By Long Island Senior Advisor Care Team · September 7, 2026
CDPAP lets a Long Island family member be hired and paid as a Medicaid personal assistant. But New York raised the eligibility bar on September 1, 2025 and moved every paycheck to one statewide company. Here is what qualifies now.
CDPAP pays a person your parent chooses -- and that person can be you
New York runs a Medicaid program that most Long Island families discover late, usually from a neighbor rather than a discharge planner. It is called the Consumer Directed Personal Assistance Program, or CDPAP, and its premise is unusual: instead of a home care agency assigning whoever is available that week, the Medicaid member recruits, hires, trains, schedules and, if necessary, fires their own aide. The state calls that person a personal assistant. The state pays them.
The New York State Department of Health describes the eligible pool plainly. A personal assistant can be a friend or a family member, so long as they are not the member's spouse, not the member's designated representative, and not the parent of a consumer under age 21. An adult daughter in Bay Shore who has been driving to Brentwood four nights a week for two years is squarely inside that definition. A husband caring for his wife is not.
The services a personal assistant may perform are broader than most families expect. Under the program rules they can include anything normally provided by a personal care aide, a home health aide, or a nurse. That last category matters: CDPAP is one of the few routes in New York where a trained family member can lawfully handle tasks -- wound care, injections, tube feeding -- that a licensed agency aide is forbidden to touch without a nurse present.
None of this makes CDPAP a stipend or a caregiver grant. It is a Medicaid home care benefit with a different staffing model bolted on. Your parent must be Medicaid-eligible, must have a stable medical condition, must have a documented need for home care established through a state-approved assessment, and must be capable of self-directing their own care or have a designated representative who can do it for them.
The eligibility bar moved on September 1, 2025, and it moved up
This is the single most important thing for a Long Island family starting from scratch in 2026. On September 1, 2025, New York implemented what the Department of Health calls the Minimum Needs Requirements for both Personal Care Services and Consumer Directed Personal Assistance Services. The bar is now specific and it is higher than what came before.
To meet it, a Medicaid recipient age 21 or over must be assessed as needing at least limited assistance with physical maneuvering with more than two Activities of Daily Living. For a person with a diagnosis of dementia or Alzheimer's disease, the standard is different and somewhat lower: at least supervision with more than one Activity of Daily Living. Activities of Daily Living are the hands-on basics -- bathing, dressing, eating, toileting, transferring, walking.
Read that carefully, because it is where families get turned down. A mother who cannot manage her own pill organizer, cannot drive to the pharmacy, cannot shop, and cannot balance a checkbook has enormous need -- but every one of those is an instrumental activity of daily living, not an ADL. Under the current test, instrumental needs alone do not open the door. Something physical has to be happening with the body.
The requirement applies to initial assessments and to reassessments occurring on or after September 1, 2025. It also reaches beyond CDPAP: the Department applies it to anyone age 18 or older seeking to enroll in a Managed Long Term Care plan or a Medicaid Advantage Plan, which on Long Island is most of the people asking about home care in the first place.
There is a carve-out, and it is worth knowing whether your parent is inside it. Individuals who were already authorized for or receiving personal care or CDPAP services, or who were continuously enrolled in an MLTC plan, as of September 1, 2025 continue to be evaluated under the previous criteria. The state also exempts enrollment in PACE -- the Program of All-Inclusive Care for the Elderly -- from the Minimum Needs test entirely.
The assessment is run by a state contractor, not by your parent's doctor
Families often assume the family physician writes an order and home care follows. That has not been how New York works for several years. Initial Community Health Assessments for personal care and CDPAP are conducted through the New York Independent Assessor program, which the Department of Health operates under contract with Maximus Health Services.
The process has two moving parts. A nurse performs a Community Health Assessment using the state's Uniform Assessment System (UAS-NY), in person or by telehealth. Separately, a clinician from the Independent Practitioner Panel performs a medical assessment, also in person or by video. Neither of those people works for your parent's cardiologist or for the MLTC plan, and neither of them knows your mother.
That is precisely why the visit deserves preparation. The nurse is scoring how much help your parent needs with specific physical tasks, on a specific day, based largely on what she sees and what she is told. A parent who has spent eighty-one years insisting she is fine will tell that nurse she is fine. Long Island adult children have watched an entire application collapse on that one conversation.
Be in the room. Keep a two-week log before the visit -- who helped with the shower, who cut the food, how many times someone was needed to get her off the couch and to the bathroom. Describe the worst days, not the best ones, because a good day at 10 a.m. is not the baseline the family lives with. If there is a dementia or Alzheimer's diagnosis, make sure it is documented; the state has a specific form for it (DOH-5821), and it is the difference between the "more than two ADLs" test and the lower "more than one ADL with supervision" test.
The New York Independent Assessor line is 1-855-222-8350, staffed Monday through Friday 8:30 a.m. to 8 p.m. and weekends 10 a.m. to 6 p.m. Assessments are generally scheduled within roughly two weeks of the call.
One company now issues every CDPAP paycheck in the state
Until 2025, hundreds of regional fiscal intermediaries handled CDPAP payroll across New York -- many of them small, local, and fluent in the languages their neighborhoods spoke. On April 1, 2025, that ended. New York consolidated the function into a single statewide fiscal intermediary: Public Partnerships LLC (PPL). Every CDPAP recipient in the state is now required to work with PPL.
The fiscal intermediary's job is administrative, not clinical. PPL processes the personal assistant's wages and benefits, handles income tax and wage withholding, and maintains the employment records the state requires. It does not decide how many hours your parent gets -- that authorization comes from the MLTC plan or the local district -- and it does not supervise the aide. Supervision remains the consumer's job. So does recruiting, training, arranging backup coverage when the aide has the flu, and keeping payroll records.
The transition was rough by any measure, and the state itself acknowledged it publicly: the Department of Health issued cease-and-desist letters in March 2025 to fiscal intermediaries and home care agencies it accused of misleading consumers about the change, and tens of thousands of consumers were still mid-registration at the peak. If you are reading this in 2026 and starting fresh, that history matters mainly as a warning to go to the source rather than to whichever agency calls your house.
PPL's consumer line is 1-833-247-5346. If PPL cannot resolve something, the Department of Health has published escalation numbers: 1-866-712-7197 if your parent is enrolled in a managed care plan, or 518-474-5888 if they are not enrolled and are working through the local district instead.
One detail Long Island families should not overlook: the state publishes its CDPAP consumer materials in Spanish, Haitian Creole, Korean, Russian, Polish, Arabic, Bengali, Chinese, and Yiddish in addition to English. If the person who actually manages your mother's care is more comfortable reading Spanish, do not let an English-only packet from a third party become the version of the rules your family operates on.
In Nassau and Suffolk, CDPAP almost always runs through an MLTC plan
This is the structural fact that surprises families who read about CDPAP on a national website. Managed Long Term Care enrollment has been mandatory in both Nassau and Suffolk since the transition that began in 2013, for Medicaid recipients age 21 and older who need community-based long-term care services for more than 120 days.
So the practical sequence on Long Island is rarely "apply for CDPAP." It is: establish community Medicaid, get assessed, enroll in an MLTC plan, and then tell that plan you want your authorized hours delivered through consumer direction rather than through one of its contracted agencies. The plan authorizes the hours. PPL pays the person. Your family finds and manages that person.
It also means the plan is the entity you argue with when the hour count comes back lower than the need. That is a different conversation from the eligibility conversation, it has its own appeal rights, and it is worth writing down every reduction in writing rather than accepting a phone explanation. We walk through how the 120-day threshold triggers all of this in our guide to Managed Long Term Care.
CDPAP is not the only Medicaid path, and it is not always the right one. If the goal is moving a parent out of a nursing home and back into the community with services attached, the NHTD waiver is a different mechanism. If the goal is a licensed residential setting where Medicaid covers the services, that is the Assisted Living Program. These are alternatives to weigh, not steps in a sequence.
What CDPAP is actually worth against the alternatives
New York does not publish a Nassau-specific or Suffolk-specific cost survey, and neither does anyone else -- the numbers that circulate as "Long Island prices" are marketing estimates, not measured data. What does exist is CareScout's 2025 survey of New York State medians, published in 2026: roughly $6,673 a month for a non-medical caregiver at 44 hours a week, about $7,110 a month for assisted living, and about $15,528 a month for a semi-private nursing home room.
Set those next to each other and the arithmetic that drives so many Long Island decisions becomes obvious. Forty-four hours a week of private-pay help -- six hours a day, not overnight coverage, not weekends fully staffed -- costs nearly what a licensed assisted living residence costs. The family that is quietly covering the other 124 hours a week themselves is not saving money on paper. They are spending an adult child's working hours instead of dollars.
CDPAP does not lower that true cost. What it does is redirect the Medicaid dollar to the person already doing the work, which changes the household math in a way an agency contract cannot. A daughter who has cut back to part-time to manage her mother's mornings is being paid for hours she was going to spend anyway. That is the honest case for the program, and it is a strong one.
It is also worth being clear about what CDPAP will not do. It authorizes hours, not around-the-clock presence. It does not pay rent, and it does not follow your parent into an assisted living residence. If the real problem is that no one can safely be alone overnight, consumer direction may not be the answer -- see how in-home care compares to assisted living before committing a family member's next three years to it.
A place like Brentwood shows why this program matters here
Brentwood is the kind of Long Island community where CDPAP fits the housing stock and the family structure better than any brochure setting does. The 2020 Census counted 62,387 residents in the Brentwood CDP across 10.95 square miles -- roughly 5,697 people per square mile, one of the densest concentrations of households in Suffolk County, in a hamlet inside the Town of Islip served by the LIRR Ronkonkoma Branch.
The senior care supply there does not mirror that density. Brentwood has nursing homes -- Maria Regina Residence at 1725 Brentwood Road and Ross Center for Nursing and Rehabilitation at 839 Suffolk Avenue among them -- but a family looking for a licensed assisted living residence is looking outside the hamlet, toward Bay Shore, Islandia, Hauppauge or Holtsville. The realistic local options are: stay home with help, or leave.
That is exactly the choice CDPAP was built for. In a multigenerational household where an adult child already lives in the home or two streets over, the program converts an informal arrangement that is already happening into an authorized, paid, documented one -- with the ADL threshold as the gate. We cover the local landscape in more detail on our Brentwood senior care page.
The same logic holds in Bay Shore, Central Islip, Deer Park and Wyandanch, and it holds for very different reasons in Great Neck and Freeport. Wherever the family is already providing hands-on care and the parent intends to stay in the house, consumer direction deserves a look before an agency contract does.
What to do this month, in order
First, establish whether your parent already had services or MLTC enrollment as of September 1, 2025. If yes, they are evaluated under the older criteria and your path is considerably easier. If no, plan around the Minimum Needs Requirements from the start.
Second, call your county's Office for the Aging before you call anyone selling something. Nassau County Office for the Aging: 516-227-8900. Suffolk County Office for the Aging: 631-853-8200. Long Island is split cleanly at the county line -- there is no shared regional agency, and the office for the wrong county cannot open a case for you. Both run NY Connects and can screen for MLTC, the Assisted Living Program and the NHTD waiver in the same conversation.
Third, get the community Medicaid application right. Long-term-care Medicaid for seniors is an asset-tested, non-MAGI pathway with its own rules, and a rejected application costs months. If there is a house, a spouse still living in it, or any transfer in the last five years, this is the point to pay an elder law attorney for an hour. Our overview of how families actually pay for care lays out where Medicaid fits among the other sources.
Fourth, prepare for the assessment as if it were a hearing. Two-week log, worst days described honestly, dementia diagnosis documented, an adult child physically present. Call the New York Independent Assessor at 1-855-222-8350 to start it.
Fifth, register with PPL at 1-833-247-5346 only after hours are authorized, and go to the Department of Health's own CDPAP page or your MLTC plan for instructions rather than to an agency that contacted you first. If something goes wrong and PPL cannot fix it, the DOH escalation lines are 1-866-712-7197 for managed-care enrollees and 518-474-5888 for everyone else.
