The short version
New York Medicaid pays for help at home in two main forms. Personal care services (PCS) means an aide, sometimes called a home attendant, employed by a licensed home care agency. The Consumer Directed Personal Assistance Program (CDPAP) means a personal assistant whom the consumer chooses, hires, trains, and supervises, with a fiscal intermediary handling payroll. The Department of Health’s comparison chart says the goals of both programs are the same, to help consumers stay independent and remain at home, but “the types of services that can be provided and who can provide these services are different.”
Neither program is better. They fit different households, and this page is about telling which is which.
What is the same in both programs
- Both require Medicaid.
- Both require an assessment showing a need for help with daily activities. Since September 1, 2025, the Department’s Minimum Needs Requirements apply to adults 21 and over at initial assessment and reassessment. People already authorized as of that date continue under the previous criteria, which the Department calls Legacy Status.
- Both are authorized by the same decision-maker: a Managed Long Term Care plan for most adults, or the local district (in New York City, HRA’s Home Care Services Program) for people not in a plan. The number of hours comes from that authorization in both programs.
What is different
Who the caregiver is
Under PCS, the agency selects, employs, trains, and supervises the aide, and the Department’s fact sheet notes the aide “may be terminated without your consent.” Under CDPAP, the consumer selects the assistant, who may be a friend or family member “as long as they are not the Medicaid member’s spouse, their designated representative or the parent of a CDPAP consumer under the age of 21.” The Department’s chart names a parent of an adult consumer, a son, daughter, son-in-law, or daughter-in-law as examples of allowed relatives, and its administrative directive (11 OHIP/ADM-6) also describes other adult relatives, including one who lives with the consumer when the care needs make that presence necessary.
Who the employer is
The Department’s fact sheet is blunt: “A PCA is employed by a home care agency. A PA is employed by you.” The consumer, or a designated representative, is responsible for recruiting, hiring, training, supervising, and if necessary terminating the assistant; arranging back-up coverage; coordinating other services; keeping payroll records; and working with the fiscal intermediary. A consumer who cannot direct their own care can have a designated representative, an adult who makes those decisions on the consumer’s behalf, but that person cannot also be the paid assistant. If that list sounds like a job, that is the honest picture: self-direction is a responsibility, not just a benefit.
What tasks are allowed
A personal care aide works within the aide scope. The Department’s chart says a CDPAP assistant “is allowed to assist with taking health measurements such as temperature, pulse, blood pressure, sugar and glucose tests,” with “the self-administration of medications, and other services described as skilled nursing services,” under the consumer’s direction. For someone whose needs include those tasks, this difference can be the deciding one.
Training and health checks
Agency aides must complete training (minimum 40 hours) and competency evaluations. CDPAP assistants are trained by the consumer. Both must meet health requirements; Department guidance requires that each assistant’s health status be assessed before service delivery.
The statewide fiscal intermediary
In PCS the agency pays the aide. In CDPAP, the Department of Health designates Public Partnerships LLC (PPL) as the single statewide fiscal intermediary and states that all CDPAP recipients are required to work with PPL. It is named on this site only because the State designates it. The intermediary processes the assistant’s wages and benefits, handles tax and other withholdings, and keeps employment records. It does not decide who is eligible, how many hours are authorized, or the outcome of any appeal.
According to the Department’s “How to Register with PPL” guide, both the consumer and the assistant register with the intermediary: by phone at 1-833-247-5346 (TTY 1-833-204-9042), online through PPL@Home, through a community facilitator, or at an in-person session. The Department’s consumer packet lists appointment locations by borough; this site does not print addresses because they change. Check health.ny.gov/cdpap for the current list.
Switching between the two
A family can move from an agency aide to CDPAP, or the other way. The Department’s chart and fact sheet both warn that a switch requires a new authorization, including a new person-centered service plan and plan of care, and that this must be handled before switching “to prevent a gap in care.” If the same person moves from agency employment to CDPAP, “your caregiver will switch employers,” which affects their pay rate, benefits, and schedule. Nothing on this page can tell you what those numbers will be.
Questions to ask before deciding
- Is there a specific person we trust who is available, allowed under the Department’s rule, and willing to be employed by us rather than by an agency?
- Does the person who needs care, or a designated representative who is not the assistant, have the capacity and time to schedule, supervise, approve timesheets, and find back-up when the assistant is sick?
- Do the tasks involved include medication assistance or health measurements that an agency aide may not perform?
- If the person is currently receiving agency care, how will the new authorization be timed so there is no gap?
- Who authorizes the hours, the plan or HRA, and what is their process for a change of service type?
What this site will not claim
- That anyone “qualifies.” Only the plan or the local district authorizes CDPAP, and only after an assessment.
- How many hours will be approved, or when.
- What the assistant will be paid.
- That any agency, intermediary, or facilitator is better than another.
Free help
NY Connects (1-800-342-9871) can sort out which program applies, on Medicaid or not. HIICAP (1-800-701-0501) offers free counseling; say your county. ICAN (1-844-614-8800, TTY 711) is New York’s ombudsprogram for people with Medicaid who need long term care. In New York City, Medicaid is HRA (1-888-692-6116) and fee-for-service home care runs through the DSS OneNumber (718-557-1399). Plan enrollment questions go to New York Medicaid Choice (1-800-505-5678).
Questions about your own family’s situation?
NY Connects, New York’s free line for long-term services and supports. Free, any age, on Medicaid or not. They do not sell services. Relay 7-1-1
Sources
New York State Department of Health, Consumer Directed Personal Assistance Program page (revised May 2026); “Understanding the Differences Between CDPAP and PCS” comparison chart; “What to Know About: Differences Between CDPAP and PCS” fact sheet; 11 OHIP/ADM-6, CDPAP Scope and Procedures; “How to Register with PPL”; “CDPAP Resources for Consumers”; New Minimum Needs Requirements page; NYC HRA Long Term Care page; ICAN. Checked September 10, 2026. Confirm on health.ny.gov/cdpap, the DOH comparison chart, 11 OHIP/ADM-6, and icannys.org.
For a relative preparing to become a personal assistant, or a family choosing between CDPAP and agency care. Held by this site only, never passed to any agency, intermediary, trust, or attorney.