Understanding Consumer Directed Personal Assistance

CDPA, or consumer directed personal assistance, is a Medicaid program that allows older and disabled New Yorkers to take charge of their own home care services by hiring and supervising the aides they choose, not an agency.

“Consumer directed” means you are responsible for your own services, not an agency. That means that you have control over recruiting, interviewing, hiring, training, supervising, and, if needed, firing your own workers. 

The main difference between CDPA and traditional home care is CONTROL.

In traditional home care, you use an agency to send workers to you. These workers are chosen by the agency, not you. They operate on a schedule set by the agency, not the individual. They perform their tasks in the way the agency, not the individual, wants.

With CDPA, you control your own services. You decide who you hire. You decide what their schedule is. You decide how the services they provide are done. Because you employ the personal assistant (worker), you control the service.

Plus, in a traditional home care model, the worker is limited in what he or she can do, typically food preparation, toileting, showering, and household chores. In CDPA, because you are in charge and training the worker, your personal assistant can do anything from the basic tasks above to giving you medication, operating a ventilator, and wound care – tasks typically reserved for a nurse.

You are eligible to use CDPA if you:

• Have Medicaid;
• Live in New York State;
• Are willing and able to self-direct your own services, or have a designated representative who is willing to do it on your behalf;
• Need help with personal care, home health care, or skilled nursing tasks as part of a long term health condition or disability.

Eligibility is determined by the New York Independent Assessor, or NYIA. To contact the NYIA, call:

Phone: 1-855-222-8350
TTY: 1-888-329-1541

Monday to Friday, 8:30 a.m. to 8 p.m.
Saturday, 10 a.m. to 6 p.m., except for designated state holidays. They will ask for your Medicaid or Social Security number.

*activities of daily living, or ADLs, are defined as bathing or showering, dressing, getting in and out of bed or a chair, walking, using the toilet, and eating.

If you have Medicaid, call the New York Independent Assessor for an evaluation at 855-222-8350.

Visit our “Getting Started” section for a full outline of the process. 

You can also call CDPAANYS at 518-813-9537 and we can help you get started.

In CDPA, you have the freedom to hire nearly anyone to work as your personal assistant (PA). This means you have complete control over who comes into your home, touches your body, and assists you with tasks that are often quite personal.

Personal assistants do not need formal training or certification to perform the work they do. They are trained by YOU – the consumer. 

A personal assistant MUST be:

• Eighteen years of age or older;
• Able to legally work in the United States;
• Willing to have initial and ongoing health screenings as required by law (vaccinations for measles, mumps, and rubella, a health exam, and a tuberculosis test). 

A personal assistant CANNOT be:

• The consumer’s parent if the consumer is younger than 21;
• The consumer’s spouse;
• The consumer’s designated representative; 
• Anyone who appears on the Medicaid exclusion list due to past problems with fraud, abuse, or other violations.

New York State’s Medicaid program requires every CDPA consumer and personal assistant (PA) to work with a fiscal intermediary, or FI. This is the agency that will keep paperwork for you and your PA, as well as make sure that your PA is paid every two weeks. There is no out of pocket cost to you.

Using either phone or electronic sign-in/sign-out records, your fiscal intermediary will pay your PAs for the hours they work for you. The FI will also make sure that taxes for Medicare, social security, and other legal requirements are paid, and that all required paperwork is submitted and on file for you and your PAs.

A personal assistant is your worker in CDPA. The personal assistant, or PA, is someone over the age of 18  who is legally allowed to work in the United States. The PA does not need to have any specific training (unless you as the consumer want them to). 

The PA can be an individual you do not know prior to them working for you; but, it can also be a family member. Any family except a spouse or the parent of a child (defined by NYS as an individual under the age of 21 for this purpose) can be a PA.

Your personal assistants’ rate of pay will generally be hourly, between $16.20 and $22 per hour depending on the location, regional minimum wage differences, and other factors. Some agencies may offer more. It is illegal to offer less than the minimum in your region. 

• Please refer to this table for home care worker minimum wage statewide.

Different fiscal intermediaries offer different wages. Some allow overtime (over 40 hours weekly), while others do not. They also offer different benefit packages, and some offer union representation. 

A fiscal intermediary (FI) is an organization that assists consumers using the CDPA program by providing financial and other services that enable the consumer to otherwise fulfill their responsibilities as an employer.

In CDPA, the 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. In fact, they are legally forbidden from assigning PAs to you. With very few exceptions, they are also legally forbidden from telling you who you may or may not hire, and when you do or do not have to fire someone.

Click here for more information on choosing & changing your fiscal intermediary.

A designated representative, or DR, is the person who takes on consumer responsibilities such as managing and scheduling personal assistants when the consumer cannot or does not wish to do it themselves. The designated representative is also responsible for communicating with the fiscal intermediary and the consumer’s managed care plan or LDSS as needed, including being present at appointments. 

Who can be a designated representative?

• A responsible adult 
• A spouse
• A parent or guardian

Who cannot be a designated representative?

• Anyone who appears on the Medicaid exclusion list due to past problems with fraud, abuse, or other violations.
• Anyone who is working as a PA for the individual they would be assisting as a DR
• A minor child 
• A representative/employee of or a person affiliated with a Fiscal Intermediary