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History of New York’s Consumer Directed Personal Assistance Program (CDPAP)

The Consumer Directed Personal Assistance Program (CDPAP) is a New York State Medicaid program benefiting elderly and disabled individuals with stable medical conditions, by giving them the freedom to hire, train, and manage their own personal care assistants. While the program officially started serving consumers under the “CDPAP” name in 1995, its roots go back nearly two decades before that.

Until the late 1970s, patients receiving benefits to help them manage severe disabilities had few options as to the care they were given. They could be placed in institutions, which suffered from overcrowding and other poor conditions, or have their home care dictated, staffed, and run by a state-approved agency. Neither option gave patients much choice, independence, or dignity in directing their own care based on their needs and preferences (for instance, being cared for by a close friend or relative).

Then, in 1977, a group of individuals being served by existing home attendant services founded Concepts of Independence for the Disabled (later shortened to Concepts of Independence) in order to advocate and lay groundwork for allowing people with disabilities to control how and from whom they received care. Not long after, a group of citizens in wheelchairs staged a protest at the (now defunct) New York City Board of Estimate, resulting in the formation of a task force aimed at creating better state-sponsored solutions for disabled individuals’ self-directed care.  

In 1979, that task force moved forward the Client Maintained Home Attendant Plan, which split the responsibilities of overseeing care between the patients/consumers and an agency. Within the next few years, the number of people enrolled in the program through Concepts of Independence grew exponentially.

The New York State Department of Health began managing the home care program in 1992, and launched the Patient Managed Home Care Program demonstration project to determine what changes might have a positive and cost-saving impact. The successful Patient Managed Home Care Program was renamed the Consumer Directed Personal Assistance Program (CDPAP) in 1995.

By 1999, program participants numbered over 1000. Three years later, over 75% of county Medicaid offices had established CDPAP services. And by 2008, the number of enrolled statewide recipients had increased again by 60%.

As participation climbed, making the CDPAP the second-fastest growing community-based program of its kind, the New York State Department of Health approved grant funding for an outreach and expansion initiative. As part of the initiative, a training curriculum was developed and peer counselors were trained in helping consumers determine whether they were eligible for the CDPAP and if it was the best choice for their needs.

The CDPAP option has been included in all mainstream Managed Care and Managed Long Term Care Medicaid benefit packages since late 2012. Beginning in 2016, the New York State expanded who could work as a CDPAP personal assistant, allowing the parents of adult children with disabilities to be hired for those roles.

Today, every county in the state is required to have a CDPAP program and alert those eligible about it, empowering thousands of people to direct their lives and care as they see fit.