How to Fill Out and Submit the Healthfirst CDPAP Agreement Form

The Healthfirst CDPAP agreement form is the contract you sign with Healthfirst’s Managed Long Term Care plan to join New York’s Consumer Directed Personal Assistance Program. It sets out what you and the plan each owe the arrangement, and your signature is a prerequisite to receiving any CDPAP services through Healthfirst.¹ It is not an employment contract with your personal assistant, and it is not the same as the separate agreement you sign with Public Partnerships LLC (PPL), the statewide fiscal intermediary that handles payroll.

What You Are Actually Signing

The agreement is between you (or your designated representative) and Healthfirst. By signing, you acknowledge that you understand the consumer responsibilities of CDPAP and agree to carry them out. Failing to meet those responsibilities can lead to discontinuance of your CDPAP services.²

Two things the form does not do: it does not hire your personal assistant, and it does not cover payroll, tax withholding, or employment records. Those live with PPL, which has been the sole statewide fiscal intermediary for CDPAP since April 1, 2025.³ If you already signed an older version of the CDPAP agreement with Healthfirst, you will be moved to the updated version by April 1, 2026. New enrollees sign the current version at intake. The updated agreement adds a consumer responsibility to work with the statewide fiscal intermediary.

Who Signs and Who Can Be the Personal Assistant

To qualify for CDPAP, you must be enrolled in New York Medicaid, have a stable medical condition, and have a documented need for home care services based on a state-approved assessment.⁴ You also have to be self-directing: able to recruit, train, and supervise your own caregiver.

If you cannot self-direct, a designated representative signs and manages the program on your behalf. For a self-directing consumer, that is an adult you voluntarily delegate authority to. For a non-self-directing consumer, it is a parent, legal guardian, or responsible adult surrogate.⁵ The designated representative cannot also be your personal assistant and cannot be employed by the fiscal intermediary.

Before you put a name on the form, confirm the person you want to hire is eligible. Your spouse, your designated representative, and anyone legally responsible for your care cannot serve as your personal assistant. A parent of a CDPAP consumer under 21 is also excluded.⁴ Other adult relatives — an adult child, sibling, cousin — can serve, as long as the services match your plan of care and do not cost more than they would from a non-relative.⁶

What to Gather Before You Sign

Pull these together in one envelope or folder so the submission goes out complete:

Your Healthfirst member ID from your insurance card.
A completed physician’s order on Form DOH-4359. A physician documents your medical condition and confirms you can be cared for at home; this is what establishes the medical necessity for CDPAP services.⁷
Full legal names, addresses, and phone numbers for yourself (or your designated representative) and each prospective personal assistant.
The agreement form itself. The New York State Department of Health posts the standard CDPAP MCO agreement template as a downloadable PDF, and your Healthfirst care coordinator or plan representative can send you a copy as well.²

The agreement itself does not ask for Social Security numbers. PPL will collect that information from your personal assistant separately as part of payroll setup.

Filling In the Agreement

The form is short compared to the onboarding paperwork that follows it. The consumer section asks you to acknowledge your responsibilities as a CDPAP participant: recruiting, hiring, training, and supervising your personal assistant; arranging backup coverage when your regular PA is unavailable; and working with PPL to process payroll.⁴

You also acknowledge the plan’s side: Healthfirst will authorize CDPAP services only through the statewide fiscal intermediary, and the plan will investigate any report that a consumer is not meeting their obligations.³ Read the responsibilities section carefully. This is where most misunderstandings about how CDPAP actually works come from, and once you sign, the plan treats the terms as accepted.

Both the consumer (or designated representative) and a Healthfirst representative sign and date the form. The agreement does not spell out your personal assistant’s specific duties or wage rate. Duties come from your plan of care; pay is handled through PPL.

Submitting the Form to Healthfirst

The signed agreement goes to Healthfirst’s Managed Long Term Care department. Call Healthfirst to confirm the current submission method and get the correct fax number or mailing address, since those details change. Make sure every page is legible before you send it. Faded photocopies and blurry signatures are a common reason paperwork gets kicked back.

If you fax, keep the transmission confirmation. If you prefer paper, certified mail gives you a tracked record of delivery. Either way, hold on to a full copy of what you sent.

What Happens After You Submit

Your CDPAP eligibility must be established and your authorization completed before any services begin.⁸ The agreement is one piece of that. The authorization process also involves an independent assessment of your care needs and the DOH-4359 practitioner order. For managed care enrollees, Healthfirst must make a determination and send notice within the timeframes in its contract with the Department of Health.

Authorizations cannot run longer than 12 months from the date of the most recent independent assessment or practitioner order, whichever came first. If your care needs exceed 12 hours per day on average, an independent medical review panel must review the request before the plan can authorize those hours.⁸

If Healthfirst flags errors in your paperwork, you will get a notice explaining what needs correction. Fix and resend promptly. A gap in your authorization means your personal assistant cannot legally work or get paid during that period.

Your Personal Assistant’s Onboarding With PPL

Signing the Healthfirst agreement does not put your PA on payroll. Before your personal assistant can start working or getting paid, they have to register separately through PPL, and your consumer account with PPL has to be active and linked to a valid service authorization first.⁹

Your PA creates an account on PPL’s online portal (PPL@Home) and completes:

An offer letter, one per associated consumer.
The Personal Assistant Agreement with PPL.
IRS Form W-4 for federal tax withholding.
New York Form IT-2104-I for state withholding.
USCIS Form I-9 for employment eligibility verification, which every U.S. employer must complete for every hire.¹⁰
A payment method form.
A health assessment, required before work starts and again annually. PPL partners with Mobile Health for the screenings.⁹

Any required trainings must be completed within 90 days of the PA’s PPL start date. Once your PA is working, every visit has to be logged through Electronic Visit Verification. PPL uses its Time4Care app for this. Shifts that are not logged properly will delay your PA’s pay.⁹

What You Agreed to Keep Doing

Signing is the start of the arrangement, not the end. Your ongoing responsibilities as the consumer include:

Managing your PA’s schedule so shifts match your authorized care plan.
Arranging backup coverage when your PA is sick, on vacation, or otherwise unavailable.
Notifying your service coordinator about changes in your address, phone number, hospitalization, or your PA’s employment status.
Scheduling the required nursing reassessment with a registered nurse every six months.
Submitting timesheets and employment documents on time so your PA gets paid.⁴

You also have the right to end the relationship with a personal assistant who is not performing. If you do, collect any keys, change PINs on any accounts the PA had access to, and notify both PPL and your Healthfirst service coordinator right away so the authorization and payroll records stay accurate.

1
New York State Department of Health. Consumer Directed Personal Assistance Program Agreement
2
New York State Department of Health. CDPAP Member/DR/MCO Agreement
3
New York State Department of Health. CDPAP Statewide Fiscal Intermediary Policy for Medicaid Managed Care Plans
4
New York State Department of Health. Consumer Directed Personal Assistance Program
5
New York State Department of Health. Consumer/Designated Representative
6
New York State Senate. Social Services Law 365-F – Consumer Directed Personal Assistance Program
7
New York State Department of Health. Physician’s Order for Personal Care/Consumer Directed Personal Assistance Services (DOH-4359)
8
New York Codes, Rules and Regulations. New York Code 18 NYCRR 505.28 – Consumer Directed Personal Assistance Program
9
PPL. NY Consumer Directed Personal Assistance Program (CDPAP)
10
U.S. Citizenship and Immigration Services. I-9, Employment Eligibility Verification