Applying for CDPAP in Erie or Niagara County: A Walkthrough, Including the 2025 Fiscal Intermediary Change

New York's Consumer Directed Personal Assistance Program lets Medicaid recipients hire their own caregiver, often a family member. Here's how the program actually works, and what changed with its 2025 statewide fiscal intermediary transition.

By the Buffalo Senior Advisor Care Team · September 24, 2026

What CDPAP Actually Is (and Isn't)

The Consumer Directed Personal Assistance Program (CDPAP) is a New York Medicaid self-direction option that lets a Medicaid recipient — or their representative — hire, train, and directly supervise their own personal assistant, rather than being assigned an aide from a home care agency's roster. For families in Erie and Niagara counties, this is often the single most appealing Medicaid home care option, precisely because it lets a family choose who provides care, sometimes even a family member, instead of accepting whoever an agency happens to send.

It's worth being precise about what CDPAP is not: it is not a nursing home diversion waiver like the Nursing Home Transition and Diversion (NHTD) program, and it is not the same as a standard home health aide arranged through an agency. CDPAP is specifically a self-direction model for personal care and home health aide-level tasks, administered under New York's Department of Health, where the responsibility for recruiting, training, and supervising the aide sits with the consumer or their representative, not an agency care manager.

Who Can Be Hired as the CDPAP Aide

This is one of the most common questions families ask, and the rule is specific: a Medicaid recipient under CDPAP can hire most friends or family members as their paid personal assistant, but not a spouse, and not the recipient's own legally designated representative (the person acting on their behalf for the program, if one is needed). This distinction matters for a lot of Buffalo-area families where an adult child is helping a parent apply for CDPAP — that adult child can often be hired as the paid aide, but cannot simultaneously serve as both the paid caregiver and the recipient's official representative under the program.

Because these specific eligibility rules for who can and cannot be hired are exactly the kind of detail the state updates periodically, confirm current requirements directly through health.ny.gov's CDPAP program page or your county's Medicaid unit before assuming a specific family member arrangement is allowed.

Eligibility: Medicaid, Level of Care, and the UAS-NY Assessment

To access CDPAP, a person generally needs to be Medicaid-eligible under New York's aged/blind/disabled (non-MAGI) rules — a different eligibility pathway than the state's broader Medicaid expansion for younger, low-income adults — and be assessed as needing a nursing-home level of care using New York's Uniform Assessment System (UAS-NY). This assessment step is the same tool used across several of New York's long-term-care programs, not something unique to CDPAP.

Because current income and asset limits for this Medicaid pathway change periodically and were not independently confirmed as specific dollar figures for this guide, confirm exact current thresholds directly with a NY Medicaid caseworker or an elder-law attorney before assuming your family member qualifies financially. Functional eligibility (the level-of-care assessment) and financial eligibility (Medicaid enrollment under the aged/blind/disabled rules) are both required, and neither substitutes for the other.

How to Start an Application in Erie or Niagara County

The practical starting point for most Buffalo-metro families is the same regardless of which program within New York's long-term-care system eventually fits best: contact your county's Department of Social Services Medicaid unit, or NY Connects, the state's public no-wrong-door long-term-care information and assistance program. In Erie County, NY Connects is reachable through the Erie County Department of Senior Services at (716) 858-8526. Niagara County residents should contact their own county's Department of Social Services directly to begin a Medicaid application and level-of-care assessment.

Because CDPAP is administered through Medicaid managed care in many cases, families whose relative is dual-eligible for Medicare and Medicaid should also expect the conversation to touch on Managed Long Term Care (MLTC) enrollment, since MLTC plans are one of the pathways through which CDPAP services are often authorized and coordinated for people needing more than 120 days of community-based long-term care.

The 2025 Fiscal Intermediary Transition — What Changed and Why It Matters

This is the part of CDPAP that has changed the most recently, and it's worth understanding before assuming anything you've heard about the program from a year or two ago still applies. Starting in 2025, New York consolidated CDPAP's fiscal intermediary administration — the entity that actually processes payroll, taxes, and paperwork for the consumer-hired aide — into a single statewide fiscal intermediary, Public Partnership LLC, replacing the prior network of hundreds of local fiscal intermediaries that had operated across the state.

This is a significant operational shift, not a cosmetic one: families who had an established relationship with a local fiscal intermediary may have needed to transition their paperwork, payroll setup, and aide records to the new statewide administrator. New York's own health department has published consumer guidance during this transition period specifically because of confusion and, in some cases, misleading information coming from displaced local intermediaries trying to retain business. Given how actively this is still evolving, treat any specific procedural detail about the transition as fast-moving, and go directly to health.ny.gov's CDPAP page for the current, authoritative process rather than relying on a local intermediary's own marketing materials.

How CDPAP Fits Alongside Other New York Programs

CDPAP is one piece of a broader set of New York long-term-care programs, and it's easy to conflate them. The Assisted Living Program (ALP) is a different track entirely — a Medicaid State Plan service delivered inside a licensed Adult Home or Enriched Housing Program, not a self-direction option for in-home care. The Nursing Home Transition and Diversion (NHTD) waiver is also distinct — a 1915(c) HCBS waiver focused on transitioning people out of, or helping them avoid, nursing homes, and it explicitly excludes anyone already living in an ALP or other licensed congregate care setting.

For a family choosing between these options, the practical dividing line is usually the care setting: CDPAP fits a person who wants to remain at home and direct their own care using a hired aide; ALP fits someone ready to move into a licensed Adult Home or Enriched Housing Program setting; and NHTD fits someone who wants a broader package of community-transition supports (home modifications, assistive technology, care management) beyond just a hired personal aide.

Common Points of Confusion

Families sometimes assume CDPAP means Medicaid will simply "pay a family member to be a caregiver" with no further structure — in practice, the hired aide is still an employee, on payroll through the fiscal intermediary, subject to standard employment paperwork, timesheets, and tax withholding, just directed by the consumer rather than an agency. Others assume any relative can be hired; remember the specific exclusions for a spouse and for the recipient's own designated representative.

It's also worth clarifying with your Medicaid caseworker whether your family member's specific coverage pathway (straight Medicaid fee-for-service versus an MLTC plan) affects how CDPAP hours are authorized and reviewed, since this can differ based on which pathway applies.

Where to Get Current, Authoritative Information

Given how much has changed operationally with CDPAP since 2025, the single best move for a Buffalo-area family is to start at health.ny.gov's official CDPAP page rather than a secondhand summary, a local intermediary's marketing site, or an outdated article. From there, contact your county's Medicaid unit or NY Connects — (716) 858-8526 for Erie County — to begin the actual eligibility assessment and application process. For a broader look at how CDPAP fits alongside New York's other Medicaid long-term-care programs, see our state rules guide.

Common Questions