What is the CDPAP program?
CDPAP stands for Consumer Directed Personal Assistance Program. This is a Medicaid initiative in the state of New York that makes it possible for consumers to choose and hire their own personal caregivers.
What this means is that consumers who need personal care in their homes can choose friends or family (not the patient’s spouse and usually not a parent) as their caregivers and these people are eligible to receive payment for their services through a Fiscal Intermediary (that’s us) that acts as a liaison with Medicaid.
The CDPAP program acknowledges that no one can care for a patient as well as loved ones can. It’s natural for family members and close friends to act as caregivers for loved ones in need even without payment. They typically regard this work as more than just a job.
This level of care and concern is priceless and the CDPAP program exists as a way to support caregiving within families and among friends through financial reimbursement.
Elderly and disabled individuals don’t want to be a burden to their family and friends and the CDPAP program makes it possible for family members and loved ones of qualified patients to provide essential caregiving services but also get paid for their time.
To access the benefits of the CDPAP program, you must go through a fiscal intermediary who will handle Medicaid payments for your chosen caregiver.
If you are interested in signing up, give us a call at 718-568-7371.
What are the eligibility requirements for CDPAP?
The eligibility requirements for CDPAP are relatively simple. In order to qualify to receive care under the CDPAP program, the patient must meet the following requirements:
● The patient must be a Medicaid recipient in New York State.
● The patient must require home care and/or home health care. (In other words, the patient must be able to prove that they need assistance with daily living activities in the home. The patient may be asked to take an ADL or IADL test as proof.)
● The patient or their representative must be able to prove that they are self-directing or that they have a representative who can direct someone else as to how to care for them.
The CDPAP program is built on the concept of patient directed care (or care that is directed by the patient’s representative), so before a patient can apply, they must be confident in their ability to direct a caregiver in essential tasks. In addition, the patient must be able to prove that they need the help of a caregiver. There are special tests available (mentioned above) that can serve as proof of this need whenever relevant.
For individuals who want to apply to be caregivers as a part of the CDPAP program, the requirements are different. If you want to apply to be a caregiver, you must be able to provide the following:
● Proof that a patient already wants to or would be willing to hire you as their caregiver
● Proof of American citizenship or legal working status in the US
● Proof that you are of legal working age
● Completed Personal Assistant (PA) application package provided by the fiscal intermediary
● Completed pre-employment physical exam to act as proof that you are physically capable of providing the level of care that will be needed
CDPAP care providers do not have to have any formal training to be able to become members of the CDPAP program. However, they must be willing and able to learn from their patient (or a patient representative), and they also must be physically capable of providing the care that is needed.
How do I apply for CDPAP?
The simplest way to apply is to give us a call at 718-568-7371. Our dedicated staff will walk you through the process. However, to give you a better understanding of the process we have broken down the stages for you here:
1) Assessment
2) Consumer forms
3) Selection of caregiver
Let’s take a look at each of these stages in more depth:
Assessment
During this stage of the CDPAP application process, the patient must undergo a medical examination and assessment performed by a nurse. Some applicants must undergo more than one assessment, depending on the situation.
This assessment is intended to prove that the patient requires home care, and it also helps identify the exact areas in which the patient will need help. The assessment will also help the future caregiver understand the needs of the patient more clearly when the time comes.
During the assessment(s), the nurse will determine the service quantity, duration, and frequency of the care that will be needed.
The assessment stage of the CDPAP application process may also involve ADL or IADL tests that are intended to help accurately determine the type and quantity of activities of daily living care that is needed.
Some patients may be asked to undergo these tests while in other cases it may not be necessary for the patient to complete these tests. It depends on the situation.
Consumer Forms
CDPAP applicants must complete a series of forms as a part of the application process. Two of the forms that are required are:
● DOH Form (Physician’s Order) – This form is provided by and completed in the presence of the patient’s doctor. This form indicates that your doctor authorizes you (the patient) to receive the home care services that will be provided by your CDPAP caregiver.
● PCP Transfer Form – This is not a mandatory form, but it is one that a lot of new CDPAP recipients must fill out. Your doctor will fill out this form on your behalf. The PCP Transfer form permits you to transfer from one health plan to another.
You will also need to provide identifying documents (such as proof of American citizenship) and medical documents (like your Medicaid card).
Selection of Caregiver
Finally, you will have to go through the necessary steps to choose and officially “hire” your caregiver. Remember that there are specific rules and regulations regarding who can be a caregiver on the CDPAP program and who cannot (these rules are discussed later in this guide).
Also, remember that your chosen caregiver will need to be able to provide the necessary documentation and information to be eligible to become a CDPAP caregiver before you will be able to select them.
Does a patient have to be on Medicaid to qualify?
Yes, you must be on Medicaid in order to be a part of the CDPAP program. CDPAP is a government funded program that is available exclusively to Medicaid recipients.
If you do not have Medicaid and wish to apply, you will need to first apply to Medicaid, and then apply for the CDPAP program.
I don’t have Medicaid but I think I am eligible. How do I obtain Medicaid?
Because you need to have Medicaid before you register for the CDPAP program, you might be wondering whether or not you are eligible for Medicaid and how to get Medicaid if you are. Let’s first review some of the eligibility requirements for Medicaid. Individuals in New York State who fulfill the following requirements may be eligible to receive Medicaid:
● You must be either:
○ An adult with an income not over 138% of the Federal Poverty Level (FPL)
○ A pregnant woman or a woman with an infant whose income is not over 218% of the Federal Poverty Level (FPL)
● You must have proof of American citizenship and residency in New York State.
In addition, the following individuals may qualify for Medicaid as MAGI (Modified Adjusted Gross Income category) recipients:
● Foster children
● Children under age 19
● Beneficiaries of the Family Planning Benefit Program (FPBP)
● Relatives of caregivers or parents
● Women undergoing fertility treatments
Individuals who are already members of the following programs may qualify for Medicaid as non-MAGI recipients:
● Medicaid Cancer Treatment Program
● AIDS Health Insurance Program
● Social Security Income
● ADC-related medical needy
● Medicare Savings Program
If you believe that you might qualify to become a Medicaid recipient, the next step is to gather your documentation and apply to become a part of the program. The New York Medicaid Application can be submitted either online through the eMedNY portal, in person at your local District Service Office, or through mail sent to the District Social Service Office in your area.
You are also welcome to contact your local service office directly over the phone for additional guidance with the application process. If you visit a District Service Office in person, you may be assisted by a qualified representative who can walk you through the process and the required documentation for the Medicaid application process.
Make sure that you have your documentation prepared and ready to go! You will need the following documents to be able to apply for Medicaid:
● Proof of American citizenship
● Proof of New York State residency
● Completed Medicaid application form
● Proof of assets and current savings
● Proof of all sources of income
● Completed Medicaid supplement form
○ For New York City residents
○ For residents of counties outside of New York City
● Any other documents that may be requested of you by the local and state government offices during the application process.
Medicaid recipients must renew their membership in the program on an annual basis. You will not be able to apply to become a part of the CDPAP program until after you have completed and successfully received membership as a Medicaid recipient.
CDPAP Pay Rate and Salary
Payment and benefits depend on the patient’s location and insurance plan. Please call us at 718-568-7371 to find out the exact pay rate for your area.
Who can provide care under the CDPAP program?
There are a designated set of individuals who are eligible to provide care under the CDPAP program. If you are an adult relative or friend of someone who needs home care, it’s likely that you are eligible to provide care as a CDPAP caregiver, but there are some restrictions and requirements that you need to be aware of before applying as a caregiver.
Here are the individuals who are able to provide care under the CDPAP program:
● Children of elderly parents or parents who need home care
● Siblings of individuals who require home care
● Friends of individuals who require home care
● Parents of disabled or needy individuals over the age of 21 (who must have requested that their parents be their primary caregiver under the CDPAP program)
● Other adult family members, friends, or associates of a patient
People who cannot provide care services (excluding rare, extenuating circumstances) include:
● The spouse of the patient who requires home care
● The parent of the patient under the age of 21 who requires home care OR the parent of a patient over the age of 21 who has not specifically requested that their parent be their caregiver.
All CDPAP providers must also be American citizens and be able to provide proof of citizenship, or they must have legal immigration status in the United States and be able to show the necessary paperwork (such as a green card or other immigration papers).
All providers must also be of legal working age and be capable of providing the care services required. Before a person may become an official CDPAP caregiver, they will be required to undergo some medical testing (such as a TB test) as well as provide adequate documentation so as to prove that they are eligible to be the caregiver of a patient.
Can a caregiver live at the same address as the patient?
Yes, sometimes. In certain situations, a caregiver may be permitted to live at the same address as the patient, but in most situations, this isn’t the case.
According to the government’s policy, a CDPAP personal assistant can be the adult relative of a patient who does not reside with the patient. Or the personal assistant can be the adult relative who resides with the patient because the amount of care that’s required by the patient necessitates a live-in caregiver.
In other words, if the patient doesn’t require 24/7 personal care services, the caregiver may not live at the same address as the patient. However, patients who require a lot of care and who need a live-in caregiver may have the same address as the caregiver. Thus, most of the time, caregivers and patients must live at separate addresses in order to be accepted by the CDPAP program. But, there are exceptions to this rule. If the patient needs high levels of regular care, an exception may be made on a case-by-case basis.
Which family members cannot work as CDPAP aides?
Most family members are eligible to work as CDPAP aides so long as they fulfill the following requirements:
● They are of legal working age.
● They are legal American citizens or residents.
● They are physically capable of providing the care required.
● The patient has requested them as a caregiver.
● They live at a separate address from the patient (unless the patient requires 24/7 care).
However, neither spouses nor parents of minor children can work as CDPAP aides. Parents of children over the age of 21 may work as CDPAP caregivers for their children if the child has specifically requested that the parent be their caregiver. Otherwise, the parent is not permitted to enroll in the CDPAP program to provide home health care for the adult child. There is no usual exception made for spouses.
What type of training is needed to work as an CDPAP caregiver?
Caregivers do not need to have any formal training and are not required to hold any special certifications or licenses to be able to work as a home care provider as a part of the CDPAP program. Most of the training that CDPAP caregivers receive is provided by the consumer (the patient or the patient’s representative) according to their specific requirements and needs.
New York State offers new caregivers a set of training modules that have valuable information on how to work as a caregiver, but this training isn’t required.
CDPAP caregivers are authorized to provide care of the same level that a registered nurse would be able to provide. For example, caregivers can provide patients with injections, wound care, oxygen therapy, and other advanced nursing skills and services.
Thus, many caregivers choose to undergo additional training so that they can provide the best care possible, but this additional training is not required by the state of New York.
What types of home care services can CDPAP caregivers provide?
CDPAP caregivers can provide a wide range of home care services. Whereas traditional home health aides (HHAs) and personal care aides (PCAs) are more limited in the services that they can provide, CDPAP caregivers are authorized to perform many different care tasks.
One major difference is that home health aides and personal care aides must, for example, request the help of a nurse to administer oxygen and insulin injections. CDPAP caregivers, on the other hand, are able to perform the duties of a skilled nurse as well as that of the home care provider.
In addition to being authorized to provide health care services equivalent to those that a nurse can provide (such as injections, IV therapy, oxygen administration, etc.), CDPAP caregivers may also perform the following home care services:
● Assistance with bathing
● Assistance with dressing and undressing
● Preparation of meals and snacks
● Medication management and reminders
● Housekeeping (cleaning, lawn care, etc.)
● Shopping and errands
● Help with transportation (driving the patient to where they need to go OR offering support on public transport systems)
● Provide companionship
● Support with therapeutic movements and/or exercise (when applicable)
● Management of medical equipment
● Resource allocation (for medical supplies, etc.)
● Skilled nursing activities (the exact type of activity or activities vary from patient to patient according on their individual medical needs)
There may be other health care or home care services that the patient requests from the caregiver, beyond those listed above. Because CDPAP is a consumer-directed program, it’s up to the consumer or their representative to tell you, the caregiver, what is expected of you in terms of the type of care you will provide.
The list above is incomplete and highly variable and caregivers and patient representatives should be prepared to work with an assigned county caseworker and/or medical professional to determine the patient’s level of care.
A personalized care plan is drafted after the level of care is assessed by qualified professionals and a certain number of hours of care is approved making a selected caregiver eligible for compensation for those hours.
Once the level of care has been determined, patients can choose a caregiver to perform the necessary services in their home for the allotted amount of time. Any personal caregiver who is not the legal parent or spouse of the patient may be paid for their time through the fiscal intermediary (a financial management company).
What is a fiscal intermediary (FI) and why do I need one to sign up for CDPAP?
A fiscal intermediary is an organization that manages and processes benefits and wages on behalf of two parties: Medicaid and caregivers who work through the CDPAP program.
The fiscal intermediary functions as a liaison between Medicaid and personal caregivers. They ensure that patients get the assistance they need, while caregivers receive the financial stability required to continue doing their jobs.
Without a fiscal intermediary to mediate on behalf of the personal caregiver with Medicaid, personal caregivers would not be able to get paid for the provision of services.
Every state differs in terms of how it pays caregivers for personal, at-home care, but the CDPAP program in New York is one of the most well-developed, sustainable models of personal care provision in the country.
Patients must be eligible for Medicaid before caregivers can sign-up through their local Department of Social Services, but this program acknowledges the special value of care that’s provided by family members or friends along with the need to support that value with financial incentive.
What are the benefits of CDPAP compared to traditional home care?
One of the most salient benefits of CDPAP vs. traditional home care is the fact that patients can choose their own caregivers and that these chosen caregivers can be family members or friends. When the patient and caregiver have a strong emotional bond, it leads to better care results and a more satisfying work environment. Both patient and caregiver benefit from the relationship.
CDPAP offers more freedom and flexibility for both patient and caregiver. Personal care assistants don’t need to have special licensing or certification to perform their jobs. And patients who need advanced care services such as insulin shots, suctioning tracheostomies, or wound care can be cared for by friends or family members who receive special training but who work as unskilled caregivers.
In traditional home care, a home health aide or skilled nurse is hired by the agency to care for a patient. The patient typically does not know the aide or the nurse and the patient has no choice about which aide or nurse shows up to care for them during a given shift.
If the patient has a problem with a particular nurse or aide, they have little recourse. They can complain and request a different caregiver, but if the home care agency doesn’t have another caregiver available to take the shift, the patient is in a position where they must either do without a caregiver or put up with a caregiver they don’t like or don’t trust.
Through the CDPAP program everyone benefits. This program saves patients money and it allows friends and family members to get paid to function in natural caregiving relationships.
Traditional home care has many regulations and requirements that simply don’t apply when family members act as caregivers instead of a stranger and the patient (or their representative) is supervising the work for themselves.
Though traditional home care has its place along the caregiving spectrum, the CDPAP program provides a sustainable model that benefits not just the caregiver or the patient, but everyone, including taxpayers!
Is any part of New York State not included in the CDPAP program?
All sixty-two counties in the state of New York are included in the CDPAP program so Medicaid patients state-wide can access services. Give us a call if you have any concerns about eligibility based on location.
Does a caregiver need to work a minimum amount of hours per week?
Caregivers are not required to work a minimum number of hours. Rather, each caregiver is paid for the number of hours they put in each week, no matter whether there is less than one hour or more than forty.
Some caregivers work more and others work less. If you need to work full-time, but your patient has been approved for less than 40 hours of care each week, you may wish to take additional patients to fill your schedule.
Can a caregiver take care of more than one patient at a time?
Yes! Caregivers can care for more than one patient at a time, but the hours have to be split up. In other words, you can’t be on the clock caring for more than one patient at a time.
For example, if you are caring for your parents and they live together, you may spend 45 hours per week at their home providing care. Your mom may qualify for 25 hours of care per week and your dad may qualify for only 20 hours.
Though you will likely provide care for both of them during your 45 hours of time in their home, you can only be on the clock for 25 hours for your mom and 20 hours for your dad.
You may also have patients who live in separate houses. If you desire full-time work, but one patient is only approved for 15 hours per week, you may want to care for other patients to achieve a full 40 hours of work.
Can a person with special needs qualify for the program?
Special needs patients can qualify for the CDPAP program if they meet the eligibility requirements. They must qualify to receive Medicaid, require home care, and be either self-directing or have someone who is willing to act as their representative to direct their care.
The special needs patient must have a representative who assumes responsibility for hiring, training, supervision, and termination of employment or they must be capable of assuming these responsibilities themselves. This representative, known as a Designated Representative (DR), must be an adult over the age of 21 years and be able to provide proof of legal status in the United States.
Special needs patients may be chronically ill or physically disabled with a medical need for assistance to perform activities of daily living. The patient may also be in need of skilled nursing services.
These services may include any of the services that a home care aide, home health aide, or nurse would perform. After they receive the necessary training, CDPAP caregivers are authorized to provide the same services for their patients as a nurse and/or as a home care aide would be able to provide.
CDPAP applicants must complete a series of forms as a part of the application process. Two of the forms that are required are:
● DOH Form (Physician’s Order) – This form is provided by and completed in the presence of the patient’s doctor. This form indicates that your doctor authorizes you (the patient) to receive the home care services that will be provided by your CDPAP caregiver.
● PCP Transfer Form – This is not a mandatory form, but it is one that a lot of new CDPAP recipients must fill out. Your doctor will fill out this form on your behalf. The PCP Transfer form permits you to transfer from one health plan to another.
You will also need to provide identifying documents (such as proof of American citizenship) and medical documents (like your Medicaid card).