Consumer Directed Personal Assistance Program New York: CDPAP for Dementia Families

How CDPAP Works for Dementia Families

The Consumer Directed Personal Assistance Program allows Medicaid-eligible New Yorkers to recruit, hire, train, and supervise their own home care aides — known as Personal Assistants (PAs). The program's most significant feature: the PA can be an adult child, relative, or friend, which means your family can receive Medicaid funding to care for your parent directly.

For dementia families, CDPAP is often the preferred option over agency-based home care because it allows a familiar person — someone who knows your parent's routines, triggers, and communication patterns — to provide daily care rather than a rotating roster of agency aides.

The Designated Representative Role

When a Medicaid recipient has dementia and cannot self-direct their care, a Designated Representative (DR) must be appointed. The DR takes on the consumer's management responsibilities: hiring the PA, setting schedules, training them on the parent's specific needs, supervising the care, and handling timekeeping and payroll submissions.

Key restrictions on who can serve in which roles:

• The DR cannot also be the paid PA. These must be two different people.
• A spouse cannot be hired as a PA.
• A legal guardian can serve as the paid PA, but only if a separate, qualified person is appointed as the DR.
• An adult child can be the paid PA as long as someone else serves as the DR.

In practice, many dementia families set up the arrangement like this: one adult sibling becomes the Designated Representative (managing the program), and another sibling or a trusted relative becomes the paid Personal Assistant providing daily care.

The PPL Transition: What Changed

Effective April 1, 2025, New York consolidated all CDPAP administrative, payroll, and billing operations under a single statewide Fiscal Intermediary: Public Partnerships LLC (PPL). This replaced over 600 local fiscal intermediary agencies that previously handled payroll, tax withholding, and compliance for CDPAP workers across the state.

All CDPAP recipients and their Personal Assistants must now be registered with PPL. The registration process includes enrollment paperwork, tax documentation (W-4, I-9), and compliance with electronic visit verification (EVV) requirements.

The PPL rollout has faced significant turbulence. In June 2026, the U.S. Department of Justice filed a federal lawsuit against PPL and several NYS Department of Health officials alleging fraud regarding PPL's operational readiness. In July 2026, a $162 million class-action settlement (Calderon v. PPL) resolved allegations that PPL failed to pay proper wages and routed downstate PAs into non-compliant health plans.

As of July 20, 2026, PPL terminated its PPL@Home timekeeping portal. All PAs must now submit time entries exclusively through the Time4Care mobile application or compliant telephony (call-in) systems. If your family's PA has been using the web portal, they need to switch immediately.

Qualifying for CDPAP with a Dementia Diagnosis

CDPAP eligibility follows the same clinical pathway as other Medicaid home care services — your parent must qualify through the NYIAP assessment process. For dementia families, the September 2025 Minimum Needs Requirements created an important distinction:

Under the standard criteria, new applicants need limited physical assistance with at least three ADLs. Under the dementia exception, supervision, cueing, or prompting with at least two ADLs qualifies. Physical maneuvering is not required.

To activate the dementia exception, form DOH-5821 (Alzheimer's Disease and Dementia Diagnosis Verification) must be completed by an MD or DO and submitted to the NYIAP nurse before or during the Community Health Assessment. Without this form, your parent is evaluated under the stricter standard criteria rather than the dementia exception.

Once approved, the MLTC plan or local Department of Social Services authorizes a specific number of weekly CDPAP hours based on the assessment results and the Person-Centered Service Plan.

What the PA Job Actually Looks Like

A CDPAP Personal Assistant provides the same types of care an agency home health aide would, but with more flexibility:

• Assistance with ADLs — bathing, dressing, grooming, toileting, eating, mobility
• Medication reminders and administration
• Meal preparation and feeding assistance
• Light housekeeping related to the recipient's care
• Accompanying the recipient to medical appointments
• Safety supervision — particularly critical for dementia, where wandering, stove use, and fall risk require constant awareness

PAs are required to complete a health assessment and any training determined necessary by the consumer or DR. Unlike agency aides, CDPAP PAs are not required to hold home health aide certification — the program is designed to enable non-professional caregivers to serve in the role.

The PA is paid through PPL based on the authorized hours, with wages varying by region. PAs must comply with EVV — clocking in and out through the Time4Care app or telephony system — and PPL handles payroll, tax withholding, and workers' compensation insurance.

The New York Dementia & Memory Care Guide includes the full CDPAP enrollment workflow, designated representative setup instructions, and PPL registration steps — along with a tracking log template for EVV compliance.

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