferring from one FI to another,” not to those CDPAP enrollees who are forced to transfer to traditional personal care services because there is no CDPAP FI with capacity to serve them (copy on file with NYLAG EFLRP). The Legal Aid comments also stated that the State’s guidelines do not provide for directing consumers where to go for help if they face disruption in services – whether New York Medicaid Choice, the State’s enrollment broker for managed care and MLTC plans, or ICAN – the State’s Ombudsprogram for consumers in MLTC plans or receiving long-term care services in managed care plans. This article was authored by the Evelyn Frank Legal Resources Program of New York Legal Assistance Group.
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