The Consumer Directed Personal Assistance Program (CDPAP) allows chronically ill or physically disabled New Yorkers who require assistance with activities of daily living (ADLs) to hire their own caregiver. It is designed to give those who need caregiver assistance more control over their home care.

New York’s CDPAP program has undergone some changes in light of the COVID-19 pandemic. Below we will discuss how CDPAP is evolving in 2022.

What is CDPAP?

The program is funded by New York State’s Medicaid program that allows recipients to choose a relative or friend as their caregiver if they wish (except for a spouse), allowing that person to get paid for their services.

Recipients assume full responsibility for choosing, instructing, and even firing these caregivers, acting as their employer in a sense. Because of this, the recipient must be fit to make informed choices about their own care, manage the scheduling of their caregiver, and keep payroll records (or, in the case of a disabled child, their parent can make that decision).

A nurse assessor determines whether the recipient is eligible for CDPAP and whether the caregiver can meet the appropriate needs. The assessor also determines the frequency of caregiving and duration of a recipient’s eligibility for the program.

How do Medicare recipients access CDPAP?

Recipients taking part in the CDPAP program must organize their care via a Managed Care or MLTC Plan or local Medicaid agency (the Human Resources Administration or Department of Social Services). 

If you are only eligible for Medicaid (and do not have Medicare), you will be required to enroll in a Mainstream Medicaid Managed Care (MMC) plan that will determine your eligibility for home care services. If you are eligible for both Medicaid and Medicare, you will enroll in CDPAP through Managed Long Term Care (MLTC).

In order to pay their caregivers, recipients must choose a New York State-authorized Fiscal Intermediary (FI). FIs operate as private insurance companies that contract with governing entities to process wages for caregivers (much like a payroll service).

However, these two requirements will change in 2022 to require more state oversight.

Is CDPAP closing?

CDPAP is not closing or ending, but some significant changes are being made in 2022. Some of these changes had been planned earlier but were put on hold in light of the COVID-19 pandemic. 

The most significant change to the CDPAP program involves new “New York Independent Assessor” (NYIA) procedures. These will add an extra step and more requirements for recipients wishing to enroll in CDPAP.

Some healthcare organizations have expressed concern that there are not currently enough medical professionals to act in this capacity in light of the COVID-19 pandemic.

What were some of the changes?

  • Independent Assessments

New CDPAP regulations will require recipients seeking to join the program to obtain an independent assessment by the NYIA to ensure they are eligible. 

The assessment process includes:

–          A Community Health Assessment (CHA) conducted by a Registered Nurse

–          A clinical exam conducted by an approved clinician who has no prior relationship with the recipient.

In addition, the NYIA will require an evaluation of the recipient’s care plan by an Independent Review Panel (IRP) to ensure it is “appropriate and reasonable.” This will add an extra step beyond creating the care plan with a managed care or MLTC program.

  • New Lookback Requirements

While some expected budget cuts were not enacted, another new piece of legislation was approved that would institute a “lookback” for those receiving long-term home care through CDPAP.

This means:

–          New applicants and spouses will have to provide financial records going back 2.5 years to ensure the person applying for CDPAP meets the economic guidelines and has not offloaded assets in the recent past in order to qualify for the program.

–          If an applicant is found to have sold or transferred an asset below fair market value, they may become ineligible for Medicaid or have the payment of their home care costs reduced.

There are concerns that this requirement will result in much longer processing times for Medicaid and CDPAP applications.

  • New Minimum ADL Requirements

CDPAP’s home caregiver services will be more difficult to access due to new qualification requirements. Recipients must now require assistance with “physical maneuvering with more than two” ADLs. This means that you must need help with at least three Activities of Daily Living (ADL) in order to qualify for paid caregiver services. (However, recipients with dementia will still need two.)

These ADLs must be affirmed by an independent physician and approved by the new independent assessor instead of the local Medicaid agency, MCO, or MLTC program. Because of this, the “Independent Assessor” procedures will be implemented before the new minimum ADL requirements.

  • Fiscal Intermediary Changes

New regulations also dictate that a consumer cannot enroll with more than one fiscal intermediary in order to pay their caregivers.

These changes will likely result in delays for those who need managed home care. They will also force CDPAP recipients to change the way they organize their fiscal intermediaries. But most significantly, it will restrict the eligibility of many New Yorkers who do not meet the new ADL requirements.

Benefits of using FreedomCare as a Fiscal Intermediary (FI)

When you only have one shot at choosing a fiscal intermediary, working with someone you trust is crucial. FreedomCare is committed to helping families care for each other and to giving patients with chronic illnesses or disabilities the dignity they deserve by letting them choose their caregivers and remain in their homes as long as possible.

With over 45,000 clients, FreedomCare serves more New Yorkers than any other agency. We’ve even introduced new technology such as InstaPay4Care to ensure caregivers get paid on time and without the bureaucracy. Our services are also available in Missouri, Nevada, and Pennsylvania.

FreedomCare is a contracted provider of CDPAP and is committed to helping Medicare recipients navigate the new legislation so they can pay for the caregivers who love them.

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