Staten Island home care choices, CDPAP personal assistants, and hearing rights

Staten Island is Richmond County, and it is the one borough where families routinely assume the rules are different because everything else feels different: fewer buses, more houses, and a ferry between them and the agencies. They are not. Medicaid is administered by HRA citywide, CDPAP runs on state rules with one statewide fiscal intermediary, and fair hearings go through the state. The practical differences are real: one NYC Aging counseling site for the whole borough, long travel to any appointment, and caregivers who are mostly adult children driving between their own homes and a parent's house.

Staten Island's home care households skew toward homeowners on the Mid-Island and South Shore who have aged in place, plus renters and public housing residents on the North Shore around St. George and Stapleton. Because of the distances, a relative often ends up doing the care, which is why the CDPAP question comes up so often: can the daughter in Great Kills who already drives to Eltingville every day be paid?

The Department of Health's answer is that a personal assistant may 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, sons-in-law, and daughters-in-law generally can serve; a relative who lives in the same house can serve when the amount of care makes their presence necessary (11 OHIP/ADM-6). How many hours are authorized is decided by the assessment, and no page can promise it.

The second group is consumers comparing CDPAP with agency personal care services. Here the honest comparison includes travel: an agency aide has to get there, while a CDPAP personal assistant is usually nearby. Against that, CDPAP puts scheduling, training, and back-up coverage on the consumer, and back-up is hard when the only other relative lives in New Jersey. Switching later requires a new authorization and plan of care.

Medicaid eligibility and renewals for Richmond County residents go through the HRA Medicaid Helpline; HRA's Staten Island office location is on nyc.gov/hra. Fee-for-service consumers get personal care and CDPAP authorizations through HRA's Home Care Services Program, reached by the DSS OneNumber (718-557-1399). 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 official plan-enrollment line.

Every CDPAP consumer on the island 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 no PPL office on Staten Island; phone and online registration are the practical route, and PPL also lists facilitators and in-home appointments (check pplfirst.com or health.ny.gov/cdpap).

Fair hearings are requested through the state Office of Temporary and Disability Assistance regardless of borough. Managed care members generally file a plan appeal first (within 10 days of the notice date or the effective date, whichever is later, to keep services unchanged), and then have 120 days from the plan's final decision to request a fair hearing, with aid continuing only if requested within 10 days of that decision. Fee-for-service consumers generally have 60 days from the notice, with aid to continue if the request is made before the effective date or within 10 days of mailing, whichever is later. Request it through OTDA (online at otda.ny.gov/hearings, by phone, fax, or mail; the current channels are on that page).

Typically requested when a Staten Island relative registers with the statewide fiscal intermediary. 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 each personal assistant's health status to be assessed before service delivery (11 OHIP/ADM-6, citing 10 NYCRR 766.11).
• PPL registration for both consumer and personal assistant, by phone or online since no island office is listed.
• The consumer's Medicaid ID and the current service authorization from HRA or the plan.
• A back-up plan; the consumer must arrange back-up coverage, which here means naming a second relative early.

Orientation only: Staten Island University Hospital North in Ocean Breeze and South in Prince's Bay, Richmond University Medical Center in West Brighton, and the Staten Island Ferry terminal and Borough Hall in St. George, where most public offices on the island cluster.