Isaac Prentice
May 13, 2026
For many individuals who depend on personal care assistance, the ideal arrangement is having someone they trust, ideally a family member, provide that care. The Consumer Directed Personal Assistance Program, known as CDPAP, is the most widely discussed program in the country that makes this possible through Medicaid funding.
This guide explains what CDPAP is, how it works, who qualifies, and what the implications are for both the care recipient and the family member who becomes a paid caregiver.
CDPAP (Consumer Directed Personal Assistance Program) is a New York State Medicaid program that allows individuals who need home care assistance to recruit, hire, train, and supervise their own personal assistants, including family members (with some exceptions). The care recipient or their representative acts as the employer of record, and the personal assistant is compensated through Medicaid funding via a fiscal intermediary. CDPAP is one of the most comprehensive consumer-directed home care programs in the United States.
CDPAP fundamentally restructures the typical home care model. Rather than a home care agency assigning an aide to a client, the care recipient takes control of who provides their care and how.
The key parties in CDPAP:
The consumer (care recipient):
The Medicaid-eligible individual who needs home care. They must be able to either direct their own care or have a designated representative (such as a family member with legal authority) who can do so on their behalf. The consumer or representative is considered the employer of record.
The personal assistant (PA):
The individual hired by the consumer to provide care. This can be a family member, friend, neighbor, or anyone chosen by the consumer. The personal assistant cannot be the consumer’s legally responsible relative (spouse or designated representative) in most circumstances.
The fiscal intermediary (FI):
A Medicaid-authorized organization that handles the administrative and financial aspects of the employment relationship: payroll, taxes, workers’ compensation, and benefits for the personal assistant. The consumer directs the care but the FI handles the paperwork.
The care recipient must:
The personal assistant must:
CDPAP has relatively lower formal training requirements for personal assistants compared to many other home care programs, which is part of what makes it accessible for family members who are already providing informal care.
CDPAP personal assistant wages are set by the fiscal intermediary and reflect the Medicaid reimbursement rates for New York City and surrounding counties. As of recent data, CDPAP rates range from approximately $17 to $21 per hour in the New York City metro area, making it one of the highest-paying personal care aide programs in the country.
Rates outside the NYC metro area are somewhat lower but still competitive with standard home care agency wages.
CDPAP is specific to New York, but most states have their own consumer-directed or self-directed care programs through Medicaid HCBS waivers that operate on similar principles. Names vary by state:
| State | Program name |
| California | IHSS (In-Home Supportive Services) |
| Texas | CFC Option / STAR+PLUS consumer directed services |
| Pennsylvania | Participant-Directed Option under ODP waivers |
| Ohio | SELF waiver / PASSPORT waiver consumer direction |
| Florida | iBudget consumer direction |
| Illinois | Self-Directed Services under DHS programs |
For a broader overview of how these programs work nationally, read our guide on Medicaid waiver programs: getting paid as a family caregiver.
Can a spouse be a CDPAP personal assistant?
Generally no. Most consumer-directed programs, including CDPAP, exclude legally responsible relatives (spouses and parents of minor children) from serving as paid personal assistants. Adult children, siblings, and other non-spousal family members are typically eligible.
Does a CDPAP personal assistant need formal certification?
CDPAP has lower formal training requirements than many other programs. However, personal assistants who wish to strengthen their application, demonstrate professional competence, or eventually work in other home care contexts benefit significantly from completing a formal training program such as NCOOA’s PCA or HHA course.
What happens if the care recipient’s needs change?
The care recipient can request a reassessment to adjust the number of approved hours or the scope of care. Changes in the consumer’s medical condition that require skilled nursing tasks beyond the personal assistant’s scope may require supplemental professional services.
Can CDPAP personal assistants work for multiple consumers?
Yes. A personal assistant can work for multiple CDPAP consumers, which increases their total hours and income. Scheduling is managed independently between the PA and each consumer.
Whether you are a family member entering CDPAP or a consumer-directed program for the first time, or a personal assistant looking to add credentials that increase your value and employment options, NCOOA’s online caregiver training programs are an accessible and professional way to get there.
