New York Consumer Directed Personal Assistance Program: New York 2026 Guide

New York’s Consumer Directed Personal Assistance Program (CDPAP) lets Medicaid members who need home care choose, train and supervise their own personal assistants, who can be relatives and friends. It is offered under the state’s Community First Choice Option (CFCO) and is available through regular Medicaid and through Managed Long Term Care plans.

This page explains who can use CDPAP in 2026, how family members can be paid, what the program covers, how to apply, and how it fits with nursing home Medicaid. For the full statewide rules on income, assets, spouses and the look-back, see our New York Medicaid guide.

Figures change periodically. Double-check current amounts before relying on them.

What CDPAP is

CDPAP is the self-directed version of home care. The member, or a designated representative, recruits and directs the assistant, while a fiscal intermediary handles payroll, benefits and paperwork. In April 2025, New York moved CDPAP from hundreds of local fiscal intermediaries to a single statewide fiscal intermediary with regional partners, so every assistant must be registered with the statewide fiscal intermediary to be paid. Since April 1, 2025, the statewide fiscal intermediary has been the single payroll agency for the program. CDPAP assistants can perform tasks that otherwise would need a home health aide or nurse, such as giving some medications, because the program’s rules allow consumers to direct them.

Family caregiver and self-directed programs let a Medicaid member, or a representative, choose who provides care and, in many cases, pay a relative or friend. Payroll and paperwork usually run through an agency, so the family does not act as an employer alone. Who can be paid varies: adult children usually can, spouses often cannot.

Who qualifies in 2026

New York looks at both how much help a person needs and what they own and earn. In general, to qualify for CDPAP an applicant must:

• be eligible for New York Medicaid, including through spend-down or a pooled trust;
• need help with personal care, home health aide tasks or skilled nursing tasks, based on an assessment;
• be able to make informed choices about their care, or have a designated representative who can; and
• for those in MLTC, have CDPAP authorized by the plan.

Income and assets. The financial side of CDPAP follows New York’s long-term care Medicaid rules. Countable assets include bank accounts, investments and property other than the home, while the home, one car, personal belongings and certain burial funds are usually not counted. Gifts made in the five years before applying can trigger a penalty that delays waiver services, just as it would delay nursing home coverage.

Financial rules follow New York community Medicaid: in 2026, $1,836 a month of income for one person or $2,489 for a couple (with a spend-down or pooled trust above that) and $33,038 in assets. There is no look-back yet for community Medicaid.

New York’s 2026 long-term care Medicaid numbers, from our state guide:

If you are married. The spouse who stays home is protected: federal spousal impoverishment rules let them keep a share of the couple’s assets and, if their own income is low, part of the applicant’s income. The spousal allowance pages explain how these amounts are figured.

Services CDPAP can cover

CDPAP can pay for:

• hands-on personal care, such as bathing, dressing, toileting and eating
• home health aide tasks
• some skilled tasks, such as medication administration, that the consumer directs
• housekeeping and meal preparation tied to the care plan
• paid care from adult relatives, except a spouse, a parent of a child under 21, someone legally responsible for the consumer, or the consumer’s designated representative

What is usually not covered. Payment is for care tasks in the plan, not for rent, food or household bills. Most caregiver pay is taxable, though some live-in payments are excluded from income.

How to apply for CDPAP

The steps below describe the usual path. Many people apply for Medicaid and request the waiver at the same time, so that the money and care tests run side by side.

1. Get on New York Medicaid through the local Department of Social Services or HRA.
2. Complete the independent assessment for community-based long-term care.
3. If in an MLTC plan, ask the plan to authorize CDPAP. If not in a plan, the local district authorizes it.
4. Register with the statewide fiscal intermediary, and have the chosen assistant complete hiring paperwork.
5. The assistant starts work for the authorized hours and submits time through the fiscal intermediary.

Practical tips. Keep copies of everything you send and note the name of each person you speak with. Assessors only see one visit, so describe what a difficult day looks like and have a regular helper in the room. Cognitive problems and fall risk count toward need. If services are denied, the notice lists the deadline to appeal.

Waiting lists and timing

CDPAP has no enrollment cap. Delays usually come from the Medicaid application, the assessment and fiscal intermediary registration.

Getting on a list early, before a crisis, is usually wise. In the meantime, families often combine state plan personal care, adult day, PACE in areas that have it, and Area Agency on Aging services. The waiver waiting lists page explains common rules.

How it relates to nursing home Medicaid

CDPAP is only for care at home. Many CDPAP members meet a nursing home level of care, so the program is a common alternative to a nursing home for people with family members willing to be paid caregivers.

CDPAP serves people who meet the same care-need standard as nursing home residents, so it is an alternative to a nursing home rather than a lower level of care. Nursing home Medicaid is an entitlement for people who qualify, so it has no waiting list, while a waiver may. If care at home becomes unsafe, a participant can move to a nursing home and keep Medicaid, though the share of income paid toward care changes. Moving the other way is often given priority, and Money Follows the Person can help.

Planning around CDPAP

Most families come to CDPAP during a change: a fall, a hospital stay, or a caregiver who can no longer keep up. Planning a little ahead makes each step easier. A good first step is a short written picture of the day: which tasks need help, who does them now, and what the backup is. The same list helps at the assessment and makes it clear where paid help matters most.

On the financial side, gather recent bank statements, income letters such as Social Security and pension notices, health insurance cards, and proof of age and residence in New York. Holding on to five years of records now saves time if fuller long-term care Medicaid is needed later. Legal documents matter too. A durable power of attorney and a health care directive let a trusted person act on applications without a guardianship.

Needs rarely stay the same, so revisit the arrangement regularly and request a reassessment when things change. Notes on falls, hospital visits and new diagnoses make later reviews easier.

Tips for families

Before a relative becomes the paid caregiver, talk as a family about how it affects siblings, the caregiver’s job and benefits, and backup care. Track tasks and hours from the start. If a relative was paid privately before Medicaid, a written caregiver agreement matters, since undocumented payments can look like gifts. Plan for backup care when the caregiver is sick or away.

Because CDPAP combines a care test, a money test and sometimes a wait, a Certified Medicaid Planner familiar with New York can be a real help: checking finances against the 2026 limits, flagging look-back issues and keeping the application on track. Typical fees vary widely: help with an application alone often runs about $500 to $6,000, full planning about $2,500 to $15,000 or more, and hourly advice about $150 to $600.

Related pages

• New York Medicaid guide
• New York Managed Long Term Care
• New York Personal Care Services
• Paid family caregivers
• Consumer-directed care
• Caregiver agreements
• HCBS waivers explained
• In-home care and Medicaid

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.