How Do I Sign Up?
Who is Eligible for CDPA?
Consumer Directed Personal Assistance (CDPA) is currently available to Medicaid eligible individuals with stable medical conditions and/or disabilities who have been authorized for home care services. These services include nutrition/housekeeping (personal care), home health aide assistance, and 24-hour skilled nursing assistance.
Consumers who use CDPA make their own schedules based on their needs for the week. This allows a great deal of freedom and flexibility of hours used from week to week. Consumers are responsible for recruiting, hiring, training, supervising and terminating their personal assistants. Personal assistants can be almost anyone the consumer chooses, as long as he or she is 18 or older and not a spouse or parent of the consumer. No medical/nursing license or certification is required of personal assistants, as long as they meet state and federal employment criteria.
In cases where the consumer is not self-directing, a designated representative will be delegated authority to recruit, hire, train, supervise and terminate the consumer’s personal assistants. The designated representative cannot also be the personal assistant.
How do Personal Assistants Get Paid?
Personal assistants’ salaries and benefits are paid by Medicaid via a fiscal intermediary (FI), which is a third-party not-for-profit organization that contracts with managed care/managed long-term care plans/local departments of social services to provide authorized services as a part of the consumer’s plan of care. FIs process personal assistants’ timesheets and payroll and bill Medicaid for hours worked. Many FIs also serve as independent living and community centers, hosting regular social functions and providing outreach and peer counseling services to consumers and their personal assistants.
Signing up through your Medicaid Managed Care/Managed Long Term Care Plan / Local District Social Services office
New York is in the process of transitioning its Medicaid program from Local District Social Services (LDSS) offices to Medicaid Managed Care plans (MMC) and Managed Long Term Care plan (MLTC). If you have enrolled in managed care, you can sign up for Consumer Directed Personal Assistance (CDPA) through your managed care plan or MLTC by contacting your case worker/care manager at the plan and informing them that you wish to enroll in Consumer Directed Personal Assistance. They will not deny you; all plans are required to offer CDPA to members who are eligible for personal care, home health care or skilled nursing services.
Your case worker/care manager will work with you to complete the steps necessary to determine eligibility and hours for CDPA. He or she will provide you with a medical assessment for your physician to complete. After this assessment is received by the plan, a social worker and nurse will conduct two more assessments – a nursing assessment and a social assessment. These assessments, taken together, will determine whether you are a good candidate for CDPA. If you qualify for CDPA, the assessments will be used to determine the hours of service for which you are authorized and the services your personal assistant (PA) is allowed to perform. These are both included on a document called your plan of care.
If you are not in a Medicaid Managed Care plan (MMC) or a Managed Long Term Care plan (MLTC), you will need to sign up for Consumer Directed Personal Assistance (CDPA) through your Local District Social Services (LDSS) office.
Once you have been approved, the county will refer your case to a fiscal intermediary (FI). You may ask to be referred to a specific FI if you already know who you would like to contract. You may also change your FI if you do not like the policies once you have enrolled. Fiscal intermediaries do not evaluate initial or ongoing program eligibility. Once the FI receives the referral, the company will contact you.
What If You Don’t Agree With the Managed Care plan or the Department of Social Services?
If you were denied participation in Consumer Directed Personal Assistance (CDPA) or you disagree with a decision regarding the amount of authorized hours or services, you have a legal right to request a Fair Hearing. A Fair Hearing is a legal meeting between a State Judge who specializes in Medicaid cases, the county or managed care plan and you (along with any representatives for your case, including legal representation.)
Whenever the managed care plan or LDSS makes a change to your plan of care (this includes changes in hours, changes in services or termination), they must send you a Notice of Decision containing the details of the change(s). This document should have a case number and the phone number for the Internal Appeals process for the managed care plan and the Fair Hearing office.
If you disagree with the determination and have filed a Fair Hearing Request, you are entitled to Aid Continuing. This means that, while you wait for the Fair Hearing to take place, you can continue to receive services at the level and quantity you had to that point.
For more information on Fair Hearings, or to file a Fair Hearing request online, click here to go to the New York State Office of Temporary and Disability Assistance, Office of Administrative Hearings’ website.