CDS New York: CDPAP Eligibility, PPL Enrollment, and Caregiver Pay

The Consumer Directed Personal Assistance Program in New York, known as CDPAP, lets Medicaid-eligible residents hire, train, and supervise their own home caregivers instead of accepting whoever a traditional agency sends. The caregiver can be a friend, a neighbor, or most relatives, and that person is paid through a statewide fiscal intermediary. Because the consumer does the training, a CDPAP assistant can handle not just bathing and meals but also tasks that would normally require a licensed nurse, such as medication administration, wound care, or catheter management.¹

Who Qualifies for CDPAP

To enroll, you need to meet all of these conditions:¹

Active New York State Medicaid coverage.
A medical condition stable enough to be managed safely at home.
An assessed need for personal care or nursing services at home, confirmed by the state’s standardized tool.
If you are 21 or older, you must meet the state’s minimum functional-limitation threshold.
The ability to self-direct your care, meaning you can make informed decisions about hiring, training, scheduling, and supervising your assistants.

If you cannot self-direct, you can appoint a designated representative, such as a relative, legal guardian, or other trusted adult, to handle those duties for you.² The representative does everything you would otherwise do, from interviewing candidates to coordinating with the fiscal intermediary. One restriction: your designated representative cannot also be your paid personal assistant.

Who You Can Hire as Your Personal Assistant

Most adults in your life are eligible, which is a core reason families choose CDPAP. The regulation does rule out several categories:³

Your spouse cannot be your paid caregiver.
If the consumer is under 21, their parent cannot be paid as the personal assistant, because parents are legally responsible for children under 21 in New York.
Your designated representative cannot double as the hands-on caregiver.
Anyone else legally responsible for your care and support, including a legal guardian, is excluded.

Adult children caring for a parent, siblings, cousins, and other adult relatives are all eligible, as long as the local district or managed care plan confirms the arrangement fits the care plan and doesn’t cost more than hiring a non-relative. Every prospective assistant must prove legal work authorization in the United States and complete a health assessment before starting.³

What a CDPAP Caregiver Can Do

Under traditional home care, services are split among workers with different credentials: a personal care aide for daily living tasks, a home health aide for certain health-related support, and a licensed nurse for skilled procedures. CDPAP collapses that into one role.¹ A single caregiver you have chosen can help with bathing, dressing, toileting, and meals, and also handle feeding tube management, catheter care, injections, and medication administration.

Skilled tasks are verified during the state assessment. If the care plan includes them, you or your assistant may need to demonstrate the procedure or supply a written protocol showing the steps.⁴

What You’re Responsible For as the Consumer

CDPAP is not a hands-off arrangement. You, or your designated representative, carry real managerial duties:¹

Recruiting and hiring your personal assistants.
Training them on every task in your care plan, including any skilled nursing procedures.
Setting their schedule and overseeing the quality of care day to day.
Arranging backup coverage when your regular assistant is unavailable.
Keeping payroll records accurate and submitted on time to the fiscal intermediary.
Terminating an assistant who is not working out.

If managing another person’s work isn’t realistic for you or your representative, agency-based Personal Care Services may be a better fit. The tradeoff is less flexibility and no say over who shows up.

How to Enroll in CDPAP

Enrollment starts with a physician’s order. The form is DOH-4359, “Physician’s Order for Personal Care/Consumer Directed Personal Assistance Services,” signed by a licensed medical professional after examining you and documenting your diagnosis, functional limitations, and clinical needs.⁵ You fill in the demographic and Medicaid identification sections yourself.

With the order in hand, contact the New York Independent Assessor Program (NYIAP), currently run by Maximus Health Services, to schedule your assessment.⁶ A registered nurse comes to your home for a Community Health Assessment and evaluates your physical capabilities, cognitive function, and living environment using the state’s standardized tool. A clinician on an Independent Practitioner Panel then reviews the clinical data. If your proposed care plan averages more than 12 hours of service per day, an additional Independent Review Panel examines whether the plan is appropriate and safe.

The assessment determines how many hours of care you are authorized each week. After authorization, your Managed Long Term Care plan or Local Department of Social Services links the authorization to the fiscal intermediary so your payroll account can be activated, and the fiscal intermediary completes the employment paperwork for your assistant. From the first assessment call to the first payroll cycle, expect several weeks.

The Single Fiscal Intermediary: PPL

Every CDPAP consumer now works with the same fiscal intermediary. As of April 1, 2025, Public Partnerships LLC (PPL) is the sole statewide fiscal intermediary for all CDPAP recipients in New York.¹ If you were enrolled before that date, you had to register with PPL to keep receiving services.⁷

PPL processes your assistant’s wages and benefits, withholds income taxes, and maintains the employment documentation. It does not take over any of your responsibilities for hiring, training, or supervising.

Caregiver Pay, Overtime, and Live-In Shifts

CDPAP personal assistants earn at least the applicable New York minimum wage. As of January 1, 2026, that is $17.00 per hour in New York City, Long Island, and Westchester County, and $16.00 per hour in the rest of the state.⁸ Actual pay rates are often somewhat higher and vary by region and managed care plan.

Assistants who work more than 40 hours in a week are generally entitled to overtime at one-and-a-half times their regular rate. For live-in caregivers on 24-hour shifts, New York applies the longstanding 13-hour rule: the aide is paid for 13 hours of a 24-hour shift, provided they get 8 hours designated for sleep (with at least 5 hours uninterrupted) and 3 hours for meals. Any work actually performed during the designated sleep or meal periods is compensable on top of the 13-hour base.

The Tax Break for Live-In Caregivers

If you live in the same home as the person you care for, you may be able to exclude your entire CDPAP payment from federal gross income. Under IRS Notice 2014-7, payments received through a Medicaid Home and Community-Based Services waiver program qualify as “difficulty of care” payments excludable under Internal Revenue Code § 131, but only if the caregiver provides services in their own home.⁹

The IRS treats “the provider’s home” as the place where the caregiver actually lives and carries out normal daily routines like sharing meals with family. If you live with the consumer and have no separate residence, your payments are excludable. If you keep your own home and travel to the consumer’s home to work, the exclusion does not apply. Multiple caregivers living with the consumer can each claim the exclusion on their own qualifying payments.⁹ Many CDPAP families miss this entirely.

Electronic Visit Verification

Federal law requires Electronic Visit Verification (EVV) for Medicaid-funded personal care involving an in-home visit, and New York applied it to personal care services on January 1, 2021.¹⁰ Your personal assistant uses an EVV-compliant system to clock in and out, capturing the service type, who received it, who provided it, the date, the location, and the start and end times. Paper timesheets generally do not comply. Live-in caregivers who permanently reside with the consumer are exempt.

If You’re Denied or Your Hours Are Cut

If your application is denied, your authorized hours are reduced, or your services are discontinued, you can request a fair hearing through the New York State Office of Temporary and Disability Assistance. Your notice will state the reason for the decision and the deadline to request a hearing. File your request before the effective date of the reduction or termination, and your services generally continue at the existing level until the hearing is decided, a protection called “aid continuing.”

Hours disputes are a common hearing scenario: the assessment authorizes fewer hours than you believe you need, and the hearing gives you a chance to present additional medical evidence. Come with your physician’s order, the notes from your community health assessment, and your own records of daily care needs.

1
New York State Department of Health. Consumer Directed Personal Assistance Program (CDPAP)
2
New York State Senate. New York Social Services Law 365-F – Consumer Directed Personal Assistance Program
3
Cornell Law Institute. 18 NYCRR 505.28 – Consumer Directed Personal Assistance Program
4
New York State Department of Health. 11 OHIP/ADM-6 – Consumer Directed Personal Assistance Program
5
New York State Department of Health. Physician’s Order for Personal Care/Consumer Directed Personal Assistance Services
6
New York State Department of Health. New York Independent Assessor Program (NYIAP)
7
New York State Department of Health. CDPAP Update – New York State Department of Health Provides Transition Information
8
NY.gov. New York State’s Minimum Wage
9
Internal Revenue Service. Certain Medicaid Waiver Payments May Be Excludable From Income
10
New York State Department of Health. Electronic Visit Verification (EVV) Program Guidelines and Requirements