CDPAP is a Medicaid program offered in the State of New York. It allows anyone who is chronically ill or disabled to hire family members or friends as their caregivers. In this article, we explain everything you need to know about CDPAP regulations, whether you are a patient or a caregiver. 

What Is CDPAP?

Consumer Directed Personal Assistance Program (CDPAP) is a New York Medicaid program that provides services to low-income individuals who are chronically ill or physically disabled and not capable of living independently. Because CDPAP is a Medicaid program, the service is free for consumers.

CDPAP beneficiaries can choose a family member or a friend to act as a caregiver who will help them in activities of daily life and provide skilled nursing services. The program allows beneficiaries to receive care at home instead of having to move to an assisted living community or a nursing home.

CDPAP Regulations for the Patient 

To benefit from the CDPAP service in New York, you must meet the following criteria:

  • Reside in the State of New York. The program is offered in all New York counties.
  • Be enrolled in Medicaid or be eligible for Medicaid. If you need to enroll in Medicaid, you can get in touch with your local Medicaid office. Please note that Medicare does not cover CDPAP.
  • Have a stable medical condition.
  • Be able to provide evidence that you need some or total assistance with activities of daily life, such as walking and mobility, personal hygiene, dressing, taking necessary medication, meal preparation, and so on.
  • Be self-directing. In case you are not self-directing, you must have a designated representative who can direct your care.
  • Be able to participate in the required assessment processes. If you are non self-directing, your designated representative must be able to assume this task.

In addition, the CDPAP program requires that you choose a fiscal intermediary. Fiscal intermediaries are private companies contracted by Medicaid that provide assistance with administrative aspects of home care. They are also responsible for paying caregivers. 

Finally, before you can get approved for CDPAP, you have to undergo two different in-home assessments: one from the state and one from your health plan. After that, a registered nurse will decide how many hours of care you can get. The maximum is 60 hours per week, but overtime pay is available. 

A CDPAP patient can have more than one caregiver, allowing several family members or friends to share the responsibility. As a beneficiary, you will be able to make all the decisions when it comes to the scope of your caregivers’ services and their schedules. You will be responsible for recruiting and supervising your caregiver(s) and you can decide to terminate their contract whenever you wish.

What Does Self-Directing Mean According to the New York State Department of Health (NYS DOH)?

According to the New York State Department of Health (NYS DOH), a self-directing CDPAP recipient (also called a consumer) is someone who: 

  • Can manage personal assistance
  • Is capable of making choices regarding activities of daily living
  • Understands the implication of these choices
  • Can assume the responsibility for the outcome of their decisions. 

To be considered self-directing, you must:

  • Know what to do in emergency situations
  • Not have a recent history of unintentional wandering
  • Not show any signs of unintentional negligence
  • Understand the consequences of harmful behaviors such as not taking your medications or refusing to seek help in a medical emergency.

In other words, as a self-directing individual, you know exactly what tasks are needed for your daily routines and care, but you need help to implement them. 

Individuals who suffer from any type of cognitive decline such as Alzheimer’s disease, for example, or experience delusions or disorientation, are considered to be non self-directing because they are not capable of making rational and intentional choices. Non self-directing patients must have a designated representative who will manage their care in order to be eligible for CDPAP.

CDPAP Regulations for the Caregiver

A CDPAP beneficiary can designate as a caregiver almost any other person, such as a family member, a neighbor, a friend, or even an in-home aide who worked for the patient in the past.

However, there are a few exceptions. The following individuals are not allowed to act as caregivers: 

  • Legal spouse
  • Designated representative, and
  • Parent or legal guardian (if the child is under the age of 21).

To become a CDPAP caregiver, you must meet the following requirements:

  • Be above the age of 18.
  • Be a legal resident of the State of New York. 
  • Complete a standard medical exam to make sure you are physically capable of caring for someone and that you don’t have limitations that may impact your ability to act as a caregiver. The exam includes drug screening, blood tests, and screening for rubella and rubeola.
  • Complete all the necessary payroll documents.

As a CDPAP caregiver, you are not required to have a degree, license or certification of any kind, or even caregiving experience. As long as you are given adequate training, you are allowed to perform medical and health tasks in addition to helping the patient with the activities of daily living. CDPAP aides can administer medication and provide skilled nursing services that are normally performed by licensed nurses, such as:

  • Taking vital signs
  • Routine monitoring of health conditions
  • Wound care
  • Giving insulin shots
  • Administering oxygen
  • Suctioning tracheostomies. 

Do I need to be a US citizen to become a caregiver? 

You don’t have to be a US citizen to become a CDPAP caregiver. As long as you are authorized to work in the United States and can prove legal residence in the State of New York, you are eligible to take on this role. 

Do I need a background check?

No. As opposed to working as a home care aide through an agency, you don’t need to undergo a background check to serve as a caregiver through the CDPAP program.

History of CDPAP Legislation

The idea of caregiving at home dates all the way back to the late 1970s. At that time, very few options were available when it came to home care. Disabled or chronically ill people were often placed in overcrowded nursing homes and had their care run exclusively by a state-approved agency with little or no say over care providers. This lack of options did not only deprive patients of any choice, but also took away their sense of independence.

In 1977, a group consisting of both disabled and non-disabled individuals formed Concepts of Independence for the Disabled (CID), a community-based alternative to institutionalization. The group advocated for allowing people with disabilities to have more control over their care. They believed that choosing a care provider would be a much more beneficial experience for disabled individuals.

In August 1978, after a group of severely disabled people held a protest demonstration outside the chambers of the New York City Board of Estimate, a joint Family and Adult Services/ Community Task force was established. The Task Force met regularly for a year and a half. During that time, they explored a variety of approaches for developing a program that targeted the needs of severely disabled individuals with a stable medical condition who wished to manage the delivery of their own home care.

In 1979, the Client Maintained Home Attendant Plan came into force. This plan split the responsibilities of overseeing care between the patients/consumers and agencies. 

In 1992, the New York State Department of Health took over the Home Care program from the Department of Social Services. They proposed the first statewide home care project called the Patient Managed Home Care Program. The purpose of the program was to explore options to improve the quality of state-provided home care, while at the same time keeping the care affordable.

The Patient Managed Home Care Program proved to be a great success. In 1995, it was renamed to the Consumer Directed Personal Assistance Program. CDPAP soon became one of the fastest growing community-based programs of its kind and by 1999 it reached over 1,000 members. 

By 2002, more than two-thirds of New York State Medicaid offices provided CDPAP services, and in 2008 the program saw a 60% increase in enrolled members. Since 2012, most Managed Care and Managed Long Term Care (MLTC) Medicaid benefit packages have offered the program as a home care option. 

In 2016, New York State expanded the eligibility to act as a paid caregiver under CDPAP. Patients were now allowed to hire their relatives as their personal assistants as long as they were not legally responsible for the patient’s care and support. This meant that children could get paid for taking care of their parents and parents could get paid to take care of their children above the age of 21. 

Today, thousands of eligible individuals join the CDPAP program on a yearly basis. Every county in the State of New York is required to offer CDPAP services and to inform citizens on how they can take control of their own care.

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