Consumer Directed Personal Assistance Program: How CDPAP Works in New York

Under CDPAP, the person who needs care chooses and directs their own caregiver, often a family member.

Maybe your father needs help getting dressed each morning, and you are already the one who drives over before work. It's common to wonder whether New York will pay you for that care. Many families also feel unsure about how the program works now that the state changed who runs it.

New York's Consumer Directed Personal Assistance Program, or CDPAP, lets a Medicaid member choose, train and direct their own home caregiver, and that caregiver is often a relative or close friend. The person getting care is called the consumer. The caregiver is called a personal assistant. You stay in charge of who helps and when.

What changed is the back office. In 2025, payroll for the whole program moved to one company, Public Partnerships LLC (PPL). By March 13, 2025, the New York State Department of Health reported that over 70% of CDPAP consumers in the North Country had started or finished that move. The department also said PPL had 41 facilitators, including 11 Independent Living Centers, helping people register that year.

Help came in many languages, too. PPL had nine direct language lines at the time.

So the payroll office is new. The heart of the program is not, and it still begins with a question about Medicaid.

Who qualifies for CDPAP in New York?

In short: Who qualifies for CDPAP in New York?: To qualify, the person receiving care needs New York Medicaid, a documented need for help with daily tasks, a.

To qualify, the person receiving care needs New York Medicaid, a documented need for help with daily tasks, a doctor's order, and the ability to direct care or a representative who can.

Before you call anyone, it can help to check these four things:

1. Medicaid enrollment. The person receiving care is enrolled in New York Medicaid, within the state's own income and asset limits.
2. A need for hands-on help. They need help with activities of daily living, which are the basic self-care tasks of bathing, dressing, toileting, moving from bed to chair, and eating.
3. A doctor's order. A physician confirms that they need help at home.
4. Someone to direct care. They can manage their own care, or they have a designated representative who can do it for them.

ElderHearth's 2026 guide to paid family caregiving lists those same core requirements: Medicaid enrollment under New York's income and asset limits, a doctor's confirmation of need, and the ability to direct care personally or through a representative. Some program guides add that the doctor's order should say the person's condition is stable enough to benefit from care at home.

The common assumption is that Medicare pays for this kind of help. It does not. CDPAP is a Medicaid program, so Original Medicare or a Medicare Advantage plan on its own does not open the door. One New York caregiver posting online summed up the rules as citizenship or a green card, New York residency, a patient 21 or older, and Medicaid eligibility. Another family was told by an agency that their mother would need to change her insurance before she could enroll. Mix-ups like these are very common, and you are not alone if the rules have felt tangled.

Eligibility rests on the person receiving care, not on the caregiver. A New York home care worker put it plainly back in 2019, saying the program is "driven by the eligibility of the recipient, not your own insurance." Your health plan as the helper does not change the answer.

Once Medicaid is in place, a nurse assessment decides how many hours of help are approved. ElderHearth notes that authorized hours follow the person's assessed level of need. One caregiver mentioned that the assessment repeats every year, so keeping medical records and notes handy can make each round a little easier.

A review of 5 sources on eligibility points to the same order of steps. Medicaid comes first. The assessment comes second. If I could ask families to check one thing before anything else, it would be Medicaid enrollment, because nothing else can move until that question is settled.

Medicare still matters for the rest of your care, even when it cannot pay for CDPAP. Understood Care accepts Original Medicare in New York, and plans we accept there include Medicare Advantage plans from UnitedHealthcare and Aetna, insurers that together cover about 69% of the state's Medicare Advantage members. If you are comparing Medicare patient advocate services for seniors, it helps to know where Medicare support ends and a Medicaid program like CDPAP begins.

And once eligibility is settled, the next practical question is who handles payroll and paperwork, which is exactly the part New York rebuilt in 2025.

What changed when CDPAP moved to a single fiscal intermediary?

New York now runs all CDPAP payroll through one company, Public Partnerships LLC, instead of hundreds of local fiscal intermediaries, but the rules on who qualifies stayed the same.

A fiscal intermediary is the organization that handles payroll, taxes and paperwork so the consumer can focus on care. For years, families picked one from a long list of local agencies. According to a 2025 New York NOW report, more than 700 fiscal intermediaries handled those tasks before the state's budget required every CDPAP member to use a single one: Public Partnerships LLC, known as PPL. One elder law firm, writing in 2024, warned that the change would leave families dealing with a large company rather than a small local office. PPL is based in Georgia and works with a small number of subcontracting agencies.

The New York State Department of Health described the single fiscal intermediary as "legislatively mandated." That phrase matters. It means the change came from state law, not from a policy memo that could be quietly reversed. In March 2025, the department reported that about 125,000 consumers and about 135,000 workers had started or completed registration with PPL ahead of the April 1, 2025 deadline. The state also estimated in 2025 that another 10% of consumers statewide were moving from CDPAP to agency-based Personal Care Services.

If you are registering now, or returning after a stretch of agency care, the department listed three ways to do it:

1. Call PPL's support center at 1-833-247-5346 (TTY: 1-833-204-9042).
2. Register online through PPL@Home at pplfirst.com/cdpap.
3. Work with PPL or an approved facilitator, including an Independent Living Center near you.

The rollout was rough for many families. New York NOW reported in 2025 that the early problems were getting people onto PPL's systems quickly and getting prompt answers. Two state senators later questioned how the contract was awarded, alleging an "11 billion" contract may have been rigged. Many caregivers worked without pay for weeks while calls went unanswered, though reporting since then notes there have been fixes. A class action brought with the Legal Aid Society also accuses PPL of wage theft against thousands of CDPAP workers.

I understand why so many families felt shaken. Here is the thing, though. The payroll channel changed. PPL runs the payroll, while your nurse assessment and your Medicaid plan still decide how many hours you get. The Department of Health sent cease and desist letters in 2025 to agencies that gave families false information, including false claims about who could provide care.

My honest read is that PPL is the system families will be working with for the foreseeable future. Planning around it is kinder to yourself than waiting for the old local agency to come back. Paperwork details matter a great deal when one office serves a whole state, much like how most utility allowance denials trace to one missing form. Keep copies of everything you submit.

With the payroll side sorted, the bigger question for most families is who they are allowed to hire.

Who can you hire as a CDPAP caregiver, and what are you responsible for?

You can hire almost any adult relative or friend, including adult children and siblings, but not a spouse, a parent of a consumer under 21, or your designated representative.

In CDPAP, the person receiving care is called the consumer, and the caregiver is called a personal assistant. A 2026 guide to paid family caregiving in New York explains that family members can be paid caregivers, with two main exceptions: the consumer's spouse, and a parent of a consumer who is under 21. Adult children, siblings, other relatives and trusted friends are all eligible.

Contrary to what many families heard during the switch to PPL, adult children were never shut out. One New York home care provider's guide says caregiver training usually covers infection control, safety and basic caregiving skills.

Person	Can they be the paid caregiver?	What to know
Spouse	No	The main exclusion that trips families up
Parent of a consumer under 21	No	Applies only while the consumer is a minor or under 21
Parent of a consumer 21 or older	Yes	Only if the parent is not also the designated representative
Designated representative	No	The person directing care generally cannot also be paid for it
Adult child, sibling, grandchild, other relative	Yes	Needs to be an adult who is eligible to work in the U.S.
Friend or neighbor	Yes	Same adult and work eligibility rules apply

The bar for caregivers is low on paper. A personal assistant can be just about anyone who is an adult and eligible for employment in the United States. Under state policy, no drug screen or background check is required, and no healthcare license is needed. That freedom puts the choice of whom to trust squarely with the consumer.

The designated representative rule is where families get stuck most often. A designated representative is the person who directs care when the consumer cannot do it alone. In a 2025 caregiver support forum thread, a sibling described being asked to sign paperwork so their mother could keep being paid to care for a 24-year-old sister who needs constant care. Commenters explained that a parent who is also the designated representative would not be allowed to be the paid caregiver. As one put it, "I can see why the program might not want the person getting paid for caregiving to also be the only decision maker about that money."

If your family is in this spot, I would gently suggest naming a different relative as the representative, and asking exactly what that role involves before anyone signs.

Being the consumer also comes with real duties. You, or your representative, take on these four jobs:

1. Find and hire your personal assistants.
2. Train them in the care you need.
3. Supervise their work and coordinate their shifts.
4. Confirm or deny the hours they report to the state's payroll vendor.

That last task carries weight. If someone pressures a consumer to approve hours that were not worked, or pretends to be the consumer, someone needs to contact the payroll vendor on the consumer's behalf. Careful records protect everyone. The same habit of documenting everything helps on the Medicare side too, especially when Advantage plans slow-walk lift chair approvals and a paper trail becomes your best tool.

Some families split approved hours across several relatives so no single person carries the whole load, which leads naturally to how those hours get decided in the first place.

What should New York families do next with CDPAP?

Plan around PPL as the program's payroll office for the long haul, keep careful records of every hour and call, and expect the yearly assessment to come back around.

The single payroll office is set in state law, and I don't expect it to go away soon. What you can control is the paper trail. In 2025, Richard Blum of the Legal Aid Society described CDPAP workers whose pay came up short in several ways, including this one: "They weren't getting paid for all their time." If the approved hours feel too low, it can help to ask your Medicaid plan how it set them.

The reward can be real. One caregiver on a Reddit thread said they were paid $500 a week to care for their grandmother. Another commenter said their application ran for months and called the process "annoying," though they still felt it would be "worth it in the end."

Both can be true at once. If I could offer one gentle piece of advice, it would be to move at a steady pace rather than rush the forms and redo them later.

This week, it can help to start a simple notebook: the date, the hours worked, and the name of anyone you spoke with at PPL.