CDPAP in the Bronx: A First-Timer’s Complete Guide to Getting Paid Care from Someone You Actually Trust

The Bronx has always been a borough where families take care of one another. From multigenerational households in Mott Haven to families across Fordham, Highbridge, Soundview, and Co-op City, relatives and trusted friends often step in when someone needs help with daily activities.

A daughter may reduce her work hours to care for a parent. An adult son may help a family member with bathing, meals, medications, or transportation. A sibling or close friend may provide care every day without receiving anything in return.

What many Bronx families do not realize is that New York’s Consumer Directed Personal Assistance Program (CDPAP) can allow eligible Medicaid recipients to choose their own caregivers and have those caregivers paid through Medicaid.

For families hearing about CDPAP for the first time, the program can sound complicated. Who qualifies? Who can be a caregiver? How much does it cost? How do you apply? What happens after you are approved?

This guide explains the CDPAP process in plain language so Bronx families can understand what to expect.

What Is CDPAP?

The Consumer Directed Personal Assistance Program, commonly known as CDPAP, is a New York Medicaid program that gives eligible individuals greater control over their home care.

Instead of having a traditional home care agency assign a caregiver, the Medicaid recipient can choose a person they know and trust to provide approved care.

Depending on program requirements, that caregiver may be a:

• Family member
• Adult child
• Sibling
• Close friend
• Trusted neighbor
• Other eligible individual

The caregiver is paid through Medicaid.

This can be especially valuable for Bronx families that already rely heavily on relatives and close community networks for caregiving.

CDPAP does not necessarily create a new caregiving relationship. Instead, it can provide compensation for an existing relationship when the Medicaid recipient meets the program’s eligibility requirements.

The program is governed by New York State Department of Health regulations under Social Services Law § 365-f.

Why CDPAP Can Be Important for Bronx Families

The Bronx has a large Medicaid population and many families face significant financial challenges when someone requires long-term care.

Traditional private-pay home care can cost thousands of dollars each month. At the same time, many families already have someone providing much of that care without compensation.

CDPAP offers a different model.

Rather than asking a family to choose between paying for expensive private care and relying entirely on unpaid caregiving, eligible Medicaid recipients may be able to direct their own care and have an approved caregiver compensated through the program.

For families in neighborhoods such as Fordham, Highbridge, Soundview, Mott Haven, and Co-op City, this flexibility can make a significant difference.

Who Qualifies for CDPAP in the Bronx?

CDPAP eligibility generally involves two major areas:

1. Financial eligibility
2. Functional eligibility

Meeting one requirement does not necessarily mean you meet both.

Financial Eligibility

Because CDPAP is a Medicaid program, the individual generally must qualify for Medicaid.

The source information identifies 2024 New York Medicaid income figures of approximately:

• $1,732 per month for a single adult
• $2,340 per month for a household of two

However, Medicaid financial rules can differ depending on the applicant’s circumstances.

Seniors and people with disabilities may be evaluated under different eligibility pathways than other applicants.

If you already have Medicaid, you may have already satisfied the financial eligibility portion and can focus on determining whether you meet the functional requirements for home care.

Functional Eligibility

Financial eligibility is only one part of the process. The individual must also have a medically documented need for home care.

This can involve a chronic illness, physical disability, cognitive impairment, or another condition that makes assistance with everyday activities necessary.

Examples may include:

• Parkinson’s disease
• Multiple sclerosis
• Cerebral palsy
• Congestive heart failure
• COPD
• Diabetes with complications
• Dementia
• Physical disabilities

The individual may require help with Activities of Daily Living (ADLs) such as:

• Bathing
• Dressing
• Toileting
• Feeding
• Transferring
• Walking

They may also need assistance with certain Instrumental Activities of Daily Living (IADLs) such as meal preparation or medication management. Medical documentation is an important part of establishing the need for care.

Does the Consumer Have to Direct Their Own Care?

CDPAP is based on consumer direction. The Medicaid recipient generally must be able to make decisions about their own care. If the individual cannot self-direct, a designated representative may be able to take on that responsibility.

A designated representative may include an appropriate family member, legal guardian, or another person who has the authority to act on the individual’s behalf. This can be particularly important for individuals living with conditions such as dementia.

Who Can Be a Paid CDPAP Caregiver?

One of the biggest advantages of CDPAP is the ability to choose someone you already know.

Eligible caregivers may include adult children, siblings, other relatives, friends, or trusted individuals who meet the program’s requirements.

However, there are restrictions. Under the rules described in the source material, a spouse or legally responsible relative, such as a parent of a minor child, cannot generally be the paid CDPAP caregiver.

Because New York’s CDPAP rules can change, families should confirm current caregiver eligibility with their Medicaid plan or an enrollment counselor before making decisions.

What Does CDPAP Cover?

CDPAP can cover a broad range of personal care and approved skilled tasks when they are included in the individual’s care plan and the caregiver has received appropriate training.

Personal Care

Care may include:

• Bathing
• Grooming
• Dressing
• Oral hygiene
• Skin care

Mobility Assistance

A caregiver may help with:

• Transfers
• Positioning
• Walking
• Mobility support

Nutrition

Approved care may include:

• Meal preparation
• Feeding assistance
• Certain trained feeding procedures

Health-Related Tasks

One distinctive feature of CDPAP is that a trained personal assistant may perform certain health-related tasks that would traditionally require a licensed healthcare professional in a conventional home care arrangement.

Depending on the approved care plan and training, these tasks may include:

• Medication-related assistance
• Wound care
• Catheter care
• Monitoring vital signs
• Other approved skilled tasks

The exact services must be authorized and included in the individual’s care plan.

Household Support

Light housekeeping may also be covered when it is directly related to the Medicaid recipient’s care.

How Many Hours of CDPAP Care Can You Receive?

The number of authorized hours is not automatically the same for every recipient.

A nursing assessment evaluates the individual’s functional needs, and the Medicaid plan’s care manager uses that information when developing the care plan.

Some people may qualify for only a few hours of assistance each day. Individuals with significant care needs may qualify for substantially more.

The source material notes that some Bronx families caring for people with significant functional limitations may receive 12 to 24 hours of daily coverage under an approved care plan. The actual number of hours depends on the individual’s documented needs and authorization.

What CDPAP Does Not Cover

CDPAP is designed to provide personal care and approved health-related assistance.

It does not generally cover:

• Housing or room and board
• Transportation costs
• Medical equipment and supplies as part of the CDPAP service itself
• Services for individuals who do not meet functional eligibility requirements
• Companion-only services without an eligible need for personal care

Other Medicaid benefits may cover some of these needs separately.

How to Apply for CDPAP in the Bronx

The CDPAP application process involves several steps. Understanding the sequence can make the process much easier.

Step 1: Confirm Your Medicaid Status

If you already have Medicaid, you can generally move forward to determine whether you qualify for home care.

If you do not have Medicaid, you must first apply. The source information identifies the NYC HRA Medicaid enrollment system as one pathway for Bronx residents.

Families can contact the NYC HRA Medicaid line at: 718-557-1399

You may also apply through the appropriate NYC benefits system or in person through the Bronx Department of Social Services. If the care need is urgent, ask whether your circumstances qualify for expedited processing.

Step 2: Obtain a Physician’s Order

Your doctor must document the need for home care. Speak with your primary care provider or another healthcare professional familiar with your condition. Ask for documentation explaining why assistance with daily activities is medically necessary.

The source material identifies healthcare organizations such as Montefiore Medical Center, Lincoln Medical Center, Urban Health Plan, and BronxCare as examples of places where patients may ask their healthcare providers about home care referrals.

Step 3: Enroll in Managed Long Term Care

Many Bronx Medicaid recipients who need ongoing home care services must enroll in a Managed Long Term Care (MLTC) plan.

The MLTC plan coordinates long-term care services and assigns a care manager.

The source material identifies plans including:

• VillageCareMax
• VNSNY CHOICE
• Elderplan/HomeFirst

Available plans can change, so confirm which plans currently serve your area and circumstances.

Step 4: Complete the Nursing Assessment

A registered nurse evaluates the individual’s functional needs.

The assessment helps determine the amount and type of care required.

Be honest and thorough during the assessment.

Make a list beforehand of everything your loved one needs help with.

Do not focus only on what happens during the daytime.

If your loved one needs assistance during the night, explain that as well.

If the assessment does not accurately reflect the person’s needs, ask about the process for requesting a reassessment or appealing the decision.

Step 5: Work With the Fiscal Intermediary

CDPAP caregivers are processed through a Fiscal Intermediary (FI).

The FI handles administrative responsibilities such as:

• Payroll
• Taxes
• Workers’ compensation
• Employment documentation
• Compliance requirements

The source material states that New York transitioned CDPAP fiscal intermediary services to Public Partnerships LLC (PPL) under a statewide model beginning in 2025.

Because the CDPAP administrative structure has changed, families should confirm the current FI arrangement with their MLTC plan or the New York State Department of Health before enrolling.

Step 6: Enroll Your Caregiver

Once your caregiver is selected, they must complete the required enrollment paperwork.

This can include:

• Identity verification
• Tax documents
• Employment forms
• Required training documentation

A caregiver does not necessarily need to hold a nursing license or CNA certification to participate.

However, they must meet the program’s eligibility requirements and receive appropriate training to perform the duties included in the care plan.

What to Expect During Your First 90 Days

For a first-time applicant, the first three months may generally look something like this:

Weeks 1–4

You may work on:

• Medicaid confirmation
• Physician documentation
• MLTC enrollment

Weeks 4–8

The process may include:

• Nursing assessment
• Care plan development
• Authorization of care hours

Weeks 8–12

You may then move into:

• Fiscal intermediary enrollment
• Caregiver onboarding
• Payroll setup

Actual timelines vary depending on Medicaid status, documentation, assessments, plan requirements, and other factors.

What Surprises First-Time CDPAP Families?

Several parts of the program often surprise families.

The Nursing Assessment Is Not a Test

Some people become nervous before the assessment because they think they need to prove that their loved one is disabled enough to qualify. Instead, think of it as an opportunity to explain the person’s actual needs.

Prepare notes before the appointment. Write down everything the person needs help with, including tasks that may seem minor.

Your Caregiver Is an Employee

A CDPAP caregiver is not simply receiving cash from a family member. They are employed through the program and receive wages, tax documentation, and other employment protections.

The Consumer Directs the Care

The consumer or their designated representative has significant responsibility for directing the caregiver’s work. This includes establishing the schedule and ensuring that the caregiver performs the approved duties.

How Much Does CDPAP Cost?

For an eligible Medicaid recipient, the source material states that the out-of-pocket cost for approved CDPAP services is $0.

Medicaid covers the authorized caregiving services and associated administrative costs. There is generally no CDPAP premium, deductible, or copayment for the covered service itself.

The caregiver’s wages are a separate issue. According to the source material, Bronx CDPAP caregiver wages have typically ranged from approximately $17 to $21.50 per hour depending on the plan and payroll structure, although rates can change.

Families should confirm current wages before making employment decisions. For comparison, private home care through an agency can cost approximately $25 to $35 per hour out of pocket. For an eligible Medicaid recipient, CDPAP can therefore eliminate a major financial burden.

Common Questions About CDPAP in the Bronx

Can my adult daughter be my paid caregiver?

Generally, yes. Adult children may qualify as CDPAP caregivers if they meet the program requirements. The spouse exclusion still applies under the rules described in the source material.

Can a friend be my caregiver?

A qualified friend may be able to serve as a CDPAP caregiver. The caregiver must meet all applicable enrollment and program requirements.

Can CDPAP pay for transportation?

No. Transportation is not part of the CDPAP benefit itself. However, Medicaid may provide transportation through a separate benefit for eligible recipients. Ask your care manager about non-emergency medical transportation if you need help getting to medical appointments.

What if my CDPAP application was denied?

A denial does not necessarily mean you have no options. You may have the right to appeal through a Medicaid Fair Hearing. The source information identifies 1-800-342-3334 as a number for requesting a fair hearing.

You can also discuss the denial with your enrollment counselor and ask whether updated medical documentation or a reassessment may be appropriate.

Can someone with dementia receive CDPAP?

Potentially, yes. If the individual cannot direct their own care, an appropriate designated representative may be able to manage the consumer-direction responsibilities. The representative must meet applicable program requirements.

Choosing the Right Support Team

Because CDPAP involves multiple steps, having knowledgeable support can make the process easier.

When choosing an enrollment support organization, consider whether they:

• Understand Bronx Medicaid procedures
• Know the local MLTC landscape
• Provide bilingual assistance
• Explain the process clearly
• Respond promptly to questions
• Help families understand required documentation

Spanish-speaking support can be particularly valuable for many Bronx families.

A good support team should help you understand your options without making promises about eligibility or authorization before your circumstances have been properly reviewed.

Take the Next Step: Check Your CDPAP Eligibility

If you or a loved one in the Bronx already receives Medicaid and needs help with daily activities, CDPAP may be worth exploring.

You do not need to understand every Medicaid rule before making your first call.

A preliminary eligibility consultation can help you understand:

• Whether you may qualify
• What documentation you need
• Whether an MLTC plan is required
• What your next step should be
• How the caregiver enrollment process works

The source information states that homecaremedicaidny.com offers free eligibility consultations for Bronx residents.

Related: Telehealth Medicaid Therapy Services — learn how virtual sessions are covered under New York Medicaid.

Related from Home Care Medicaid NY: Home Care Medicaid