August 17, 2022

Are you eligible for Medicaid in New York and need home health care assistance? Then you need to know more about the Consumer Directed Personal Assistance Program (CDPAP).

CDPAP is a Medicaid program that is exclusively available to New York state residents. Qualifying residents can receive home health care at no additional cost. That’s right – this program is completely free to qualifying individuals.

The most interesting thing about this program is that you can self-direct your care. That means you can choose your own home health care aide. Many eligible individuals use this program to hire their friends or relatives for care.

If you would like to participate in New York’s CDPAP program, you’ve come to the right place. Keep reading this guide for absolutely everything you need to know about qualifying and applying for CDPAP.

What Is CDPAP?

CDPAP is an acronym for the Consumer Directed Personal Assistance Program. Medicaid offers this program to residents of New York state. All 62 New York counties must offer CDPAPs to eligible adults.

Eligible people include those with chronic illnesses and physical disabilities. Typically, qualifying individuals need help with one or more ADLs (activities of daily living) or require skilled nursing.

But what’s the difference between CDPAP and regular home care programs? CDPAPs offer more control for patients. Specifically, you can choose whether you want a CDPAP agency, a representative of your choosing, or yourself to direct your care.

If you choose one of the two latter paths, you or the aide you designate must take care of the following:

  • Selecting your home health aide
  • Training your home health aide
  • Scheduling your home health aide
  • Keeping records of your home health aide’s payments
  • Coordinating a backup home aide when yours is sick or injured
  • If needed, firing your home health aide

Sometimes, these tasks can be far too complex for even the most capable patients and their representatives to handle. Then, you can choose a reputable CDPAP home care agency to take care of these items for you.

Another big difference between CDPAP and traditional home health care programs is the type of care aides can deliver. Traditional home aides can only deliver a limited number of services.

Home health aides of your choosing, on the other hand, can perform more skilled tasks. Even if your aide is not a nurse, he or she can administer insulin injections, oxygen, tracheostomies, and more.

Who Can You Hire as a Home Aide?

If you choose to self-direct your CDPAP program, you can pick your own home health aide. You can hire almost anyone to be your aide unless it is your spouse.

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Why? Because the two limitations on home aide choice are that you can not pick someone who is legally responsible or a designated representative for you.

Spouses and parents are legally responsible individuals. Spouses are legally responsible for their partners, so your spouse can not be your home health aide. Also, parents of adult children who require care may not qualify as home health aides unless:

  • The parent does not live with the adult child
  • The parent lives with the adult child, but only because the latter’s needs require the parent to live with the adult child

A designated representative is the person your choose to administer your CDPAP program if you choose not to self-direct your own care. In other words, the person you choose as your representative can not also be your aide.

Finally, you can not hire someone as your home aide if they are not currently authorized to work in the US.

Who Is Eligible for CDPAP?

The state of New York provides strict eligibility requirements for CDPAP applicants. These include:

  • You must be enrolled in or eligible for Medicaid
  • You must require or already be receiving home health care
  • You must choose a representative to direct or self-direct your care

Medicaid Eligibility: Explained

You don’t have to hold a current Medicaid plan to qualify for CDPAP. All you have to do is prove you’re eligible for Medicaid. Here are the eligibility requirements to qualify for Medicaid in New York state:

  • You must be a New York resident
  • You must be pregnant, responsible for a child aged less than 18 years old, blind, have a disability, or be 65 or older
  • You must be considered low income

The criteria for “low income” depends on your household size. For example, a household of 1 is considered low income if it brings in $18,075 or less before taxes. A household of 8 can earn up to $62,018 to qualify as a low income.

More on the Home Health Care Requirement

Do you receive home health care services? As long as you meet the other two requirements listed here, you can qualify for CDPAP.

Qualifying home care services include long-term home health care programs, AIDS home health care programs, and home health attendant programs.

What Are Designated Representatives?

You must be willing to choose a designated representative before applying for CDPAP. The designated representative can be yourself or someone else. Just remember that whoever you choose must select, train, and manage your health aide.

Your designated representative can be any of the following:

  • Your parent
  • Your legal guardian
  • A responsible adult who social services deem appropriate, including your son or daughter, relative, or friend

Your designated representative can not be the same person you choose as your home aide. He or she also can not be your personal assistant or any other person who is a paid employee of yours.

Remember that you can choose a CDPAP agency as your designated representative. These vendors contract with NYS Medicaid to provide CDPAP services at no additional cost to you.

Often, this is the easiest way to choose a representative. That’s because these agencies are highly skilled and experienced in managing CDPAP aides.

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How to Apply for CDPAP in New York

How you apply for a CDPAP program in New York depends on whether you have Medicaid, Medicaid, and Medicare, or neither.

People who have Medicaid but not Medicare must enroll in a Mainstream Medicaid Managed Care plan. You can then request CDPAP services from your plan. To do so, you’ll have to fill out Form M11q and apply for CDPAP.

People with Medicaid and Medicare must enroll in a Managed Long-term Care program. Then, your long-term care plan will determine your eligibility for CDPAP.

Some individuals who have Medicaid and Medicare are exempt from the requirement to enroll in a long-term care program. You can find a list of these exceptions here.

Do you qualify under one of the above exclusions? Then you can instead apply for a CDPAP at your local social services department. Once social services approve your application, you will have to enroll in a Managed Long-term Care program after 120 days.

This last option is also the correct way to apply for individuals who are not currently enrolled in Medicare or Medicaid. However, you must first prove your “Immediate Need” for home health services.

Once you determine where to apply, here are the four steps to getting your application approved.

1. Obtain a Physician’s Order for Services

Regardless of how you apply for a CDPAP, you must first receive a Physician’s Order for Services. Your personal physician must send this form to the local social services office. You can find this form here.

The Order for Services will detail your doctor’s opinion that you require a home health aide. Without this type of order, you can not continue the process of applying for a CDPAP program.

2. Receive a Home Assessment

Once social services receive your Physician’s Order for Services, they will schedule a home assessment. During the home assessment, a certified nurse will visit your home and ask you about your health needs.

The purpose of this assessment is twofold. First, the nurse will determine whether your home is eligible for CDPAP services. Second, the nurse will decide how often, how much, and for how long you should receive CDPAP services.

3. Choose Your Aide

Once you pass the home assessment, you can then officially apply for CDPAP. However, you must first decide on your home aide. You need to decide this first because the application will request that person’s information.

The good news is that you don’t have to choose a certified nurse as your home aide. You can choose literally anyone you want except for your spouse or parent. That means you can pick your child, neighbor, or current caregiver.

4. Fill Out the Correct Forms

Once you choose your home health aide, you are one step closer to finishing your application. All you have left to do is to fill out the proper forms.

If you’ve been following this guide, you will have already received a Physician’s Order for Services from your doctor. Now, you will also need to ask your doctor to complete a PCP Transfer Form.

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The PCP Transfer Form does what its name suggests. With this document, your doctor can order a transfer from your current health plan to the health plan under which you enrolled in your CDPAP.

When your doctor sends in this form, that’s it! You can now receive care from your family member or friend under New York’s CDPAP program.

Do CDPAP Home Aides Get Paid?

By now, you may be thinking: all of this sounds too good to be true. There must be a catch, right? Wrong!

As long as you qualify for New York’s CDPAP, you can choose your own home health aide. And Medicaid will pay the home aide of your choosing.

But exactly how much will your aide get paid? The exact compensation your aide will receive depends on a few factors, including whether or not you go through an agency.

According to Indeed, the average CDPAP home health aide earns around $127 per day. That equates to about $15.88 per hour if your aide works an eight-hour shift. This daily salary is about $0.88 more than New York’s minimum wage of $15 per hour in 2022.

Services Your Home Aide Will Provide

Your CDPAP home aide will perform all the services your regular home aide did. That includes helping you with the Basic Activities of Daily Living or ADLs that Medicaid defines. The ADLs are:

  • Walking or ambulating
  • Eating without too much trouble
  • Getting dressed
  • Grooming oneself to look appropriate
  • Going to the bathroom, using the toilet appropriately, and cleaning once finished
  • Bathing, both the face and the body
  • Transferring from the bed to a chair or wheelchair or from the bed to the floor with a walker

Remember that we also mentioned this: your CDPAP home health aide can help with skilled tasks. Regular home health aides typically can not help with skilled tasks unless they hold a nursing certification.

The skilled tasks your CDPAP aide can help you with include but are not limited to:

  • Administering medications (including injections)
  • Checking your pulse
  • Checking your temperature
  • Checking your blood pressure
  • Administering topical medications and treatments
  • Administering tube feeding
  • Taking care of injuries, including applying dressings to wounds
  • Managing your dietary needs

The fact that CDPAP aides can help you with these skilled tasks is a major benefit to you. Of course, you should always remember that your aides will only be as good as the training you offer him or her. This reason is why some people prefer a CDPAP agency to train their aides for them.

IS CDPAP in NYC for You?

CDPAP is a patient-driven home health care program offered to New York state residents. Through this program, you can select your friends or family members to take care of you and get paid. Contact your social security office or long-term managed care plan provider today to get started.

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