Waiver Description
New York’s Consumer-Directed Personal Assistance Program goes by several names, including the abbreviations CDPAP, CDPAPNYS, and CDPA. It is less a program and more a method of receiving benefits under other programs. However, many people think of it as a distinct program and it may be easier to do so. In short, Consumer-Directed Personal Assistance is designed for elderly or disabled persons that require personal care, home health, or skilling nursing care and wish to maintain control over whom provides these services. As consumers of care services, they are choosing to direct their own care, hence the phrase “consumer direction.” To avoid confusion, readers should note that consumer-direction is also sometimes referred to as participant direction, self-direction, or cash and counseling.
The CDPAP program works as follows. Eligible individuals decide to participate in the program; they work with a county caseworker and medical professional to determine the level of care they require and to create a “Care Plan”. The Care Plan contains the number of hours of care they will require each week. Participating individuals are then given the flexibility to hire, train, and supervise their care providers (also referred to as “PA”s).
One factor that makes this program especially popular is that friends and certain family members can be hired as care providers / PAs. Spouses and legal guardians are not permitted to be paid caregivers, but siblings, ex-spouses, and adult children are eligible. While program participants are responsible for the hiring and management of their care providers, a Fiscal Intermediary is used to oversee time-sheet processing and employee payments.
One common question candidates have is if beneficiaries must live at home. The program’s regulations make no mention either way. However, persons familiar with the program have stated that beneficiaries must reside at home or be in the process of moving back into a private home.
CDPAP is a Medicaid program offered under the NY Managed Medicaid Long Term Care Program and the Community First Choice option. It is a Medicaid entitlement program.
Did You Know? In New York alone, nearly a quarter million people receive assistance from Medicaid for long term care. A surprise to many is that two-thirds of them receive assistance at home or in assisted living.
Eligibility Guidelines
Functional / Medical Requirements
To be eligible, elderly or disabled NY residents must demonstrate the need for assistance with their activities of daily living. In other words, they must qualify for home care, personal care, or skilled nursing and they must be eligible to receive New York Medicaid.
Financial Requirements
Qualifying for Medicaid financially can be a laborious process. State employees review a family’s income, assets, and asset transfers as far back as five years, a process known as a “Medicaid look back.” Unfortunately, if one has violated the look back rule, a period of Medicaid ineligibility may be the penalty.
For 2022, the New York Medicaid income limit for a single applicant over the age of 65 is $934 / month, and for a two-person household, the limit is $1,367. If one spouse of a married couple is not applying, they are called the “community spouse,” or “well spouse”. In this situation, the applicant spouse is able to transfer monthly income to his or her non-applicant spouse. As of 2022, up to $3,435 / month may be transferred to the non-applicant spouse to bring his / her income up to this amount.
If a single individual is applying for benefits, he or she is permitted to keep up to $16,800 in resources. A two-person household is permitted to retain much higher financial resources, up to $24,600. The community spouse may hold up to $137,400 in funds across all the couple’s financial accounts. This is in addition to the $16,800 in assets the applicant spouse can retain. However, not all assets are counted towards the asset limit. For instance, one’s primary home is exempt as long as the equity value does not exceed $955,000. Household furnishings, personal items, and one car are also exempt from the asset limits under Medicaid.
Persons with complicated cases or whose assets or income are greater than Medicaid’s allowable limits may wish to work with an elder care financial planner or elder law attorney to structure their finances appropriately to qualify for Medicaid. Learn more about how Medicaid planners work.
Finally, once an applicant has met the medical and financial criteria, participants must access the CDPAP program through New York’s Managed Medicaid Long Term Care Program or Community First Choice option.
Benefits and Services
The CDPAP program provides for a wide range of care services. During the creation of the Care Plan, all the necessary services and hours required will be determined. Possible benefits can include personal care, assistance with the activities of daily living and instrumental activities of daily living, and skilled nursing services. Services provided under this program are self-directed, meaning the program participant or their legal representative can choose the provider of services.
How to Apply / Learn More
Interested New York residents should contact their local Department of Social Services to learn more about accessing this program through their Medicaid plan. New applicants must first complete the enrollment process with Medicaid Managed Long Term Care. One can also learn more about CDPAP on the New York State Department of Health webpage.
