Immediate Need CDPAP

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CDPAP is a New York Medicaid program that allows anyone who is chronically ill or disabled to hire family members and friends as caregivers. Usually, when you apply for a home care program, you have to wait for months before you can receive the service. But if you have an immediate need, it’s possible to speed up the process and get approval in only twelve days.

This guide explains how Immediate Need CDPAP works, what are the requirements, and how to enroll so that you can get home care as fast as possible.

What Is Immediate Need CDPAP?

CDPAP (short for Consumer Directed Personal Assistance Program) is a Medicaid program offered in the state of New York. The program provides services to low-income individuals who are chronically ill or physically disabled and can’t live independently. The CDPAP allows you to receive care at home instead of having to move to an assisted living community or a nursing home.

In Medicaid documents, people receiving home care are called “consumers.” CDPAP is a consumer-directed program which means that you are responsible for managing your own care. If for any reason you are unable to take on the responsibility for your care, you can choose a person who will serve as your “designated representative.” In this case, it’s your representative who will coordinate your home care.

As a CDPAP beneficiary, you can choose your own caregiver. It can be almost any family member, a neighbor, a friend, or even an in-home aide who worked for you in the past. In the CDPAP program, caregivers are called “personal assistants.”

Your caregiver will help you with daily tasks or “activities of daily living” like bathing, cooking, and household chores. They can also assist you with transportation for shopping and doctor visits, for example. CDPAP caregivers are also allowed to administer medication and provide skilled nursing services. These services, like wound care, giving insulin shots, administering oxygen, and suctioning tracheostomies, can otherwise only be performed by licensed nurses.

What are the benefits of CDPAP?

CDPAP has many benefits compared to using traditional home care health aides/home attendants. Here are some of them:

With CDPAP you are free to choose your own caregiver.
Your loved ones can provide care and get paid for it.
With a family member or friend taking care of you, you will have better care at home and need fewer hospital visits.
Your caregiver doesn’t need to have any special licensing or certification.
You decide your caregiver’s services and schedule. You can also terminate their contract whenever you wish.
Because CDPAP is a Medicaid program, the service is completely free for beneficiaries.

What is the difference between CDPAP and Immediate Need CDPAP?

The Immediate Need CDPAP program has the same benefits as CDPAP. The only difference is that when you have an immediate need, it takes less time to get approval. If you are living with a disability or illness and don’t have anyone to help you, the long wait can be difficult both financially and emotionally. Through Immediate Need CDPAP, you can get the home care you need in less than two weeks instead of having to wait for months.

Who Can Apply for Immediate Need CDPAP?

To apply for Immediate Need CDPAP, you must first qualify for the regular CDPAP service. This means that you have to meet the following criteria:

You must live in the state of New York. The Immediate Need CDPAP is offered in all New York counties.
You have Medicaid or are eligible for Medicaid.
You have a long-term physical disability or chronic illness that require home care.
You (or your designated representative) are able to train a caregiver.

Besides, there are additional requirements that are specific to Immediate Need CDPAP. You must be able to show that:

You are not receiving payment from long-term care insurance plans.
You don’t qualify for home care through other local or federal programs. For example, if your Medicaid plan provides personal care services, then you don’t qualify for Immediate Need CDPAP.
You are not receiving help with household activities and medical needs from a nurse or personal assistant.
You are not receiving help from an informal caregiver like friends or family.
You have no family members or friends who are able to help you with your daily activities while you wait for the regular CDPAP application to get processed.
You are receiving Medicaid home and community-based services (HCBS) such as adult day care, but you have an immediate need for home care.
You have no adaptive or specialized supportive equipment or supplies to assist you in your daily activities. You also don’t have the resources or insurance to purchase adequate supportive devices.
You don’t require any special health care equipment such as respirators or suctioning equipment.

If you don’t qualify for Immediate Need CDPAP, you will need to apply for a regular CDPAP.

How to Apply for Immediate Need CDPAP (Step-by-Step Guide)

To apply for the Immediate Need CDPAP, you need to:

Apply for Medicaid (if you don’t have Medicaid coverage)
Fill out several government forms
Submit the completed forms
Wait for application assessment
Choose or get assigned a Fiscal Intermediary
Choose your caregiver

You can apply for Immediate Need CDPAP whether you are at home, in a hospital, or a nursing home.

Applying for Immediate Need CDPAP if you have Medicaid

If you already have Medicaid coverage, you can apply directly for Immediate Need CDPAP. In this case, the application process will be faster.

It is important to keep in mind that CDPAP is covered by Medicaid but not Medicare. However, if you have both Medicaid and Medicare, you are eligible for the CDPAP program.

To apply directly for Immediate Need CDPAP, you need to complete the following forms:

Access NY Supplement A form (DOH-4495A) if you reside in New York City or Access NY Supplement A form (DOH-5178A) if you reside anywhere else in New York State. You have to complete this form if your Medicaid coverage doesn’t include community based long-term care services (HCBS) or you are over 65 years old, blind or certified disabled, chronically ill, or institutionalized and applying for coverage of nursing home care.
M-11Q Medical Request for Home Care form if you live in NYC or Physician’s Order for Services (1-DOH-4359) if you live anywhere else in New York State. These forms are filled out by your physician who is enrolled in the Medicaid program. They must be less than 30 days old. The physician will sign the form and send it to the local social services for assessment.
Attestation of Immediate Need (OHIP-0103) where you have to confirm that you meet all the Immediate Need CDPAP requirements.
A cover letter where you explain why you have an immediate need for CDPAP.

You also need to provide the status of your Medicaid application if previously approved or filed. If you already have Medicaid, you will be asked to submit your Medicaid approval notice and Client Identification Number (CIN).

Applying for Immediate Need CDPAP if you don’t have Medicaid

If you meet all the criteria for an Immediate Need CDPAP and you don’t have Medicaid coverage, you can apply for Medicaid and Immediate Need CDPAP at the same time.

Who is eligible for Medicaid?

Medicaid is a program for low-income New York State residents who can’t afford medical services. To qualify for Medicaid, you must fall within one of the following categories:

You’re pregnant
You’re the guardian of a child younger than 18 years
You are blind, have a disability, or have a family member with a disability
You’re above the age of 65

MAGI and non-MAGI groups

The necessary documentation needed to apply for Immediate Need CDPAP will depend on whether you fall under the Modified Adjusted Gross Income (MAGI) or non-MAGI Medicaid eligibility groups.

MAGI eligibility groups include pregnant women, childless adults aged 19-64 who are not on Medicare, and parents/caretaker relatives.

Non-MAGI eligibility groups include people over the age of 65, individuals who are blind or disabled, and those who do not meet the criteria of any MAGI eligibility groups.

To apply for Immediate Need CDPAP and Medicaid, you need to complete the following forms:

Access NY Health Insurance Application (DOH-4220).
Access NY Supplement A form (DOH-4495A) if you reside in New York City or Access NY Supplement A form (DOH-5178A) if you reside anywhere else in New York State. You have to complete this form if your Medicaid coverage doesn’t include community based long-term care services (HCBS) or you are over 65 years old, blind or certified disabled, chronically ill, or institutionalized and applying for coverage of nursing home care.
M-11Q Medical Request for Home Care form if you live in NYC or Physician’s Order for Services (1-DOH-4359) if you live anywhere else in New York State. These forms are filled out by your physician who is enrolled in the Medicaid program. They must be less than 30 days old. The physician will sign the form and send it to the local social services for assessment.
Attestation of Immediate Need (OHIP-0103) where you have to confirm that you meet all the Immediate Need CDPAP requirements.
A cover letter where you explain why you have an immediate need for CDPAP.
If you are in a MAGI eligibility group: attestation of household income and residence/citizenship documents.
If you are in a non-MAGI eligibility group: residence/citizenship documents, proof of age, recent paycheck, proof of current benefit, and any additional medical coverage documentation.

Where should I send my application?

Where you will send your application depends on whether you live in NYC or elsewhere in New York State.

NYC

New York City residents should submit the package to the New York Human Resource Administration (HRA) at the following address:

HRA–HCSP Central Medicaid Unit

785 Atlantic Avenue, 7th Floor

Brooklyn, NY 11238

You can also eFax a copy of the complete application and all documents to HRA HCSP 1-917-639-0665. In this case, you have to use the HRA HCSP Transmittal Form HCSP-3052.

New York State (except for NYC)

If you live anywhere in New York State except for NYC, you should send your application to the Local Department of Social Services.

What Happens After I Submit the Application?

When you submit the Immediate Need CDPAP application, your forms are assessed by a nurse and a social worker. After your application is accepted, you can go ahead and choose your caregiver.

Application assessment

The Human Resource Administration or social services office will check all the documents you’ve sent in to see if anything is missing. They will also conduct a social and nursing assessment in your home to make sure you are eligible.

If they need any further information, they will contact you within four days after receiving your application. You will get a letter informing you about any additional documentation or details you need to provide. You must reply by the date indicated in the letter, otherwise, you will have to start a new application.

When your local Medicaid office has received the complete information, they have to reply within twelve days. They will let you know if you’re eligible for Immediate Need CDPAP and how many hours of care per week or month can be covered by CDPAP.

Fiscal Intermediary

The CDPAP program requires that you work together with a Fiscal Intermediary. Fiscal Intermediaries are private companies contracted by Medicaid. They can help you with any administrative aspect of your home care. They are also responsible for paying your caregiver.

Your Medicaid service coordinator or plan care manager will provide you with a list of Fiscal Intermediaries. You can also search for your local Fiscal Intermediaries through the Consumer Directed Personal Assistance Association of New York State website. Or you can ask to be assigned a Fiscal Intermediary if you don’t want to look for one.

Choosing a caregiver

Once you have had your application approved, you can choose your caregiver. As a CDPAP recipient, you can have more than one caregiver. This can be very convenient, as it allows family members to share the responsibility to better accommodate their schedules.

Your caregiver can be any adult except:

A spouse
A designated representative
A parent of a disabled child under 21 years old.

These individuals are considered “legally responsible” for you, and legally responsible persons can’t serve as your personal assistants under the CDPAP program.

Caregivers are not required to have any education or certification in healthcare. However, they must have a full exam by a doctor with a TB test and show proof of measles/rubella immunity.

How many hours of home care will I get?

You are allowed to make decisions on most aspects of your home care except for the number of weekly hours you get. During the assessment visit to your home, a Medicaid nurse will determine how many weekly hours of care you need. This number will depend on your individual circumstances. Your Medicaid Managed Care plan will make the final decision on the number of hours you will receive.

How Fast Can I Get Approved for Immediate Need CDPAP?

When you apply for regular CDPAP, it will take your Medicaid office anywhere between 45 and 90 days to process the application.

However, if you are applying for an Immediate Need CDPAP, the approval process is much faster. As soon as you are approved, the Medicaid office must implement home care services within twelve days. If you are applying for Medicaid as well, approval will take up to seven days.

This means that if you qualify for Immediate Need CDPAP, you will have the home care service started in about 2-3 weeks.