What CDPAP is, stated precisely
Most Medicaid home care works one way: a licensed agency employs aides, the agency assigns one to you, and if the fit is wrong you ask for a different assignment. CDPAP inverts that. The Medicaid recipient, or a designated representative acting for them, becomes the one who finds the person, decides the schedule, trains them for their own needs and supervises the work.
The state’s reason for running it this way is practical rather than sentimental. Someone who already knows the household, speaks the language spoken at home and understands the routine provides more usable help than a stranger on a rotating schedule, and the arrangement holds together longer.
The consequence people care about most: the assistant can be a relative or a friend. Which relatives are permitted has exclusions, and a spouse generally cannot serve in the role. Ask your plan for the current rule for your exact relationship rather than assuming either way, because this is the detail people most often get wrong in both directions.
What changed with PPL
Under the state budget enacted for the 2024-25 fiscal year, New York eliminated the network of roughly 600 fiscal intermediaries that had handled CDPAP payroll and administration, and replaced them with one statewide intermediary: Public Partnerships LLC, known as PPL. It became the sole fiscal intermediary on April 1, 2025, and the deadline for consumers and assistants to register with it was August 1, 2025.
What that means today:
| Question | Answer |
|---|---|
| Who employs the personal assistant | PPL, for payroll and employment purposes, statewide |
| Who chooses and directs the assistant | The consumer or their designated representative, unchanged |
| Where timesheets and payroll questions go | PPL |
| Where questions about hours and the care plan go | Your managed care plan or the local district, not PPL |
| Does the county or plan change this | No. One intermediary now covers every county and every plan |
The transition was disruptive, and households that missed the registration window spent months untangling it. If yours is one of them and there are still gaps in pay or in coverage, that is worth raising with a legal services organization rather than absorbing.
Which questions go where
This is the practical confusion the single-intermediary structure created, and getting it right saves entire afternoons.
PPL handles the employment relationship. Registration of an assistant, background clearances, timekeeping, paychecks, tax paperwork, employment questions.
Your Medicaid managed care plan, or the local district if you are not in a plan, handles the care. How many hours you are authorized, the assessment that set them, changes to the plan of care, and any denial or reduction.
Calling the wrong one gets a polite answer that does not help. When you call, say which of the two you are asking about in the first sentence.
How to start, in order
1. Get Medicaid, in the right category. CDPAP requires Medicaid coverage. For people 65 and older or applying on the basis of disability, that application generally goes through the local department of social services rather than NY State of Health. If income is over the limit, that does not end it: see spend-down and, for ongoing care, a pooled income trust.
2. Get assessed. Home care hours come from an assessment of what help you need with daily activities. This is the step that determines everything downstream, so it is the step to prepare for: have a clear account of what happens on a bad day rather than an average one, and have your doctor’s documentation available.
3. Choose CDPAP rather than agency care. Say it explicitly. It is an option, and it is not always offered.
4. Register the assistant with PPL. Employment paperwork, identification, clearances and health requirements. Start this early, because it is the step where timelines slip.
5. Set up timekeeping and check the first paychecks carefully. Payroll problems in the first two months are common enough that assuming they will not happen is unwise.
What CDPAP does not solve
It is not a job program. The hours are set by the recipient’s assessed need, not by what a family member needs to earn.
It does not cover medical treatment. It covers help with daily living: bathing, dressing, meals, mobility, medication reminders, and tasks the recipient directs. Clinical care is a different service.
It does not remove the Medicaid income and asset rules. If you are over the income limit, the spend-down or trust question comes first.
It does not protect against reassessment. Hours get reviewed, and they can be reduced. A reduction notice has a deadline attached, and the deadline for keeping your current hours while you appeal is much shorter than the deadline for appealing at all.
If hours are denied or cut
A notice reducing or denying home care hours is a Medicaid decision, and it comes with two clocks. You have 60 days from the notice date to request a state fair hearing. But to keep your current hours running while you wait, the request must come before the change takes effect, which in practice means within about 10 days of the notice, and you have to use the words aid continuing.
Missing the second deadline does not end the appeal; it means the hours stop while it is decided. That distinction is the single most consequential thing on this page. The full procedure, with the phone number.
Questions people ask
Can I pay a family member to take care of me through CDPAP?
That is the core of the program. Which relatives are eligible has exclusions, and a spouse generally cannot be the paid assistant. Ask your plan about your exact relationship before making arrangements.
Who is my personal assistant’s employer now?
PPL, the single statewide fiscal intermediary since April 1, 2025. You still choose, train and supervise the assistant; PPL handles employment and payroll.
What happened to my old fiscal intermediary?
The roughly 600 previous intermediaries were eliminated under the state budget enacted for 2024-25. All CDPAP payroll moved to PPL, with a registration deadline of August 1, 2025.
How many hours will I get?
That comes from an assessment of your need, not from a formula we can publish. Prepare for the assessment as the decisive step, and appeal if the result does not match the situation.
My income is too high for Medicaid. Is CDPAP out of reach?
Not necessarily. New York’s Excess Income program and pooled income trusts exist precisely for this, and a trust is the usual route for people who need ongoing home care.
Do I have to use CDPAP instead of an agency?
No. Agency-based personal care is the alternative, and for someone with nobody available to hire it is the better answer. The full map of Medicaid home care.
Sources
- NY Health Access — CDPAP fiscal intermediary transition (checked 2026-09-07)
- LeadingAge New York — CDPAP transition to a single fiscal intermediary (checked 2026-09-07)
- New York State Department of Health — Medicaid (checked 2026-09-07)
More in Medicaid in New York: Who Qualifies, How to Apply, How to Keep It
- Medicaid and Long-Term Care in New York: Nursing Home, Assisted Living, or Home — Medicaid, not Medicare, pays for long-term care in New York: at home, in assisted living or in a nursing home. The look-back, and why advice comes first.
- Medicaid Work Requirements in New York, 2027: Who Must Report 80 Hours and Who Is Exempt — From 2027, many Medicaid adults 19 to 64 must show 80 hours a month or an exemption. Letters by September 30, checks from March renewals. What to do now.
- Where to Apply for Medicaid in New York City: Two Doors, and Which One Is Yours — New York runs Medicaid applications through two separate systems. Which one handles your case depends on your age and why you are applying, and going to the wrong one costs weeks.
This page explains how the system works. It is not medical advice. More.