CDPAP, agency home care, and family caregivers in the Bronx

The Bronx is Bronx County on every Medicaid form, and Medicaid here is run citywide by the NYC Human Resources Administration (HRA), not by a county office. The rules for the Consumer Directed Personal Assistance Program (CDPAP) are state rules, so a family in Co-op City and a family in Mott Haven work with the same single statewide fiscal intermediary and the same fair hearing system. What is local is the help: two NYC Aging counseling sites and many households where the person receiving care speaks Spanish and the person filling out forms does not.

This hub is for three kinds of Bronx households. The first is a family caregiver, often a daughter or grandson, who is already doing the work and wants to know whether Medicaid can pay them through CDPAP. The state Department of Health says a personal assistant can be a friend or relative as long as they are not the consumer's spouse, designated representative, or the parent of a consumer under 21. Adult children, in-laws, and a parent of an adult consumer generally can serve (DOH comparison chart).

The second is a consumer, or the person helping them, who has been offered a choice between CDPAP and agency personal care services (PCS) and does not understand the difference. Under CDPAP the consumer hires, trains, and supervises the worker; under PCS an agency does. Switching later means a new authorization and plan of care.

The third is anyone in the Bronx whose Medicaid home care hours were reduced or ended and who has a notice in hand. That is a rights question with deadlines, covered below.

Medicaid eligibility, renewals, and address changes for Bronx residents go through the HRA Medicaid Helpline, the same number used in the other four boroughs. If the consumer is on fee-for-service Medicaid (not in a managed long term care plan), personal care and CDPAP authorizations come from HRA's Home Care Services Program, reached through the DSS OneNumber at 718-557-1399, which also lists Home Care CASA office locations. If the consumer is in a managed long term care plan, the plan does the assessment and authorization, and New York Medicaid Choice (1-800-505-5678, TTY 1-888-329-1541) is the state's official line for plan enrollment questions.

Every CDPAP consumer in the state, including the Bronx, must register with Public Partnerships LLC (PPL), which the Department of Health designates as the single statewide fiscal intermediary (health.ny.gov/cdpap). The DOH consumer resources document lists a PPL appointment location in the Bronx; check pplfirst.com or health.ny.gov/cdpap for the current list.

Fair hearings are statewide. When hours are cut, a managed care member generally files a plan appeal first and then may request a state fair hearing through the Office of Temporary and Disability Assistance (OTDA). Fee-for-service consumers request the hearing directly. Either way, the request goes through OTDA (online at otda.ny.gov/hearings, by phone, fax, or mail; the current channels are on that page).

What the statewide fiscal intermediary typically asks for when a Bronx family member registers as a personal assistant. The current list is on health.ny.gov/cdpap and in the DOH "How To Register With PPL" document.

• Government photo ID and proof of eligibility to work in the United States, for the employment forms the fiscal intermediary processes.
• A health assessment. DOH requires that each personal assistant's health status be assessed before service delivery (11 OHIP/ADM-6, citing 10 NYCRR 766.11).
• PPL registration for both the consumer and the personal assistant.
• The consumer's Medicaid ID and the current service authorization from HRA or the plan, so the fiscal intermediary knows how many hours it may pay.
• A phone or computer for timekeeping; the consumer, not the family member, approves the hours.

Orientation only, never a recommendation: Montefiore Moses in Norwood, NYC Health + Hospitals / Jacobi near Pelham Parkway, NYC Health + Hospitals / Lincoln in Mott Haven, and BronxCare on the Grand Concourse.