If you or a family member is eligible for New York Medicaid home care, CDPAP — the Consumer Directed Personal Assistance Program — is sometimes the best choice. CDPAP lets you select, hire, train, and schedule your own caregiver. The caregiver can be a friend, a neighbor, or any family member other than your spouse. Medicaid pays for the care through an administrator.
The CDPAP program puts the person receiving care, or their representative, in charge of the person who provides the care. Since March 2025, PPL (Public Partnerships LLC) has been the administrator of CDPAP statewide.
Here is what New York families need to know: who is eligible for CDPAP, who you can hire as your caregiver, and where an Elder Law attorney fits in.
Please note: Getting your caregiver paid through CDPAP is an important way to remain in charge of your (or your loved one's) care. However, you will need to take a number of steps before you can enroll in the CDPAP program. These steps include protecting your assets, applying for and achieving Medicaid eligibility, and undergoing Medicaid’s evaluation of your care needs.
What is CDPAP?
CDPAP is a New York Medicaid program that lets you hire your own in-home caregiver — including members of your own family — instead of accepting whoever a traditional home care agency assigns. It is available to Medicaid recipients who are eligible for home care services and who can self-direct their care (or who have a designated representative who can direct it for them).
CDPAP differs from traditional home care in three important ways. First, you (the consumer) are the employer of the caregiver, not an agency. You choose the person, you train them, and you decide the schedule. Second, CDPAP caregivers — called Personal Assistants (“PAs”) — can perform certain skilled tasks that a Home Health Aide or Personal Care Aide cannot, including administering medications, giving injections, and assisting with home dialysis. Third, family members (again, with one important exception – your spouse) can be paid as CDPAP PAs.
Additional information about CDPAP can be found on the NY State Department of Health website’s CDPAP page.
Who is eligible for CDPAP?
To use CDPAP you must satisfy three requirements. First, you must be eligible for New York Medicaid. Community Medicaid is the specific program that covers home care in New York; a separate program covers nursing home care. If you are not yet Medicaid-eligible, the eligibility rules and the strategies for qualifying are a subject unto themselves. See our companion article on Achieving Medicaid Eligibility.
Second, you must be evaluated as someone who needs home care services. This determination is made by a needs assessment conducted through your Managed Long Term Care (“MLTC”) plan. The assessment establishes how many hours of care per week you are approved to receive.
Third, you must be able to self-direct your care, or you must have a designated representative — often a spouse, adult child, or trusted friend — who can direct it for you. A designated representative is someone other than your CDPAP PA, like your Agent under your Power of Attorney. They have the ability to make decisions for you.
Self-direction means you can make decisions about who cares for you, when, and how. There is no age requirement for people who use CDPAP; participants range from infants with disabilities to seniors in their nineties (or even older!).
Who can you hire as your CDPAP caregiver?
This is the question most families ask first. The rules are more permissive than most people expect.
Other than a very few exceptions, almost any adult can be hired using the CDPAP program. You can hire a family member of any kind, except for a spouse. This includes siblings, adult children, nieces, nephews, cousins, and adult children. You can hire a parent (if you are an adult child using CDPAP for yourself).
Other eligible options include a friend, neighbor, former co-worker, or a member of your religious community. You cannot hire a designated representative (a person in charge of directing your care) to be your paid caregiver.
This flexibility is what makes CDPAP so valuable to families where a relative or friend is already providing care and would be doing so anyway.
Your caregiver must be at least 18 years old and legally eligible to work in the United States. They must complete a health assessment and any documentation PPL requires. They do not need to be a certified Home Health Aide or Personal Care Aide. That lack of a certification requirement is one of the defining features of CDPAP, because it means you can hire the person who already knows you and your needs, and train them yourself in exactly how you want to be helped.
How does the PPL transition affect you now?
As of April 1, 2025, every CDPAP consumer in New York was required to transition to PPL as the Fiscal Intermediary. PPL now handles everything the former Fiscal Intermediaries used to handle: payroll, tax withholding, workers’ compensation, benefits, timekeeping, and Electronic Visit Verification.
Thirty-seven of the former Fiscal Intermediaries were selected as “facilitators” with a limited support role, primarily helping consumers navigate the transition and providing customer service. The facilitators do not process payroll; PPL does.
The rollout was, by most accounts, difficult. If you or your caregiver had a problem during the transition and gave up trying to register with or use CDPAP, it is worth trying again.
If you are still not registered with PPL and want to be, contact one of the approved facilitators (a current list is maintained at pplfirst.com/cdpap-facilitators/) or call PPL directly at 833-247-5346. Be persistent. If the first call does not get you what you need, call again.
Rates, hours, and what CDPAP pays in 2026
Two other questions come up frequently: what does the caregiver get paid, and how many hours per week can we get?
On wages: CDPAP Personal Assistants in New York are paid an hourly rate set by New York State and administered by PPL. As of 2026, the base rate is $20.65 per hour in NY City. The current 2026 CDPAP PA base wage rate can be found on the FAQ page of pplfirst.com – search for “What do PAs get paid with PPL?” Overtime and shift differentials apply under standard wage-and-hour rules. Benefits, including workers’ compensation coverage, are provided by PPL as the employer of record. Caregivers who work sufficient hours may also be eligible for health insurance and paid sick leave through PPL.
On hours: this is determined by your MLTC plan’s needs assessment, not by CDPAP itself. The assessment evaluates your Activities of Daily Living (bathing, dressing, toileting, transferring, eating, and continence) and your Instrumental Activities of Daily Living (meal preparation, medication management, housekeeping). Based on the assessment, the MLTC plan assigns you a number of hours of care per week, ranging from a few hours to twenty-four-hour care in the most intensive cases.
If you believe the hours assigned to you are inadequate, you have the right to appeal. Appeals are decided by the MLTC plan first, and if the plan denies the appeal, you can request a Fair Hearing with the New York State Office of Temporary and Disability Assistance. Do not accept an inadequate assessment without appealing — the appeal process, while slow, changes outcomes in a meaningful percentage of cases. Elder Law firms, including Lamson & Cutner, often assist with Fair Hearings.
Where an Elder Law attorney fits in
You do not need an attorney to use CDPAP. Once you are Medicaid-eligible and once your MLTC assessment is complete, the CDPAP mechanics are handled by PPL and your caregiver. However, you are likely to need an Elder Law attorney to advise and assist you with other essential parts of the process.
Eligibility: you need to be Medicaid-eligible in the first place. Many families come to us assuming they cannot qualify for Medicaid because they own a home, have retirement savings, or receive Social Security income above Medicaid’s “income limit.” In most cases, these assumptions are wrong. New York permits several legal strategies for protecting assets and qualifying for Community Medicaid, and for protecting income. These strategies include creating a Medicaid Asset Protection Trust and joining a Pooled Income Trust in New York.
“The families who come to us with a preference for CDPAP usually have caregivers who have already been providing care informally for years,” says Mr. Cutner. “They want their loved one to continue receiving their care from the person who already gives it, but have the care be paid by Medicaid. That way the family isn’t bearing the financial burden that comes from time and wages lost due to the demands of caregiving. That is exactly what CDPAP was designed to do.”
Getting help
CDPAP is one of the most important programs available to New York families managing long-term care. It preserves choice, it allows families to be paid for the care they are already providing, and it works. But the value of CDPAP depends on becoming Medicaid-eligible in the first place, and on integrating CDPAP into a broader Elder Law and estate plan that protects your assets and reflects your wishes.
Lamson & Cutner has helped New York families with Community Medicaid planning, CDPAP integration, and long-term care strategies for nearly twenty years. Our offices in Manhattan and in Westchester County work with families throughout the New York City metropolitan area, Long Island, and Westchester, Rockland, Putnam, Dutchess, and other upstate counties. If you would like to discuss your situation, Contact us to schedule a consultation.
Frequently Asked Questions
No. Under CDPAP rules, a spouse cannot be paid as a CDPAP Personal Assistant. This is the one clear family-member exclusion. Adult children, siblings, other relatives, and friends can all be paid CDPAP PAs. If your spouse is your primary caregiver and you need paid help, one common arrangement is to have another family member be the paid PA while the spouse continues to provide unpaid support and, if needed, act as the designated representative.
Yes. Adult children are among the most common CDPAP caregivers. There is no requirement that the adult child live with you or be a licensed caregiver. Any adult child who is legally eligible to work in the United States can be paid as your CDPAP PA, provided you (or your designated representative) hire them and direct their work.
The hours are determined by the needs assessment conducted by your Managed Long Term Care plan. Assessments consider your Activities of Daily Living and Instrumental Activities of Daily Living. Approvals range from a few hours per week to twenty-four-hour care in the most intensive cases. If the initial assessment does not provide enough hours, you have the right to appeal — first to the MLTC plan, and if necessary, through a special process called a Fair Hearing.
No. One of the defining features of CDPAP is that the Personal Assistant does not need to be a certified Home Health Aide or Personal Care Aide. The consumer (or their designated representative) trains the PA in exactly how they want to be helped. This is what allows CDPAP PAs to perform skilled tasks — such as administering medications — that certified aides in traditional programs are not permitted to perform.
Start the Medicaid application immediately and consider CDPAP in parallel. The Community Medicaid application and approval process typically takes several months. During that time, you may need to pay privately for care. An Elder Law attorney can advise on strategies to achieve eligibility for Medicaid and protect your assets at the same time. The Elder Law attorney will take care that the application is complete and properly documented on first submission, thereby avoiding a costly delay or denial.
You can replace them. Because you are the employer, you make the hiring and firing decisions. If a Personal Assistant is not working out, notify PPL and hire a replacement. There is no requirement to justify the change. The replacement PA must then complete the same registration and documentation process.
As of April 1, 2025, PPL is the only Fiscal Intermediary permitted to administer CDPAP in New York. The former Fiscal Intermediaries either transitioned to “facilitator” roles (with a limited support function) or exited the program. If you are currently being served by an entity other than PPL, contact PPL to confirm your registration is properly in place.
A Home Health Aide is a certified caregiver assigned to you by a Licensed Home Care Services Agency. You do not choose the aide, and the aide is limited in what tasks they can perform under state regulations. A CDPAP Personal Assistant is a caregiver you choose and train yourself, and who can perform a wider range of tasks including administering medications. Home Health Aides are often the right fit for people who do not want to manage a caregiver relationship themselves. CDPAP is often the right fit for people who want to keep an existing caregiver, hire a family member, or have specific care preferences that a general-purpose aide cannot easily accommodate.
Yes, if your MLTC assessment approves you for overnight hours. Overnight care and “live-in” arrangements are both possible under CDPAP, subject to standard wage-and-hour rules including required rest periods for the caregiver. The specific structure depends on your care needs and on the number of hours approved.
Your income is not a factor in the determination of your eligibility for Community Medicaid. If your monthly income exceeds Medicaid’s “income limit,” you can either contribute your “surplus income” to the cost of your care, or you can protect your “surplus income” by depositing it into a Pooled Income Trust. The eligibility requirements and administration of Pooled Income Trust accounts are worth understanding before you enroll. See our page on Pooled Income Trusts in New York.
The appeal is a two-step process. First, appeal to the Managed Long Term Care plan that conducted the assessment; they must reconsider and respond in writing. If they deny the appeal, request a Fair Hearing with the New York State Office of Temporary and Disability Assistance. Fair Hearings are conducted by an administrative law judge. You have the right to representation, and outcomes are meaningfully different from the MLTC plan’s internal review in a significant percentage of cases. Our firm can provide representation at Fair Hearings.
No, but your MLTC plan may change. If you move within New York State, your CDPAP eligibility continues; you may need to enroll in an MLTC plan that operates in the new county, and the needs assessment may need to be redone. If you move out of New York State, CDPAP does not follow you. Other states may have similar programs but with different rules and different names.
Yes, through PPL as the employer of record. CDPAP PAs receive workers’ compensation coverage automatically. Those who work sufficient hours per week are eligible for health insurance and paid sick leave. Tax withholding, unemployment insurance contributions, and other statutory employer obligations are handled by PPL.
You hire another. Because you are the employer, you handle the transition. Ideally, you would identify potential backup caregivers in advance so that a departure does not leave you without care. PPL and the approved facilitators can help you find replacements, but the choice remains yours.
You must be eligible for Community Medicaid before you can enroll in the CDPAP program. Your best first step would be to consult with an Elder Law attorney to determine how you can achieve Medicaid eligibility. You may need to take steps to transfer and protect your assets before you can apply for Medicaid.
Once you are financially eligible for Medicaid, you will need to prepare and file a Community Medicaid application for home care. Engaging an Elder Law firm to complete your Medicaid application will likely be the best and most cost-effective choice. Applications are long and complicated, and making a mistake that delays Medicaid approval, or results in a denial, can cost you thousands of dollars.
Once you are Medicaid-approved, your MLTC plan will conduct a needs assessment. At that point you can enroll in CDPAP through PPL.
The care journey is a multi-step process, and roadblocks (that will cost you money) can pop up anywhere. That’s why it’s valuable to have a team in place that will guide you through the paperwork maze as quickly and efficiently as possible.
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