Hochul’s Budget Cuts Could Change Home Care For Your Loved Ones

The Consumer Directed Personal Assistance Program (“CDPAP”) is one of the methods that NY State provides home care services to individuals who are on medical assistance programs (“Medicaid”). The CDPAP allows elderly, disabled, and chronically ill adults and children to choose and hire their own personal assistants to care for them at home. Started as a pilot program in New York in 1992 under the name “Patient Managed Home Care Program”, CDPAP was adopted as an official NYS program under the Social Services Law in 1995.

Governor Hochul’s 2024-2025 budget proposes significant changes to CDPAP. The budget will eliminate the ability to appoint a designated representative, limiting participation to those who can self-direct their care. Mandated training for personal assistants and capped hours of work are also proposed, potentially impacting the quality and availability of care. Additionally, New York State Department of Health may establish minimum criteria for hiring, potentially limiting choices for participants, while personal assistants’ wages could face reductions.


This Alert offers a detailed explanation of the CDPAP program and outlines Governor Hochul’s proposed changes to the program in the 2024-2025 Budget which is expected to pass by April 1, 2024.

If you are currently receiving CDPAP services as a participant or if you are providing care to a CDPAP participant as the personal assistant, these proposed budget cuts may affect you. Please contact Young Mee Jun at yjun@hdrbb.com, Allison Busch at abusch@hdrbb.com, or the HDRB&B attorney with whom you normally work with any questions.


Why does CDPAP exist?

The CDPAP was created to allow “greater flexibility and freedom of choice” for chronically ill and/or physically disabled individuals in obtaining home care services under NY state Medicaid.

Generally, when dual eligible Medicaid recipients (who also receive Medicare) need chronic care at home, they join a Managed Long Term Care (“MLTC”) plan. The MLTC plan then authorizes the number of service hours and arranges the personal assistants/home attendants from a pool of New York State licensed home care service agencies contracted with the MLTC plan. The home attendants are assigned based on the Medicaid recipients’ geographic location and the home care agency’s staff availability. As a result, the individuals who need the care do not have much choice or authority on how their personal assistants are selected.

The CDPAP was created to provide greater autonomy and freedom to those who choose to participate in the program by allowing the person in need, or their designated representative (designated representatives must be determined fit to train and direct the CDPA by Medicaid), to hire and direct their own personal care during the service hours authorized by the MLTC plan.

Under the current CDPAP, the participants, or their designated representatives are responsible for the hiring, training, supervising, managing, and terminating their personal assistants. They are free to choose the type and quality of their personal attendants.

Who Can Be The Consumer Directed Personal Assistant (“CDPA”)?

Currently, anyone (children, friend, neighbor, niece, etc.) who is not legally responsible for the care and support of the Medicaid recipient can be the CDPA. The following are examples of legally responsible persons who have a legal duty to provide care and support to the Medicaid recipient and therefore cannot be paid for their service:

  • Spouse
  • Parent of a minor child
  • Legal guardian of the person

How Are The CDPA Paid?

The CDPA hired by the CDPAP participant must enroll with a Fiscal Intermediary (“FI”) agency authorized by the New York State Department of Health. The FI functions as a “payroll” entity and handles the administrative and financial aspect of CDPAP. The CDPA are paid by the FI agency at a contracted rate which can range from $17/hour to $30/hour.

What Are The Current Eligibility Criteria To Participate In CDPAP?

In order to participate in CDPAP, the individual must:

  • Be eligible for medical assistance;
  • Be eligible for long term care and services;
  • Have stable medical condition;
  • Be self-directing, or if non self-directing, have a designated representative;
  • Need some or total assistance with one or more personal care tasks, home health aide tasks or skilled nursing tasks;
  • Be willing and able to fulfill the consumer’s responsibilities or have a designated representative who is willing and able to fulfill such responsibilities; and
  • Participate as needed, or have a designated representative who participates, in the required assessment and reassessment processes

What Are The Proposed Changes to CDPAP In Governor Hochul’s 2024-2025 Budget

The new budget set to pass by April 1, 2024 proposes eliminating some of the key features of CDPAP:

  1. Currently, if the CDPAP participant is unable to self-direct care, a “designated representative” can direct the care on the participant’s behalf. The proposed budget will eliminate the ability to appoint a designated representative and limit CDPAP only to people who can “direct” their own care effective October 1, 2024. This change can bar people with Alzheimer’s disease or other types of dementia or cognitive impairments, those with TBI (traumatic brain injury) and intellectual and developmental disabilities from participating in CDPAP.
  2. Under the current rules, the Medicaid recipients participating in CDPAP can hire anyone and train their chosen personal assistant to meet their care needs. The budget proposes a mandated training requirement for the CDPA. If the budget passes, the training responsibility will be removed from the person in need and assumed by the State. The training requires an additional step in arranging the CDPA which can delay the process.
  3. New York State proposes to set a maximum daily and weekly limit on the hours personal assistants can work. The proposal, if passed, would authorize the New York State Department of Health to limit how many hours the aide can work each day and each week. Many participants of CDPAP need round-the-clock care which cannot be staffed by the licensed agencies. If this proposal passes, the Medicaid recipients may not be able to receive 24/7 care they need.
  4. The budget proposes that the New York State Department of Health will set forth a “minimum selection criteria” for recruiting and hiring personal assistants. If this proposal passes, the CDPAP participant’s ability to hire personal assistants of their choice may become limited.
  5. The CDPAP “personal assistants” hourly wages may be reduced.

QUESTIONS? If you are currently receiving CDPAP services as a participant or if you are providing care to a CDPAP participant as the personal assistant, these proposed budget cuts may affect you.

Please contact Young Mee Jun at yjun@hdrbb.com, Allison Busch at abusch@hdrbb.com, or the HDRB&B attorney with whom you normally work with any questions.

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