From Upstate to Downtown: How Family Caregivers Get Paid in New York

The Consumer Directed Personal Assistance Program (CDPAP)

By Leah Felderman BA MA  
Updated: 01/22/2020  
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CDPAP Freedom to Choose Caregivers in New York Photo by Luke Stackpoole on Unsplash

New York state has, by far, one of the most well known and comprehensive programs for elderly Medicaid recipients to take control of their home care. Aside from Uncle Frank, who has always wanted to relocate to sunny Florida and saunter around in his bathing suit all day, most of our aging loved ones wish to remain in their homes. At this stage in life, remaining home requires a little (if not a lot) of help. The battleground for aging in place is a familiar one: your elderly relative wishes to remain in their home but they are resistant to help from anybody, nevertheless a stranger. Perhaps a relative or close friend is the key to fulfilling their wishes to successfully and safely age in place. While it's fantastic to get by with a little help from our friends, those eligible for Medicaid can receive significant funding to pay for this help with home care from a caregiver of their choice. The Consumer Directed Personal Assistance Program (CDPAP) helps eligible residents of all 62 counties in New York state and residents of all boroughs in New York City utilize their Medicaid benefits to employ and pay the caregiver(s) of their choice. From family to close friends to a beloved neighbor, here is how New York pays family caregivers.

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Who is eligible for CDPAP?

CDPAP is for the consumer, i.e. the elderly Medicaid recipient in need of home care. Eligibility is as follows:

Medicaid

Not just for the impoverished, down on their luck, or unemployed-Medicaid fills a very needed gap in an unfortunately flawed healthcare system. Health care, and aging, is expensive; applying for Medicaid may be the best option for your elderly loved one. As of January 2019, the Medicaid net income threshold for a family of 1 is $10,300 and a family of 2 is $15,200, with $15,450 and $22,800 of allowable assets respectively.1 If your elderly loved one is eligible for Medicaid and not already an official recipient, then start the application process today!

New York residents can apply for Medicaid in the following ways:

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Home Care and Compensation Through CDPAP

Approximately 75,000 New Yorkers rely on home care services through CDPAP.2 The consumer (the elderly Medicaid recipient needing home care) can generally hire any person they wish with the exception of a spouse (or their "designated representative" if the elderly consumer is not capable of self-directing care).3 Typically a designated representative is needed for those elderly that are too medically and/or mentally incapacitated to make care decisions; a designated representative is usually already in place via legal guardianship or other responsible adult surrogate.

To be eligible to receive CDPAP the consumer must need skilled and/or unskilled care. The responsibilities of the elderly consumer (or their representative) are significant prior to starting the program. Take note that there are 3 approvals necessary: approval for Medicaid, demonstration of the need for home care, and finally CDPAP approval.

Personal assistants hired through CDPAP do not have the same training requirements that are required of home care aides employed through an agency. However, any aide selected by the CDPAP recipient must meet the same requirements as it relates to immunizations, health tests and examinations.4 Furthermore, if skilled care is needed then an RN must certify and validate that the skilled tasks are capable of being fulfilled under direction of client (or designated representative). However, with CDPAP the home care aide will not need any formal medical training for skilled tasks (such as insulin injections, oxygen administration, etc.) which would otherwise be attended to by a CNA or RN.

The total amount of eligible hours for home care is determined upon approval of CDPAP. Pay rates for attendants are determined by a variety of factors including current Medicaid allowances, zip code of care recipient, and the particular Fiscal Intermediary chosen by the recipient. In New York state the pay rates range from approximately $11-$15 hourly.5

What is a Fiscal Intermediary?

The New York State Department of Health states:

A Fiscal Intermediary, or FI, is an organization that is contracted with a managed care plan and/or the Local Department of Social Services (LDSS). The FI works like the human resources entity for the CDPAP. It provides supports to you [the consumer], including payroll and benefits for the personal assistant of your choice.6

The CDPAP recipient's choice of FI has no impact on hours or approval into the CDPAP program. It is important to remember that which ever FI is chosen to work with, the program is ultimately administered and approved through Social Services and Medicaid. However, there are a wide variety of home care agencies that have a wide range of experience with CDPAP and many offer assistance with navigation through the CDPAP process.

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Fiscal Intermediary Reimbursement

Make no mistake, FIs do not participate in the CDPAP without financial compensation. Payroll, program supervision, and CDPAP consumer consultation costs the FI company; in turn they structure their involvement to benefit financially. How much can an FI benefit? Enough so to where the number of FIs have increased by almost 1000% since 2012! That is not a typo: one thousand percent increase in the number of businesses acting as an FI for the CDPAP program! There are currently over 600 FIs statewide, up from 58 just prior to 2012.7 Yet, not all FIs are created equal. There have been plenty of documented instances of FIs taking advantage of the client and the program, not administering the funds and/or services as intended. With 600+ companies getting a piece of the CDPAP funding pie, there are growing concerns about financial waste and fraud.

CDPAP Budget Cuts

On September 1st 2019, the NYS Department of Health implemented a policy to change how CDPAP FIs are reimbursed. To summarize, the policy significantly decreased the reimbursement cap for FI administrative costs in order to cut the budget. However, the policy was short lived. Disability rights advocates filed a lawsuit challenging the cuts, and the State of New York Supreme Court nullified the policy on October 10th, 2019.8

While state officials and CDPAP advocates work towards a solution, the NYS Department of Health reassures CDPAP recipients that there will be no change in benefits, hours of service, or care plans of consumers.9 Furthermore, even with the proposed budget cuts, CDPAP consumer benefits are not targeted. Rather, the state hopes to improve the quality / reduce the quantity of FIs by implementing stricter oversight and requirements.

CDPAP is a wonderful program that helps New York state residents achieve their goal of #aginginplace!

Sources:

Leah Felderman BA MA
 

About the Author

Leah Felderman is a proud alumnus of University of Central Florida (BA) and San Diego State University (MA). She has worn many occupational hats including teaching, hospitality management, government contractor and non-profit organizer. She is an intrepid international traveler having visited over 60 countries before happily settling down into her new life chapter of domesticity as a mom and Coast Guard wife.



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