Unlocking Care: Eligibility Requirements for NY's Consumer Directed Program

Key Eligibility Criteria for NY's CDPAP Program

New York's Consumer Directed Personal Assistance Program (CDPAP) allows chronically ill or physically disabled individuals greater freedom in choosing their home care. Unlike traditional agency-based care, CDPAP enables participants to hire, train, schedule, and set wages for their own home health aides.

New York's CDPAP program requires prospective participants to meet criteria in three key areas:

Health Status and Disability Requirements

To enroll in CDPAP, an individual must have a chronic medical condition or disability that impacts at least one "activity of daily living" (ADL). ADLs include:

• Bathing and grooming
• Dressing and changing clothes
• Eating
• Transferring/moving around
• Toileting and managing bladder/bowel requirements

Most participants must need help with at least two of these daily tasks. However, those requiring extensive assistance with just one ADL may still qualify in some cases.

In addition to ADL impairment, CDPAP requires that the disability:

• Be expected to last at least 120 days
• Prevent independent performance of ADLs
• Require the health services of a private duty nurse or home health aide

Those whose need for assistance is short-term do not qualify for services under Consumer Directed Personal Assistance.

Medicaid Eligibility Rules

Since CDPAP is funded by Medicaid, participants must be enrolled in Medicaid and have a qualifying chronic condition or disability documented by their doctor. Medicaid eligibility depends on:

• Having income below a certain threshold
• Meeting asset limits in savings and property
• Residency status
• Age (over 65 or declared disabled by Social Security/Medicare)

Those enrolled in Original Medicare or Medicare Advantage Plans do not automatically qualify for CDPAP on that basis. One must be specificallysigned up for New York State's Medicaid program.

Residential Status Requirements

To receive services under CDPAP, an individual must reside in a private house, apartment, assisted living facility, or other community-based setting. Nursing home residents are not eligible.

Additionally, some supportive housing facilities do not permit CDPAP aides. So residence requirements depend in part on the policies of one's care home or apartment building. Those in hospitals, rehabilitation centers, or prisons cannot access services either.

Step-by-Step Guide to Assessing Your Eligibility

Wondering if you or a loved one may qualify for CDPAP? Here is a step-by-step guide to gauging your eligibility:

Step 1: Evaluate Your ADL Impairment

Make a list of all "activities of daily living" that require assistance. As noted above, ADLs cover bathing, dressing, eating, mobility/transferring, and toileting. If you need extensive help with just one of these tasks or moderate help with two or more, you may meet the disability requirement.

Step 2: Confirm That Your Disability Will Last 120+ Days

CDPAP only assists those whose need for care will extend at least 120 days. So your medical team must confirm that your condition is long-term. Temporary illnesses or injuries do not qualify.

Step 3: Check Your Medicaid Status

Applying to Medicaid can take 45-90 days, so check on your status as early as possible. To enroll in CDPAP, you must have active Medicaid insurance under New York State's coverage guidelines. Verify that services are in place.

Step 4: Evaluate Your Living Situation

Remember, only those residing at home, in an apartment/condo, or in an assisted living community can utilize CDPAP. If you live independently or in a compliant housing facility, you meet this requirement.

Step 5: Have Your Doctor Verify and Document Your Disability

Finally, your physician must formally document your need for extensive/frequent home health services related to an impairment in ADLs. This written verification is required during the application process.

By evaluating these five eligibility areas, you can determine if CDPAP is an option in your home care journey.

Applying for Consumer Directed Personal Assistance

If initial self-screening indicates you may qualify for CDPAP, the next step is starting the formal application process. submission instructions vary by New York county and borough. However, there are two main channels:

1. Local Departments of Social Services - Each county and borough has an office that oversees benefits access. Visit or call yours to begin your CDPAP application.
2. Independent Living Centers - These nonprofits help connect individuals to CDPAP and other disability/health programs. Use this directory to find one near you.

When applying, have the following documentation ready for submission:

• Physician's order verifying need for home health services
• Records demonstrating Medicaid enrollment
• Identification documents (birth certificate, NY State ID, etc)
• Proof of residence

The approval process involves assessment by a registered nurse, after which a formal determination will be made regarding your eligibility for Consumer Directed Personal Assistance.

Using CDPAP Services Effectively

Once enrolled in CDPAP, participants can hire and supervise their own home health aides, rather than using agency-contracted assistants. This allows greater control, flexibility, and continuity in one's care.

However, managing services effectively also requires understanding program requirements and resources. Key pointers include:

Hiring Considerations

• Aides must undergo background checks and meet basic qualifications
• Wage minimums may apply depending on county/jurisdiction
• Personality match and care philosophy should align

Utilization Reminders

• CDPAP covers personal care only, not medical services or household tasks
• Services must be provided in a community setting (not nursing facilities)
• Hour limits exist depending on one's Medicaid plan

Ongoing Management

• As the employer, the participant handles scheduling, training, and firing
• Fiscal Intermediaries can assist with payroll, taxes, and administrative burdens
• Back-up aide networks must be arranged to cover emergencies

Learning these parameters helps participants access CDPAP's unique benefits while following program rules.

FAQs

Can family members get hired as aides under CDPAP?

Yes, participants can choose relatives (except spouses), friends, or other acquaintances to serve as home health aides if they meet qualification standards. However, family member wages may be capped based on relation/role.

What options exist for seniors who need care 24/7?

For those requiring round-the-clock care, CDPAP offers two options:

1. Hire separate aides to cover morning, afternoon, evening, and overnight
2. Utilize a live-in aide

By tailoring schedules creatively through CDPAP, constant assistance is possible.

Can CDPAP provide transportation to medical appointments?

No, CDPAP only covers personal care and related tasks inside the home setting. For help getting to health appointments and procedures, participants can utilize Medicaid's transportation services.

What happens if a CDPAP aide calls out sick?

Participants must set up emergency back-up aide systems to fill gaps from call-outs. Having contact info handy for 2-3 alternative assistants prevents lapses in care.

Exploring these and any other questions you may have will lead to deeper insight on using your CDPAP benefits effectively after enrolling.

CONCLUSION

New York's Consumer Directed Personal Assistance Program presents a life-changing opportunity for those requiring extensive home health support. By choosing their own providers, participants gain greater authority over the care journey.

However, unlocking access requires clearing certain eligibility hurdles related to health status, insurance coverage, residence, and disability documentation. This guide outlines key criteria to evaluate in assessing if CDPAP is right for your situation.

By understanding requirements, navigating application channels, and utilizing resources correctly, the chronically ill and disabled can take advantage of enhanced independence and flexibility. With the door unlocked to self-directed assistance, new possibilities open in managing personal wellness.

SOURCES

1.https://freedomcare.com/cdpap-regulations

2.https://www.googleadservices.com

3.https://nyhc.com/cdpap-eligibility

4.https://www.cdchoices.org/cdpap-requirements-for-ny