The Consumer Directed Personal Assistance Services (CDPAS) program offers an alternative, Medicaid-funded model for individuals requiring in-home support. This state-level initiative provides home health care assistance, including skilled nursing and personal care tasks, to people with chronic illnesses or physical disabilities. CDPAS aims to empower recipients with greater control over their long-term care services, allowing eligible individuals to receive necessary support while remaining in their own homes.
Defining Consumer Directed Assistance
The core philosophy of CDPAS, sometimes called CDPAP, is rooted in “consumer direction” and self-determination. This model shifts the authority over care from a traditional home health agency to the recipient, known as the consumer. The consumer gains the power to recruit, hire, train, schedule, and supervise their own Personal Assistant (PA). This level of control departs significantly from standard care where the agency assigns personnel.
This self-directed approach affords the consumer flexibility in choosing a caregiver familiar with their personal needs and routines. Consumers often hire friends, neighbors, or certain family members, creating a more comfortable and trusting care environment. The increased autonomy extends to the services provided, allowing the PA to perform tasks typically requiring a licensed nurse, such as administering certain medications. The consumer dictates how and when the authorized hours of care are utilized, ensuring the support aligns with their personal lifestyle.
Qualifying for Services
Eligibility for CDPAS requires meeting both financial and medical criteria. The individual must be enrolled in or eligible for Medicaid, a joint federal and state program. Since income and asset limits vary by state, the applicant must first establish financial eligibility. They must then demonstrate a medical need for home care services.
Medical eligibility centers on the applicant’s need for assistance with everyday activities, categorized as Activities of Daily Living (ADLs) or Instrumental Activities of Daily Living (IADLs). ADLs include bathing, dressing, eating, and mobility; IADLs cover tasks like meal preparation, managing finances, and shopping. A thorough assessment, conducted by a healthcare professional, determines the level of physical assistance, supervision, or cueing the individual needs to perform these tasks.
A separate requirement is the ability to direct one’s own care. The applicant must be deemed “self-directing,” meaning they are capable of making choices about their care and managing the personal assistant. If the consumer cannot direct their own care due to cognitive or physical limitations, they must designate a representative to assume those responsibilities. This representative must be willing and able to handle the managerial duties for the consumer.
Managing Your Caregiver
Once enrolled in CDPAS, the consumer or their designated representative assumes the responsibility of being the employer. This role involves actively recruiting and interviewing potential Personal Assistants, and providing necessary training for the consumer’s specific needs. The consumer is also responsible for setting the PA’s work schedule, supervising performance, and handling disciplinary actions, including termination of employment.
State programs commonly restrict who can be hired as a paid Personal Assistant. Typically, the consumer’s spouse cannot be hired. Furthermore, in many states, a parent cannot be the paid caregiver for a child under the age of 21. The program also requires a separation of roles: the designated representative who directs the care cannot serve as the paid Personal Assistant.
The administrative burden of payroll and compliance is handled by a Fiscal Intermediary (FI), which contracts with the state’s Medicaid program. The FI processes the PA’s wages, handles tax withholdings, and manages employee benefits. While the FI acts as the employer of record for administrative purposes, the consumer retains authority over the care provided and remains the functional supervisor of the Personal Assistant.