Can a Family Member Be a Paid CDPAP Caregiver in New York?

Yes, But There Are Rules About Who Can and Can't Serve

One of CDPAP's biggest draws for families is that it lets Medicaid pay a family member to provide care that they may already be providing for free. Adult children, grandchildren, siblings, nieces, nephews, and other relatives can all be hired as paid personal assistants under the Consumer Directed Personal Assistance Program. But the rules about who qualifies — and who's specifically excluded — are more nuanced than most families realize.

Who Can Be a Paid CDPAP Caregiver

Most family members are eligible:

• Adult children — the most common arrangement. A son or daughter who has been providing unpaid care for a parent can become a paid personal assistant, receiving wages, overtime pay, and workers' compensation coverage through the fiscal intermediary (Public Partnerships LLC)
• Grandchildren (age 18+)
• Siblings
• Nieces, nephews, cousins and other extended family
• Close friends and neighbors — CDPAP doesn't require a family relationship; any trusted person the consumer selects can serve as their assistant

The personal assistant does not need any medical certification, home health aide training, or prior caregiving experience. CDPAP's design assumes the consumer (or their designated representative) will train and supervise the assistant. That said, the assistant must pass a background check and complete onboarding with PPL.

Who Cannot Be a Paid CDPAP Caregiver

Three categories relevant to family caregivers are explicitly excluded:

Spouses. A husband or wife cannot be a paid CDPAP personal assistant for their spouse. This exclusion applies regardless of financial hardship — there is no waiver or exception process.

The designated representative. If a family member has been appointed as the consumer's designated representative (the person who directs and manages the care on behalf of a parent who can't self-direct), that same person cannot also be the paid assistant. The roles must be held by different people.

Parents of minor children. A parent cannot serve as a paid CDPAP caregiver for a child under 21. This doesn't typically apply to elder care situations but comes up occasionally in families where a grandparent is the CDPAP consumer.

The spouse exclusion is the one that catches most families off guard. A wife who has been providing 16 hours of daily care for her husband with Parkinson's disease cannot be compensated through CDPAP — even though the alternative is hiring a stranger through an agency, which Medicaid would pay for at a comparable or higher rate. The exclusion is a matter of state policy, not federal law, and has been the subject of ongoing legislative debate.

How the Designated Representative Rule Works in Practice

The designated representative restriction creates a practical puzzle for families where one adult child is both the primary caregiver and the person managing their parent's affairs. Here's the typical workaround:

• Child A is appointed as the designated representative — they handle scheduling, timesheets, communication with the MLTC plan, and supervisory responsibilities
• Child B (or another relative or friend) serves as the paid personal assistant — they provide the hands-on care

If there's only one adult child available, the child can serve as the paid personal assistant, and another trusted person — the parent's sibling, a close family friend, a neighbor — can be designated as the representative. The representative role doesn't require physical presence during care hours; it's an administrative and supervisory function.

Pay Rates and Working Conditions

CDPAP personal assistants are joint employees of the consumer and the fiscal intermediary (PPL) for payroll purposes. Their pay is governed by New York labor law:

• Minimum hourly rate: At least $19.65/hour in New York City, Long Island, and Westchester, or $18.65/hour elsewhere in the state, as of 2026
• Overtime: Time-and-a-half for hours worked over 40 in a week. CDPAP assistants who provide live-in care (defined as 24-hour shifts where the assistant resides in the consumer's home) follow different overtime rules — they must be paid for at least 13 hours per 24-hour shift, with overtime applying after 44 hours in a week
• Spread-of-hours pay: If the assistant's workday spans more than 10 hours (even if they're not working the entire time), they may be entitled to an additional hour at minimum wage
• Tax withholding: PPL handles federal and state income tax withholding, Social Security, and Medicare contributions

The minimum for a full-time CDPAP personal assistant working 40 hours per week in New York City comes to approximately $40,872 annually before overtime.

What the Caregiver Role Involves

Being a paid CDPAP assistant is a real job with real obligations. The family member is expected to:

• Provide authorized services — personal care (bathing, dressing, feeding, toileting, transferring), medication administration, light housekeeping, meal preparation, and any skilled tasks delegated by the consumer or their representative
• Submit timesheets accurately through PPL's electronic portal — late or inaccurate timesheets delay payment
• Maintain reliable attendance — the consumer depends on the assistant for health and safety needs. Unexcused absences can jeopardize the consumer's CDPAP authorization
• Cooperate with the MLTC plan — the plan's care manager may conduct periodic check-ins to verify that services are being delivered as authorized

The advantage of having a family member in this role is significant: they know the parent's preferences, they understand the daily routine, they can communicate in the parent's language, and they're motivated by more than a paycheck. The advantage for the family member is equally real — compensation for work they may already be doing, plus access to workers' compensation coverage if they're injured during caregiving.

The New York Power of Attorney & Guardianship Kit covers the legal authority documents needed to enroll a parent in CDPAP when they can't self-direct — including the designated representative appointment and the POA modifications required for Medicaid applications.

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