CDPAP Eligible Conditions in New York: What Long Island Families Need to Know Before Applying

Many people assume Medicaid home care is only for older adults. That is not true. The Consumer Directed Personal Assistance Program, or CDPAP, is a New York State Medicaid program that allows eligible people who need home care to choose and direct their own personal assistants. A caregiver can be a family member or friend, subject to New York’s restrictions on who may serve as a personal assistant. For Long Island families in Nassau and Suffolk counties, understanding how eligibility works can help prevent unnecessary delays and confusion. The important thing to know in 2026 is that having a particular diagnosis does not automatically qualify someone for CDPAP. Eligibility depends on Medicaid eligibility, medical stability, assessed functional need, the applicable Minimum Needs Requirements, and the person’s ability to direct their care or have a designated representative do so.

Important note: This article provides general educational information about New York’s CDPAP rules. It is not legal, medical, or financial advice. Eligibility is determined individually by the appropriate Medicaid and assessment authorities. Program rules can change, so applicants should verify current requirements with the New York State Department of Health or their Medicaid plan.

First: What CDPAP Actually Is in Plain English

CDPAP stands for Consumer Directed Personal Assistance Program.

In practical terms:

• Consumer Directed means the person receiving care, or their designated representative, has significant responsibility for choosing and directing the caregiver.
• Personal Assistance means help with daily activities and certain health-related tasks that are authorized as part of the person’s care plan.
• Program means the service is provided through New York State Medicaid for people who meet the applicable eligibility requirements.

CDPAP differs from traditional home care because the consumer has greater control over who provides their authorized care. The consumer or designated representative is responsible for recruiting, hiring, training, supervising, and terminating personal assistants, as well as arranging backup coverage.

A family member or friend may be able to serve as a paid personal assistant. However, there are restrictions. Under current NYSDOH guidance, a consumer’s spouse, designated representative, or the parent of a CDPAP consumer under age 21 cannot serve as that consumer’s personal assistant.

What Does CDPAP Cost a Long Island Family?

For someone who is eligible for Medicaid and authorized for CDPAP services, the program is a Medicaid-funded benefit rather than a private-pay home care arrangement. The personal assistant is paid through the program’s fiscal intermediary rather than being paid directly by the consumer.

New York State currently uses Public Partnerships LLC (PPL) as the statewide Fiscal Intermediary for CDPAP. PPL handles administrative functions such as processing wages, tax withholdings, benefits, and employment records.

It is important not to confuse the state’s CDPAP reimbursement rates with the amount a family must pay privately. For 2026, NYSDOH lists a basic CDPAP rate of $26.46 per client hour in Nassau and Suffolk counties, with different rates for certain service categories. These are program reimbursement rates, not a guaranteed wage for every individual personal assistant.

CDPAP Eligibility in New York: What Actually Matters

New York does not have a simple list of diagnoses that automatically qualify someone for CDPAP.

Instead, the state looks at several requirements.

1. You Must Be Eligible for New York Medicaid

CDPAP is a Medicaid program. A person must first meet the applicable Medicaid eligibility requirements.

Having Medicare alone does not make someone eligible for CDPAP. Some people have both Medicare and Medicaid, and those individuals may qualify through their Medicaid coverage if they meet the CDPAP requirements.

Medicaid financial eligibility is separate from the medical and functional assessment used to determine whether someone qualifies for home care.

2. You Must Have a Stable Medical Condition

NYSDOH requires a person seeking CDPAP to have a stable medical condition.

This does not mean the person must be healthy or have a mild condition. It means the medical condition and resulting care needs must be sufficiently stable for the appropriate assessment and care plan to be established.

A physician or other qualified practitioner may need to provide medical documentation as part of the assessment and authorization process.

3. You Must Have an Assessed Need for Home Care

This is one of the most important points for families to understand.

A diagnosis by itself does not determine eligibility. The state looks at how the person’s medical condition affects their ability to perform daily activities and whether they require authorized personal care or skilled services.

Examples can include assistance with:

• Bathing
• Dressing
• Toileting
• Eating
• Mobility
• Transfers
• Ambulation
• Personal hygiene
• Meal preparation
• Certain skilled tasks

However, the Minimum Needs Requirements now apply to many new applicants, which means simply needing assistance with one activity is generally not enough for adults subject to the new rules.

The 2026 Minimum Needs Requirements You Need to Know

This is the biggest eligibility change families need to understand.

Beginning September 1, 2025, New York implemented Minimum Needs Requirements for Personal Care Services and CDPAP.

For Medicaid recipients age 21 or older seeking PCS or CDPAP, the person generally must be assessed as needing:

At least limited assistance with physical maneuvering with more than two Activities of Daily Living.

There is a separate standard for people with an Alzheimer’s disease or dementia diagnosis. They must generally be assessed as needing:

At least supervision with more than one Activity of Daily Living.

This means a diagnosis alone is not enough.

For example, having Parkinson’s disease does not automatically mean someone qualifies. The assessment must establish the person’s actual functional need.

There are also legacy protections. People who were already authorized for PCS/CDPAS or continuously enrolled in an applicable MLTC plan before September 1, 2025 may continue under the previous eligibility criteria rather than being subject to the new Minimum Needs Requirements in the same way as new applicants.

Conditions That May Lead to CDPAP Eligibility

There is no official NYS list of “approved diagnoses.”

However, many medical and developmental conditions can result in CDPAP eligibility when they create the required functional limitations.

Examples include:

Neurological and Neuromuscular Conditions

• Amyotrophic lateral sclerosis (ALS)
• Multiple sclerosis (MS)
• Parkinson’s disease
• Cerebral palsy
• Muscular dystrophy
• Stroke-related disabilities
• Traumatic brain injury
• Spinal cord injuries
• Other neurological conditions that significantly affect daily functioning

Chronic and Systemic Conditions

• Severe chronic obstructive pulmonary disease
• Advanced congestive heart failure
• Diabetes with significant complications
• End-stage renal disease
• HIV/AIDS with substantial functional limitations
• Cancer when treatment or disease significantly affects daily functioning
• Other chronic conditions requiring ongoing personal assistance

Developmental and Cognitive Conditions

• Intellectual and developmental disabilities
• Certain severe autism-related support needs
• Alzheimer’s disease
• Dementia
• Other conditions that significantly interfere with safe self-care

The key point is simple: the diagnosis creates the medical context, but the person’s functional needs are what matter for CDPAP eligibility.

Two people with the same diagnosis can have completely different eligibility outcomes because their functional abilities may be very different.

What About Children and Young Adults?

Children and younger adults can qualify for Medicaid-funded personal care or CDPAP services, but the assessment pathway can differ from the adult process.

Current NYSDOH guidance specifically distinguishes pediatric cases from adult assessments. For children under 18, the child’s doctor provides the required physician’s order, and the appropriate Medicaid entity conducts the community health assessment.

For this reason, families should not assume that the adult Minimum Needs Requirements apply identically to every child.

Children and young adults with significant medical or developmental needs may receive home care services when they meet the applicable Medicaid and clinical requirements.

How the CDPAP Eligibility Assessment Works in New York

The process is more structured than simply calling a home care agency.

Step 1: Establish Medicaid Eligibility

The person must qualify for New York Medicaid.

If the person does not have Medicaid, the Medicaid application generally needs to be completed before Medicaid-funded CDPAP services can be authorized.

Step 2: Complete the Required Assessment

For adults seeking PCS/CDPAP through the Medicaid State Plan, the New York Independent Assessor Program (NYIAP) plays an important role in the initial assessment process.

NYIAP conducts the Community Health Assessment and evaluates functional needs using the state’s assessment system.

Step 3: Meet the Applicable Minimum Needs Requirements

For new applicants subject to the rules implemented September 1, 2025, the assessment must establish that the person meets the applicable Minimum Needs Requirements.

Step 4: Medical Documentation

Medical documentation is used to establish the person’s condition and care needs.

For Alzheimer’s disease or dementia cases subject to the special Minimum Needs standard, NYSDOH requires documentation of the diagnosis as part of the assessment process.

Step 5: Care Planning and Authorization

If the person meets the applicable requirements, the appropriate Medicaid plan or local entity proceeds with care planning and service authorization.

The number of hours and specific services authorized are based on the person’s assessed needs and approved plan of care. Eligibility does not automatically guarantee a particular number of CDPAP hours.

Who Can Be the Paid Caregiver?

One of CDPAP’s biggest advantages is the ability to choose someone the consumer already trusts.

Depending on the circumstances, that can include:

• An adult child
• A sibling
• Another eligible relative
• A friend
• Another qualified person chosen by the consumer

However, not everyone can serve as a CDPAP personal assistant.

Current NYSDOH guidance specifically excludes the consumer’s spouse, designated representative, and the parent of a CDPAP consumer under age 21 from serving as that consumer’s personal assistant.

Because individual circumstances can affect eligibility, families should verify the caregiver relationship before making plans.

What the Consumer or Representative Is Responsible For

CDPAP gives the consumer control, but that control comes with responsibilities.

The consumer or designated representative is responsible for:

• Recruiting personal assistants
• Hiring caregivers
• Training them
• Supervising their work
• Terminating them when necessary
• Arranging backup coverage
• Coordinating care
• Maintaining required records
• Working with PPL for payroll and administrative requirements

This is an important difference from traditional agency-based home care.

What CDPAP Can Cover

Depending on the authorized plan of care, CDPAP personal assistants can provide services that normally fall within personal care, home health aide, or certain skilled nursing services.

These may include:

• Bathing and personal hygiene
• Dressing
• Toileting
• Eating and meal-related assistance
• Mobility and transfers
• Ambulation
• Housekeeping and other authorized support
• Certain skilled tasks when authorized and appropriate

CDPAP is not simply a general-purpose caregiver payment program. Services must be medically necessary, authorized, and included within the applicable care plan.

Common Misconceptions About CDPAP Eligibility

Myth #1: “You have to be elderly.”

False.

CDPAP is not limited to older adults. Children, younger adults, and people with disabilities can qualify when they meet the applicable Medicaid and home care requirements.

Myth #2: “My diagnosis is on the list, so I automatically qualify.”

False.

New York does not determine CDPAP eligibility solely from a diagnosis. Functional need, medical stability, assessment results, and the applicable Minimum Needs Requirements matter.

Myth #3: “If I only need help with one activity, I automatically qualify.”

Not necessarily.

For many new applicants age 21 and older, the Minimum Needs Requirements require at least limited assistance with physical maneuvering with more than two ADLs. People with Alzheimer’s disease or dementia are subject to a separate standard involving supervision with more than one ADL.

Myth #4: “My spouse can automatically become my paid CDPAP caregiver.”

False.

Current NYSDOH rules prohibit a consumer’s spouse from serving as that consumer’s CDPAP personal assistant. Other relatives may be eligible depending on the circumstances.

Myth #5: “Having Medicaid automatically means I qualify for CDPAP.”

False.

Medicaid eligibility and CDPAP eligibility are separate questions. A person can have Medicaid but still not meet the medical, functional, assessment, or Minimum Needs Requirements for CDPAP.

Myth #6: “CDPAP ended when New York changed the Fiscal Intermediary.”

False.

CDPAP continues in New York.

The state transitioned to a single statewide Fiscal Intermediary, Public Partnerships LLC (PPL). PPL became the only authorized statewide Fiscal Intermediary effective April 1, 2025.

What Long Island Families Should Know in 2026

The CDPAP program is still available to eligible Medicaid recipients in Nassau and Suffolk counties.

The major changes families should understand are:

• Minimum Needs Requirements began September 1, 2025.
• New applicants may be subject to the new functional thresholds.
• Legacy participants may have different protections.
• NYIAP plays a major role in the assessment process for adults seeking Medicaid State Plan PCS/CDPAS.
• PPL is the statewide Fiscal Intermediary.
• Current 2026 CDPAP rates are published by NYSDOH.
• Eligibility continues to depend on the individual’s actual medical and functional needs.

Because Medicaid rules and financial eligibility standards can change, families should verify current requirements rather than relying on older income figures or outdated CDPAP articles. NYSDOH published its 2026 Medicaid updates in August 2026.

How to Start the CDPAP Process on Long Island

If you already have Medicaid, start by contacting your Medicaid managed care plan or the appropriate local Medicaid office and asking about your eligibility for home care and CDPAP.

If you do not have Medicaid, you will generally need to establish Medicaid eligibility first.

For Nassau and Suffolk County residents, the process can involve:

1. Confirming Medicaid eligibility.
2. Requesting an assessment for home care.
3. Completing the required NYIAP or applicable assessment process.
4. Providing medical documentation.
5. Meeting the applicable Minimum Needs Requirements.
6. Completing care planning and authorization.
7. Working with PPL if CDPAP is authorized.
8. Selecting an eligible personal assistant.

Families should be cautious about anyone promising guaranteed approval based solely on a diagnosis. No legitimate service can guarantee CDPAP approval before the required Medicaid and clinical assessments are completed.

Next Steps: Find Out Whether You May Qualify

If someone in your family needs help at home, the first question should not simply be, “Is this diagnosis covered?”

The better questions are:

Does the person have Medicaid?

What daily activities do they need help with?

How much assistance do they actually require?

Does the person meet the applicable Minimum Needs Requirements?

Can the person direct their own care, or is a designated representative needed?

Those answers provide a much more accurate starting point than a diagnosis list.

If you are a Nassau or Suffolk County resident considering CDPAP, speak with your Medicaid plan, local Medicaid office, or an appropriately qualified enrollment professional to determine the current pathway for your situation.

Related from Home Care Medicaid NY: Home Care Medicaid · Home Health Aide Medicaid in New York