Choosing CDPAP or agency care in Manhattan, and appealing a cut in hours

Manhattan is New York County, and writing "Manhattan" in a county box is the most common paperwork error in the borough. Medicaid is administered by HRA citywide, the state's single fiscal intermediary handles every CDPAP consumer from Inwood to the Battery, and fair hearings run through the state. What is different about Manhattan is density of institutions: HRA's Medicaid offices, NYC Aging's main HIICAP unit, and a PPL appointment location are all inside the borough, so Manhattan families are more likely than others to walk in somewhere instead of calling.

Manhattan's Medicaid home care population lives in public housing on the Lower East Side and in East Harlem, in rent-stabilized buildings on the Upper West Side, and in the multigenerational apartments of Washington Heights and Chinatown. This hub is for the caregiver deciding whether to become a paid CDPAP personal assistant, the consumer weighing CDPAP against an agency aide, and the household that opened a notice cutting hours.

On the caregiver question, the Department of Health rule is that a personal assistant may be a friend or relative other than the consumer's spouse, designated representative, or the parent of a consumer under 21. A parent of an adult consumer, a son or daughter, and a son-in-law or daughter-in-law generally can serve (DOH comparison chart). Manhattan's specific wrinkle is the designated representative: in households where the consumer has dementia and an adult child is running everything, that child cannot be both the designated representative and the paid personal assistant. Decide which role each relative will hold before registration.

Medicaid eligibility and renewals go through the HRA Medicaid Helpline. Consumers on fee-for-service Medicaid get personal care and CDPAP authorizations from HRA's Home Care Services Program through the DSS OneNumber (718-557-1399) and its Home Care CASA offices. Managed long term care members get assessments and authorizations from the plan; New York Medicaid Choice (1-800-505-5678, TTY 1-888-329-1541) is the state's plan-enrollment line and cannot change your hours.

Every CDPAP consumer must register with Public Partnerships LLC (PPL), the statewide fiscal intermediary designated by the Department of Health (health.ny.gov/cdpap). The DOH consumer resources document lists a PPL appointment office in Manhattan; check pplfirst.com or health.ny.gov/cdpap before traveling.

When hours are cut, managed care members generally file a plan appeal first. Filing within 10 days of the notice date (or the effective date, whichever is later) keeps services unchanged while the plan reviews. After the plan's final decision there are 120 days to request a state fair hearing, but services continue during the hearing only if the hearing is requested within 10 days of that final decision (DOH, February 2018 guidance). Fee-for-service consumers request the fair hearing directly, generally within 60 days of the notice, with aid to continue if requested before the effective date or within 10 days of mailing, whichever is later (DOH GIS 25 MA/07). Request it through OTDA (online at otda.ny.gov/hearings, by phone, fax, or mail; the current channels are on that page).

What the fiscal intermediary typically asks a Manhattan relative to bring. 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 consumer and personal assistant.
• The consumer's Medicaid ID and the current service authorization from HRA or the plan.
• The name of the designated representative, if any, since that person cannot be the paid personal assistant.

Orientation only: NYC Health + Hospitals / Bellevue, NYC Health + Hospitals / Harlem, NYC Health + Hospitals / Gouverneur on the Lower East Side, and NewYork-Presbyterian/Columbia in Washington Heights. Mount Sinai Hospital, Lenox Hill Hospital, and NewYork-Presbyterian/Weill Cornell anchor the East Side. None of these names says which home care path is right; they tell a counselor where you are.