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Choosing a Fiscal Intermediary – and when to change

One key decision that you will need to make is which fiscal intermediary (FI) to choose to administer your CDPA program. New York State’s Medicaid program requires every CDPA consumer to use an FI. There are dozens – hundreds – across the state, and it can be overwhelming to make a decision. 

Here are some key things to remember:

  • Your fiscal intermediary is responsible for paying your personal assistants (PAs), making sure that taxes for Medicare, social security, and other legal requirements are paid; and making sure the required paperwork is submitted and on file for you and your PAs.

  • They are not responsible for recruiting, supervising or managing your PAs. While they may provide lists or other resources for you to find potential workers, they are legally forbidden from assigning PAs to you.

  • Not all fiscal intermediaries are the same. They can work in different parts of health care, offer different pay and benefits, and more. CDPAANYS recommends conducting thorough research before making a decision. We recommend reviewing our list of questions to ask FIs before making a decision.

  • Examples:

    • Are you a member of the Consumer Directed Personal Assistance Association (CDPAANYS) or another association? Membership in an industry association shows commitment to the highest standards and practices. CDPAANYS reviews member agencies to make sure they are in compliance with the empowering philosophy underpinning CDPA.
    • What is the hourly wage?
    • How often are PAs paid – every week, biweekly, etc?
    • Is overtime allowed?
    • What benefits, such as medical/dental insurance, paid time off, etc. are offered to PAs?
    • Do you offer any “wrap around” services, such as independent living services or services to assist people with intellectual or developmental disabilities?
    • Are PAs unionized, and if so, what does that mean for them and me?

  • CDPAANYS member fiscal intermediaries are screened and interviewed before joining to ensure they operate according to the principles and philosophy of Consumer Direction. You can find a list of CDPAANYS vetted FIs serving your region here.

  • There is no “lock-in” period or minimum time requirement to work with a fiscal intermediary. This means you can change to a different agency at any time, as long as the new agency is in your managed care plan or county’s network. However, each time you change, your personal assistants will have to complete a new onboarding process. It can sometimes be rewarding and save time and money to communicate openly with program staff at your FI to solve problems without switching.

  • This may all be brand new to you. If you have questions about this, CDPAANYS is here to help you navigate these situations. You can contact us at (518) 813-9537 or email