CDPAP is a New York Medicaid program that inverts how home care usually works. Instead of an agency assigning you an aide, you recruit, hire, train and supervise your own personal assistant, and in most households that person is a relative, a neighbour or a friend who already knows the routine.

The hours come from an assessment of what help you need with daily activities, not from a diagnosis and not from what a family member would like to earn.

In New York: the program’s administration changed completely on April 1, 2025, when the roughly 600 fiscal intermediaries that handled CDPAP payroll were replaced by a single statewide intermediary, PPL, under the state budget enacted for 2024-25. Every CDPAP personal assistant in the state is now paid through it, whatever the county or the managed care plan. The consumer still chooses and directs the assistant; what moved is the paperwork. Questions about hours and the plan of care still go to your plan or the local district, not to the intermediary.

Which relatives may be paid has exclusions, and a spouse generally cannot serve in the role. Ask your plan about your exact relationship rather than assuming in either direction.

What it is not. It is not an employment program, so the hours track assessed need rather than what a household would like to earn. It does not cover medical treatment, only help with daily living. It does not suspend Medicaid’s income and asset rules, so if you are over the limit the spend-down or trust question comes first. And it does not protect against reassessment: hours are reviewed and can be reduced, which is when the fair hearing deadlines start to matter.

Also called: consumer directed personal assistance, consumer directed care. Full guide: CDPAP in New York and what the PPL switch changed.

More in Glossary of health coverage and billing terms

  • Grievance — A complaint about how a plan behaved, which is a different process from an appeal about what it decided, and people file the wrong one constantly.
  • Self-funded plan — An employer plan where the company pays claims from its own money, which puts it under federal law and outside New York's protections.
  • Network adequacy — The requirement that a plan's network actually produce appointments, which is what makes an unreachable directory a violation rather than bad luck.
  • Managed Long Term Care (MLTC) — The plan that authorizes and pays for long-term home care in New York. It is the payer, not the care itself.
  • Spend-down (excess income) — The monthly amount of medical expense you must incur before Medicaid covers the rest of the month, when your income is over the limit.

This page explains how the system works. It is not medical advice. More.