I. The Consumer Directed Personal Assistance Program (“CDPAP”) will undergo major changes. 

Currently over 600 companies act as Fiscal Intermediaries (FIs) for the CDPAP program.  These FIs assist people who hire Personal Assistants (“PAs”) through the CDPAP program, by handling payroll and benefits.  FIs sometimes also help consumers find and train Personal Assistants.  These intermediaries are often small, local companies.  FIs are under contract with, and are paid by, Medicaid Long Term Care (“MLTC”) plans, mainstream managed care plans, and local Departments of Social Services that authorize CDPAP services.

Now the NYS Department of Health will be required to contract with a single Fiscal Intermediary – and that intermediary must already be operating in another state as a statewide FI.  That single FI will subcontract with a small number of existing FI programs.  By April 1, 2025, all 200,000 CDPAP consumers and their PAs will be transitioned to the new SINGLE FI or one of their few subcontractors, and ALL other FIs must stop operating.

That means that whichever FI is chosen, and its few subcontractors, are likely not to have a local presence in many of the parts of the state, and consumers who hire Personal Assistants will be dealing with a huge corporation rather than a small, responsive service provider.  This will eliminate almost all choice, as well as competition, from the current 600 providers.

II. CDPAP Personal Assistants may have new training requirements

The new law authorizes the Department of Health to adopt regulations “to carry out the objectives of the program including … training requirements for PAs.”  Currently, the consumer or their representative trains the PAs, and no outside training is required.  CDPAP PAs are then able to perform numerous critical tasks that long-term care aides are not permitted to perform.  These tasks include assisting patients with taking medications, injecting insulin, administering oxygen, and other duties that would otherwise require the costly services of a nurse. 

If additional training is required, this obligation will discourage potential candidates from becoming PAs.  These important workers are already in short supply: fewer PAs will mean it will take longer – or it might be impossible – to find an assistant.

III. Cuts to Medicaid that are still scheduled to occur:

• 30-Month Look back for Community Medicaid Services

The 30-month “look back” and transfer penalty for Community Medicaid services, which was enacted but which was delayed due to COVID, was not repealed.  This measure is scheduled to be implemented in 2025.  Implementation will delay or effectively deny home care services that are crucial to enable people to remain in their homes as long as possible.

This complicated change will be a nightmare to implement.  The look back will impose a penalty period for transfers made in the 30 months prior to a person applying for Community Medicaid services (these services include paying for some Assisted Living residences).  There is currently no look back.

• Three ADL Requirement

Currently, disabled people who require assistance with two Activities of Daily Living (“ADLs”) qualify for Community Medicaid services (if financial eligibility is achieved).  Implementation of this measure will require that people need assistance with three ADLs before they are eligible. 

This increased requirement will make it far more difficult for seniors in declining health to access Medicaid services.  In addition, the New York Legal Assistance Group states that this “will deny Medicaid home care illegally to Those With Vision Impairments, Intellectual & Developmental disabilities, Traumatic Brain Injuries, and many other disabilities.”  This requirement will go into effect in Fall 2024 if not repealed.

The New York State Bar Association, New York Legal Assistance Group, and the National Association of Elder Law Attorneys are all fighting to repeal this harmful legislation.  Our firm will support their efforts.

Ongoing changes to New York State’s long-term care regulations mean that it is more important than ever for anyone over 65, or earlier if you have health issues, to consult with an experienced Elder Law attorney.  The sooner you take action, the more long-term care planning can help you.  During a consultation with our firm, our attorney will explore your situation, thoroughly explain your options, and enable you to decide for yourself what plan makes the most sense for you.  

The most effective planning occurs before you have a need for long-term care, but planning can still have enormous benefits even if undertaken later.  Don’t hesitate to call – a consultation will provide you with important information and can give you priceless peace of mind.

More information on all of the CDPAP changes is available at this link: Drastic CDPAP Changes and other Medicaid Outcomes of Final NYS 24-25 Budget - New York Health Access (wnylc.com)