How to Get Paid as a Family Caregiver in New York: 2026 Guide

If you are a New Yorker caring for an aging parent, a disabled adult child, a grandparent, or an in-law, the unvarnished answer is yes: you can be paid for that work, and New York pays family caregivers more, and at greater scale, than any other state in the country. The dominant program is the Consumer Directed Personal Assistance Program, known as CDPAP, which pays roughly 280,000 personal assistants statewide and routes their wages through a single statewide fiscal intermediary called Public Partnerships LLC, or PPL. CDPAP is the headline pathway for a Medicaid-eligible relative.

But CDPAP is not the only way money moves to a family caregiver in New York. The honest menu is a stack of ten pathways, three of which pay the caregiver real wages or a stipend, two of which provide short-term wage replacement, two of which offset taxes, two of which fund services rather than wages, and one of which is a Medicaid-qualification tool that unlocks CDPAP for married couples. This guide walks through each pathway, the 2026 rules, the dollar figures, the misconceptions that show up most often in agency marketing, and the precise step-by-step a family member follows to start drawing a CDPAP paycheck.

By Brevy Care Team

Key Takeaways

• CDPAP is the dominant paid-caregiver pathway in New York. Codified at NY Social Services Law § 365-f and 18 NYCRR § 505.28, CDPAP lets a Medicaid-eligible consumer hire a family member, friend, or neighbor as their paid Personal Assistant. Spouses cannot be paid PAs for adult consumers and parents cannot be paid PAs for minor children, but parents of disabled adult children age 21 or older may be paid under Chapter 511 of the Laws of 2015.
• 2026 CDPAP wages are set by Wage Parity under PHL § 3614-c. Total minimum compensation in 2026 is $23.19 per hour in New York City, $21.72 per hour in Nassau, Suffolk, and Westchester, and $18.65 per hour in the rest of the state. Older agency marketing pages still cite legacy $4.09 and $3.22 wage parity figures that have not been operative law since January 1, 2024.
• The April 1, 2025 PPL transition consolidated 600+ fiscal intermediaries into one statewide entity. The Engesser v. McDonald class action settlement, finally approved October 3, 2025, secured retroactive registration and back-wage protections for PAs caught in the transition gap. Two parallel wage-theft cases, Calderon v. PPL and Flanagan v. PPL, are still pending in 2026.
• There is no statewide weekly cap on CDPAP hours. The NYIAP Independent Review Panel triggers at 12 or more hours per day or for live-in cases, but the IRP is a medical-necessity review, not a cap. The 60-hour cap rumor that circulates on agency websites is false.
• Live-in family CDPAP wages can be effectively tax-free at the federal level. IRS Notice 2014-7 and IRC § 131(c) exclude qualified Medicaid waiver payments from federal gross income for caregivers who share a residence with the care recipient. PPL flags these wages in W-2 Box 12 Code II. New York conforms via Tax Law § 612(c)(38).

The 10 Pathways at a Glance

New York family caregivers have ten meaningful pathways to financial relief in 2026. Three pay the caregiver directly, two are wage replacement for working caregivers, two are tax tools, two fund services that relieve the caregiver, and one is an asset-protection tool that unlocks Medicaid for a married couple.

The most-asked question is which pathway pays the most money. For most families, the answer is CDPAP. A live-in adult child caring for a parent in New York City can earn roughly $48,000 a year in CDPAP wages at the 2026 NYC rate, federally tax-free under the Difficulty of Care exclusion, with full workers' compensation, paid sick leave, and Paid Family Leave coverage. No other pathway approaches that magnitude for an unrelated or non-veteran family caregiver.

CDPAP: The Dominant Pathway

CDPAP is codified at New York Social Services Law § 365-f and operationalized at 18 NYCRR § 505.28. It is enrolled within New York's 1115 Medicaid Redesign Team demonstration, currently approved through March 31, 2027 by CMS. The structural feature that makes CDPAP work for family caregivers is self-direction. Unlike the agency-employed Personal Care Services benefit, in which a Licensed Home Care Services Agency hires, supervises, and dispatches the home-care aide, CDPAP designates the consumer (or a designated representative) as the employer of record. The consumer recruits, hires, schedules, and supervises the Personal Assistant. The PA is the W-2 employee of the fiscal intermediary, which since April 1, 2025 is a single statewide entity, Public Partnerships LLC.

Who can be the paid PA

CDPAP allows family members to serve as paid PAs. Adult children, siblings, grandchildren, nieces, nephews, in-laws, cousins, friends, and neighbors are all eligible. The exclusions, set out at § 365-f(2)(c) and 18 NYCRR § 505.28(b)(11), are narrower than most families assume but matter:

• Spouses cannot be paid PAs for adult consumers. The spouse of an adult Medicaid recipient is a "legally responsible relative" under § 365-f(2)(c) and is barred from serving as the paid PA. This is a state-law choice, not a federal mandate. Federal law at 42 USC § 1396n(j)(4) explicitly permits states to elect to pay legally responsible relatives in self-directed personal assistance programs. New York has not made that election. The workaround for married couples is for an adult child, sibling, in-law, or hired aide to serve as the PA, with spousal refusal (covered below) used to qualify the recipient spouse for community Medicaid in the first place.
• Parents cannot be paid PAs for minor children. Parents of CDPAP consumers under age 21 are barred. However, parents of adult children age 21 or older may serve as paid PAs, under Chapter 511 of the Laws of 2015, which created a specific carve-out for parents of disabled adults.
• The designated representative cannot also be the paid PA for the same consumer. If a non-self-directing consumer (a parent with advanced dementia, for example) needs a designated representative to make employment decisions on their behalf, that DR is unpaid in their DR role and cannot simultaneously be the paid PA. The practical workaround is for one family member to be the DR and a different family member to be the paid PA.

The April 1, 2025 PPL transition

Until April 1, 2025, CDPAP services were administered by approximately 600 separate fiscal intermediaries statewide, ranging from large regional entities to small mom-and-pop CDPAP agencies. The FY 2024-25 enacted state budget added § 365-f(4-a), directing the New York State Department of Health to designate a single statewide fiscal intermediary. After a contested procurement, PPL was selected and the transition went live April 1, 2025.

The transition was litigated. Engesser v. McDonald, EDNY 1:25-cv-01689, was a class action filed in early 2025 challenging harm to consumers and PAs unable to onboard with PPL in time. The court approved a class-action settlement on October 3, 2025 (ECF No. 140), securing retroactive registration, retroactive wage payments for service delivered during the transition gap, an extended onboarding window codified in 25 OHIP/ADM-02, and consumer-protection provisions during plan-of-care continuity. Two parallel PA wage-theft class actions remain pending as of May 2026: Calderon v. Public Partnerships LLC (EDNY) and Flanagan v. Public Partnerships LLC (WDNY 6:25-cv-06225), both alleging systemic underpayment, missed paychecks, and FLSA violations. As of this writing, motions to dismiss are pending and class certification has not been ruled.

Operationally, PPL is now stable for the bulk of consumers and PAs, but pockets of late-registration backlog, missed paycheck reissues, and EVV data discrepancies persist. ICAN, the state's Medicaid managed-care ombudsman, reports phone wait times improved from 60 to 90 minutes in April 2025 to 15 to 30 minutes in May 2026.

2026 CDPAP wages

CDPAP PAs are paid the home care minimum wage plus the wage parity supplement under New York Public Health Law § 3614-c, as amended by Part HH of Chapter 57 of the Laws of 2023. The 2026 figures effective January 1, 2026 are:

Many CDPAP agency marketing pages still cite the historic $4.09 per hour New York City and $3.22 per hour suburban wage parity figures. Those are not operative law for any year from 2024 forward. PHL § 3614-c was amended by Part HH of Chapter 57 of the Laws of 2023, effective January 1, 2024, which reduced the supplement as a partial offset against the home-care minimum-wage increase. Use the corrected $2.54 and $1.67 figures.

The NYIAP gateway

To get CDPAP hours, the consumer must clear the New York Independent Assessor Program, run by Maximus Federal under 22 OHIP/ADM-01. NYIAP is a three-stage process:

1. Community Health Assessment (CHA) administered by a Maximus nurse evaluator using the UAS-NY tool to score functional needs across activities of daily living, instrumental ADLs, cognition, mood, and clinical conditions. Conducted in-home or by telehealth.
2. Independent Practitioner Panel (IPP) in which a Maximus-contracted physician or nurse practitioner issues an order confirming medical necessity for personal care or CDPAS. This replaces the legacy M11q form.
3. Independent Review Panel (IRP) triggered when the CHA recommends 12 or more hours per day on average or for any live-in case. A multi-disciplinary panel reviews medical necessity. The IRP is a review trigger, not a cap.

The September 1, 2025 minimum-needs floor

MLTC Policy 25.04 and 25 OHIP/ADM-03 raised the minimum-needs floor for new MLTCP and MAP enrollees seeking CDPAP through their plan, effective September 1, 2025. The floor requires limited assistance with three or more ADLs, or supervisory assistance with two or more ADLs if a documented Alzheimer's or dementia diagnosis is on file. Pre-September 1, 2025 enrollees retain Legacy Status as long as they remain continuously enrolled. PACE is exempt from the new minimum and uses the nursing-facility level-of-care test only.

No statewide weekly cap

A persistent rumor circulates that CDPAP has a statewide 60-hour weekly cap. This is false. As of May 2026, no NYSDOH GIS, ADM, MLTC policy memo, statute, or regulation establishes a statewide weekly cap on CDPAP hours. What does exist: the NYIAP IRP review trigger at 12 or more hours per day (medical necessity review, not a cap); MLTC plan-level overtime authorization variability (some plans require pre-authorization for more than 40 hours per week to a single PA); and the 18 NYCRR § 505.14(a)(5) Level I PCS 8-hour cap, which applies to Personal Care Services only, not to CDPAP.

Live-in cases and the 13-hour rule

Andryeyeva v. New York Health Care, Inc., 33 N.Y.3d 152 (2019) is the controlling Court of Appeals decision on live-in pay. The court endorsed the New York Department of Labor's interpretation at 12 NYCRR § 142-2.1(b), holding that for residential live-in home-care shifts, the four conditions for a 13-hour pay day are: the PA works a 24-hour live-in shift; the PA is afforded 8 hours for sleep; the PA receives 5 uninterrupted hours of actual sleep; and the PA receives 3 hours of meal-break time. If any condition is not met, the PA is entitled to 24 hours of pay. PPL's EVV system, Time4Care, is designed around the 13-hour structure for live-in shifts.

Taxes and the Difficulty of Care exclusion

CDPAP PA wages are W-2 income. PPL withholds federal income tax, FICA, New York State tax, and New York City tax where applicable. PAs receive a W-2 by January 31 each year for the prior tax year.

The exception that matters most for live-in family caregivers is the Difficulty of Care exclusion under IRS Notice 2014-7 and IRC § 131(c). The exclusion treats qualified Medicaid waiver payments as not includible in federal gross income for caregivers who share a residence with the care recipient. The exclusion covers CDPAP wages, NHTD waiver wages, TBI waiver wages, and Veteran-Directed Care payments. PPL reports excluded wages with Box 12 Code II on the W-2, and New York conforms to the federal exclusion via Tax Law § 612(c)(38). The Social Security Administration excludes these payments from SSI countable income (POMS SI 00830.555) and from SSDI substantial gainful activity calculations (POMS DI 10515.015). The Supplemental Nutrition Assistance Program also excludes them. HUD does not exclude, so Section 8 income calculations continue to count Difficulty of Care payments.

For low-income live-in family caregivers, IRS Notice 2020-15 (issued after Feigh v. Commissioner, 152 T.C. No. 15 (2019)) lets the caregiver elect to include the excluded payments as earned income for Earned Income Tax Credit purposes. This recovers EITC eligibility that would otherwise be lost when the wages are zeroed out of gross income. Run both scenarios with a tax preparer and choose whichever produces the better outcome.

PA workplace rights under PPL

Since April 1, 2025, PPL is the W-2 employer of all CDPAP PAs statewide. PAs now receive workers' compensation under the New York Workers' Compensation Law; New York Unemployment Insurance, available when the consumer dies, moves to a nursing facility, or otherwise terminates the arrangement; New York Paid Sick Leave under Labor Law § 196-b at 1 hour earned per 30 hours worked, capped at 56 hours per year (PPL meets the large-employer threshold); New York Paid Family Leave eligibility for the PA's own family caregiving needs; New York Short-Term Disability under Workers' Compensation Law Article 9 (capped at the longstanding $170 per week); and FLSA and New York Labor Law overtime at 1.5 times base rate for hours over 40 per week.

PPL uses its proprietary Time4Care mobile app for Electronic Visit Verification, not HHA Exchange. Time4Care captures clock-in time, clock-out time, GPS geo-stamp, service code, and consumer signature. The consumer (or DR) timesheet approval deadline is 12:00 noon ET each Sunday for the prior week's shifts. Missing the approval window can delay the paycheck.

Step-by-Step: Getting Started in CDPAP

Most readers want the practical sequence, not the regulatory walk. Here it is.

Step 1: Confirm Medicaid eligibility, or apply. For most CDPAP consumers (seniors 65 and older, or adults who are blind or disabled), the relevant Medicaid category is community Medicaid for long-term services and supports. Apply through your local Department of Social Services, NYSOH (the State of Health marketplace), or a Facilitated Enroller. The 2026 non-MAGI income limit is approximately $1,800 per month and the resource limit is approximately $33,000 (verify the current GIS at the time of application). Pooled Income Trusts (operated by NYSARC and other nonprofits) and spousal refusal (described below) are the two most common Medicaid-qualification tools for applicants over the income or resource limits.

Step 2: NYIAP Community Health Assessment. Call New York Medicaid Choice at 1-855-222-8350 to schedule. A Maximus nurse evaluator visits in-home or via telehealth and administers the UAS-NY tool over roughly 90 to 120 minutes. The output is a CHA score with recommended hours.

Step 3: NYIAP Independent Practitioner Panel. A Maximus-contracted physician or nurse practitioner reviews the CHA and issues a medical-necessity order. Typically completed within 14 days of the CHA.

Step 4: NYIAP Independent Review Panel, if 12 or more hours per day or live-in. A multi-disciplinary panel reviews medical necessity. The IRP adds 30 to 60 days to the gateway timeline. It is a review, not a cap.

Step 5: MLTC enrollment. Most CDPAP consumers receive CDPAP through their Managed Long Term Care plan, either an MLTCP partial-capitation plan, a Medicaid Advantage Plus FIDE-SNP, or a PACE program. Enrollment is mandatory for dual eligibles age 21 or older needing community-based long-term services and supports for 120 or more days under PHL § 4403-f(7). Enroll through New York Medicaid Choice at 1-855-222-8350.

Step 6: Plan of Care development. The MLTC plan's care manager develops a written Plan of Care identifying authorized hours, tasks, and PA designation. Plan-level overtime authorization (above 40 hours per week to a single PA) varies by plan.

Step 7: PPL onboarding for the family PA. The consumer (or DR) submits the PPL Consumer Enrollment Packet identifying the designated PA. The PA completes the I-9 Employment Eligibility Verification, federal W-4 and New York IT-2104 tax withholdings, criminal-history fingerprint background check, Office of the Medicaid Inspector General exclusion-list screening under 18 NYCRR § 515.5, training acknowledgment, direct deposit authorization, and Time4Care app installation.

Step 8: First shift. Once PPL confirms enrollment, the MLTC plan releases the service authorization and shifts begin counting toward payable hours. Clock in and out via Time4Care at every shift.

Step 9: Biweekly direct deposit. Approve timesheets each Sunday by 12:00 noon ET. PPL processes payroll biweekly. The first paycheck typically arrives 2 to 3 weeks after the first approved shift. W-2s are issued by January 31, with Box 12 Code II for live-in PAs eligible for the Difficulty of Care exclusion.

Step 10: Annual reassessment. Annual NYIAP CHA re-evaluation maintains authorized hours. Any increase in needs requires a new CHA, IPP, and possibly IRP. If the plan reduces hours, the consumer has fair-hearing rights with Aid Continuing under 18 NYCRR § 358-3.6, and notice adequacy is governed by Mayer v. Wing standards.

Personal Care Services: Why Family Rarely Gets Paid Through PCS

Personal Care Services is the traditional, agency-employed Medicaid personal-care benefit, codified at 18 NYCRR § 505.14 and authorized federally at 42 USC § 1396d(a)(24). The PA is the W-2 employee of a Licensed Home Care Services Agency under PHL Article 36. The defining feature of PCS, and the reason CDPAP exists as an alternative, is that the consumer does not select the aide. The LHCSA agency assigns aides from its pool. A family member cannot simply be paid through PCS; they would have to apply for employment with the LHCSA, get hired, and be assigned to the relative's case (which agencies generally avoid for liability reasons). A narrow "no other available aide" exception exists in some local DSS practices but is rarely used and is not codified at the state level.

PCS still matters to family caregivers because many older New Yorkers receive a hybrid mix: PCS hours from an agency aide during business hours, plus CDPAP hours from a family PA on nights and weekends. PCS aide wages mirror CDPAP wages in 2026: $20.65 per hour in NYC, $20.05 per hour in suburbs, and $18.65 per hour in the rest of the state, plus the same wage parity supplement.

VA Pathways: Aid & Attendance, PCAFC, and Veteran-Directed Care

For veterans and their family caregivers, the Department of Veterans Affairs runs three relevant programs that often get conflated.

Aid and Attendance and Housebound are Special Monthly Pension enhancements layered on top of VA Pension, authorized at 38 USC § 1521 and implemented at 38 CFR §§ 3.351 and 3.352. They are paid as a monthly cash benefit to the veteran (or surviving spouse), who can use the money for any purpose including paying a family caregiver. Eligibility requires active-duty service of at least 90 days with at least one day during a wartime period, a non-dishonorable discharge, an income and net-worth test (the 2025 net-worth cap was set at the Medicaid Community Spouse Resource Allowance of $159,240, indexed annually), and an Aid & Attendance medical finding (need for ADL assistance, bedridden status, nursing-home placement, or corrected vision of 5/200 or less). The 2026 monthly maximums are refreshed each December 1 at va.gov/pension/veterans-pension-rates/. To use A&A funds to pay a family caregiver in a way that is also deducted from countable income for pension purposes, the household needs a written caregiver agreement that meets VA standards under M21-1 Part V.

The Program of Comprehensive Assistance for Family Caregivers (PCAFC), authorized at 38 USC § 1720G, pays a designated Primary Family Caregiver of an eligible veteran a tax-free monthly stipend, treated as compensation under IRC § 134 rather than gross income. PCAFC explicitly permits the veteran's spouse to be the designated Primary Family Caregiver, which makes it the single most consequential federal paid-caregiver pathway for spouses of disabled veterans. Stipends in 2026 range roughly from $1,800 per month (Tier 1) to $3,300 per month (Tier 2), geographically adjusted by GS pay locality. Eligibility requires the veteran to have a service-connected disability rating of 70 percent or higher, a need for in-home personal-care services for at least 6 months, and a successful caregiver-readiness assessment. Apply on VA Form 10-10CG. The September 29, 2025 Final Rule extended legacy-participant transition through September 30, 2028.

Veteran-Directed Care (VDC) is a self-direction model administered through the Aging and Disability Network in partnership with VA Medical Centers. It provides a flexible monthly budget, typically $1,500 to $2,500, that the veteran (or representative) can use to hire a personal-care worker of their choice including spouses, adult children, friends, or neighbors. VDC is most useful for veterans who do not qualify for PCAFC but need a CDPAP-style consumer-directed model. Not all New York VA Medical Centers participate. Call the VA Caregiver Support Line at 1-855-260-3274 to confirm participation in your VAMC catchment area.

A family caregiver of a veteran enrolled in CDPAP can also receive PCAFC or VDC payments, because the funding streams are separate. A&A counts as the veteran's income for Medicaid eligibility purposes, however, and may push a borderline-eligible veteran above the community Medicaid income limit, triggering a Pooled Income Trust requirement.

NY Paid Family Leave: The 12-Week Bridge for Working Caregivers

New York Paid Family Leave was enacted in 2016 and codified at New York Workers' Compensation Law Article 9. It provides job-protected, partially-paid leave for working New Yorkers caring for a family member with a serious health condition. PFL is funded through employee payroll deduction and is distinct from the federal Family and Medical Leave Act, which is unpaid and only covers employers with 50 or more employees. PFL covers nearly all New York private employers regardless of size.

The 2026 benefit provides 12 weeks per 12-month rolling period at 67 percent of the employee's average weekly wage, capped at 67 percent of the statewide average weekly wage. The 2025 cap was $1,177.32 per week; the 2026 cap is updated annually by the Workers' Compensation Board and published at paidfamilyleave.ny.gov. Eligibility requires 26 weeks of full-time work or 175 days of part-time work for a covered employer. Qualifying family members include a spouse, domestic partner, child, parent, parent-in-law, grandparent, grandchild, or sibling. A "serious health condition" is defined at WCL § 201(15) and 12 NYCRR Part 380-2.5 to include inpatient care or continuing treatment by a healthcare provider.

PFL is the right pathway for a working caregiver who needs to take 12 weeks off to care for a parent during a hospitalization, post-surgical recovery, or terminal illness. It is also the right pathway during a CDPAP onboarding gap, where a family caregiver may need to leave their existing job before PPL pay begins.

Tax Tools

Federal and state tax tools meaningfully reduce the cost of caregiving even when they do not pay direct wages.

The federal Credit for Other Dependents under IRC § 24(h)(4) provides a $500 nonrefundable credit for a qualifying relative claimed as a dependent. A family caregiver who provides more than half the support for a parent and whose parent's gross income is below the IRS exemption amount can claim the parent as a qualifying relative and take the $500 credit. The exemption-amount threshold is $5,200 in 2025 and is indexed for 2026.

The federal medical expense deduction under IRC § 213 allows itemized deduction of unreimbursed medical expenses exceeding 7.5 percent of adjusted gross income for the taxpayer, spouse, dependents, and qualifying relatives. Eligible expenses include in-home care expenses paid to a caregiver under arm's-length agreement, adult day health care fees, home modifications for medical purposes, and long-term care premiums (subject to age-banded caps under § 213(d)(10)).

The federal Dependent Care Credit under IRC § 21 is widely misunderstood as a paid-caregiver benefit. In practice it is narrow for elder care because the qualifying individual must share the taxpayer's home for more than half the year, must be unable to care for themselves, and the taxpayer must be working (the credit exists to offset dependent care that lets the taxpayer work). The credit is 20 to 35 percent of qualifying expenses up to $3,000 for one qualifying individual or $6,000 for two or more.

Employer Dependent Care FSAs allow up to $5,000 per year of pre-tax salary deferral for dependent care expenses (or $2,500 if married filing separately). Same restrictions as the Dependent Care Credit.

The Difficulty of Care exclusion under IRS Notice 2014-7 is the single most consequential tax tool for live-in family CDPAP PAs. Cross-reference to the CDPAP section above.

The New York State caregiver tax credit has been proposed in multiple bills over the past decade (A.9587, S.8911, A.635, A.3945). As of May 2026, none of these bills have been enacted. Some agency marketing pages and older blog posts mistakenly describe the credit as if it is law. It is not. Re-check the FY 2027 enacted budget for any change.

Services-Not-Wages: NFCSP, EISEP, and Adult Day Health Care

Three programs do not pay the family caregiver direct wages but provide service relief that often matters more than a small cash benefit would.

The National Family Caregiver Support Program (NFCSP) is the federal Older Americans Act Title III-E program codified at 42 USC § 3030s. It funds five service categories: information services, access assistance, individual counseling and caregiver training, respite care, and limited supplemental services such as home modifications or assistive devices. NFCSP does not pay direct cash wages to family caregivers. It funds respite (an outside aide while the family caregiver takes a break), education, and supports. Access in New York is through the New York State Office for the Aging and the 59 county Area Agencies on Aging plus 17 statewide Caregiver Resource Centers. Call NY Connects at 1-800-342-9871 to locate your AAA and CRC.

The Expanded In-Home Services for the Elderly Program (EISEP) is a New York state-funded HCBS program codified at NY Elder Law § 214 and administered by NYSOFA via the AAAs. EISEP provides personal care, case management, respite, and ancillary services such as home-delivered meals, transportation, personal emergency response systems, and home modifications. EISEP eligibility is age 60 or older with at least one ADL or IADL impairment, with a sliding fee based on income, and is generally for seniors who are not Medicaid-eligible (or whose Medicaid does not cover the gap). Some counties operate consumer-directed EISEP options where family members can be paid as the personal-care worker, similar to CDPAP. This is county-by-county and is not universal. EISEP is also a useful stop-gap while a Medicaid CDPAP application is pending; some AAAs can begin EISEP services within 7 to 14 days of intake, far faster than the 60 to 90 days a Medicaid plus CDPAP application typically takes.

Adult Day Health Care (ADHC) is a Medicaid-funded day program licensed at PHL Article 36 and 10 NYCRR Part 425. It provides medical supervision, nursing, ADL assistance, social activities, meals, and transportation 5 to 7 days per week, delivered through MLTC plans for community-Medicaid recipients. ADHC does not pay the family caregiver but provides 6 to 8 hours of relief 5 days per week, which is significant respite. Many CDPAP-funded households use ADHC as a daytime supplement so the family PA covers nights, weekends, and ADHC drop-off and pickup, with the day center handling daytime hours.

Spousal Refusal: The Indirect Pathway for Married Couples

New York recognizes spousal refusal under 18 NYCRR § 360-3.3(c)(7) and SSL § 366(3)(a), which allows the community spouse to formally refuse to make their assets and income available to the spouse seeking Medicaid long-term care. The refusing spouse signs a written statement; Medicaid then disregards the refusing spouse's resources for eligibility purposes. New York is one of only a handful of states that recognize spousal refusal in this form (the federal "Just Say No" doctrine traces to 42 USC § 1396r-5(c)(3)(A)). The state reserves the right to seek spousal recovery against the refusing spouse later, but in practice New York rarely pursues recovery.

Spousal refusal is not direct payment to the caregiver. But it is the financial mechanism that enables Medicaid coverage for a community-residing married couple where one spouse needs LTSS and the other has assets above the Medicaid resource limits. Once the recipient spouse qualifies for Medicaid, that spouse can enroll in MLTC and receive CDPAP hours, with a non-spouse family member (an adult child, in-law, sibling) serving as the paid PA, since spouses themselves are barred from being the paid PA in CDPAP.

Spousal refusal letters are best prepared by a New York elder-law attorney. The procedural rules are technical and the recovery exposure, while rarely pursued, is real.

Long-Term Care Insurance: For the Small Minority Who Have It

Many modern long-term care insurance policies will reimburse for informal caregivers including family members. Reimbursement-style policies pay a percentage (often 50 to 100 percent) of the policy's daily or monthly benefit for documented informal caregiver hours. Cash-benefit (indemnity) policies pay the full benefit regardless of who provides care. Trigger conditions are standardized under IRC § 7702B for tax-qualified policies: inability to perform 2 or more of the 6 ADLs without substantial assistance for 90+ days, or severe cognitive impairment requiring substantial supervision. The New York Partnership for Long-Term Care stopped accepting new policies for sale in 2021, but legacy Partnership policies remain in force and continue to pay any caregiver, including spouses, with a special asset disregard for Medicaid spend-down. If your family member has a policy, read the Informal Caregiver or Home Care Benefit section, note the elimination period (typically 30 to 90 days), and call the policy's claim hotline.

Common Misconceptions

The single most useful service this guide can provide is to flatly correct the misconceptions that show up on agency marketing pages, in older blog posts, and in well-meaning but outdated advice from neighbors.

• "My spouse can be the paid CDPAP PA." False. Spouses of adult CDPAP consumers cannot be paid PAs under SSL § 365-f(2)(c). Federal law would permit it; New York has not made that election.
• "I can be the paid PA for my minor child." False for parents of minors. True for parents of adult disabled children age 21 or older, under Chapter 511 of the Laws of 2015.
• "There is a 60-hour weekly cap on CDPAP." False. No statewide cap exists in any NYSDOH directive, statute, or regulation. The IRP review trigger at 12 or more hours per day is medical necessity review, not a cap.
• "CDPAP wages are tax-free." Partially false. CDPAP wages are W-2 income subject to all standard withholdings. The Difficulty of Care exclusion zeros out federal gross income only for live-in family caregivers.
• "CDPAP is direct cash to the consumer." False. CDPAP is W-2 payroll through PPL to the PA. The consumer never handles the wage check.
• "VA Aid & Attendance and CDPAP cannot be used together." Mixed. A&A is paid to the veteran, not the caregiver; CDPAP is paid to the PA from Medicaid. The two funding streams are separate, but A&A counts as the veteran's income for Medicaid eligibility and may trigger a Pooled Income Trust requirement.
• "The PPL transition canceled CDPAP." False. The April 1, 2025 transition consolidated 600+ fiscal intermediaries into PPL as the single statewide FI. Program eligibility, hours, and pay model are unchanged.
• "NY has an enacted state caregiver tax credit." False as of May 2026. Multiple bills proposed; none enacted.
• "NFCSP pays family caregivers." Mostly false. NFCSP funds respite, training, counseling, and limited supplemental services, not direct wages.
• "The legacy $4.09 / $3.22 wage parity figures still apply." False. PHL § 3614-c was amended by Part HH of Chapter 57 of the Laws of 2023, effective January 1, 2024. The operative 2026 supplements are $2.54 in NYC and $1.67 in Nassau, Suffolk, and Westchester.

Trying to figure out which paid-caregiver pathway fits your family? Polaris is Brevy's free care navigator. We help families confirm Medicaid eligibility, schedule the NYIAP CHA, walk through the PPL onboarding for the family PA, and compare CDPAP, PCAFC, EISEP, and other pathways side by side. Start at brevy.com.

Where to Call When Something Goes Wrong

Three free, independent resources cover most of the situations a family caregiver runs into during CDPAP onboarding or after they begin drawing pay.

ICAN (Independent Consumer Advocacy Network) is the New York State ombudsprogram for people with Medicaid who need long-term care or behavioral health services. ICAN is operated by the Community Service Society of New York and is structurally independent of NYSDOH, MLTC plans, NYIAP, and PPL, which makes it the right call when those entities are the source of a problem. ICAN handles PPL transition issues, late registration, missed paychecks, plan-of-care reduction notices, MLTC denials, and Engesser settlement claim assistance. Phone: 1-844-614-8800. Web: icannys.org.

NY Medicaid Choice (Maximus) is the enrollment broker for MLTC and the operator of NYIAP. Call them to schedule the CHA, to compare MLTC plans, or to enroll. Phone: 1-855-222-8350.

NY Connects is the no-wrong-door referral line for NYSOFA, the AAAs, and the Caregiver Resource Centers. Call them for NFCSP and EISEP intake, for elder-law referrals, and for general care-navigation support. Phone: 1-800-342-9871. Web: nyconnects.ny.gov.

For VA caregiver questions, call the VA Caregiver Support Line at 1-855-260-3274 to confirm A&A, PCAFC, and VDC eligibility and participation in your local VAMC catchment area.

For fair-hearing requests when an MLTC plan reduces or terminates CDPAP hours, the Office of Temporary and Disability Assistance Office of Administrative Hearings runs the request line at 1-800-342-3334. Request the hearing within 10 days of the notice to preserve Aid Continuing under 18 NYCRR § 358-3.6.

Frequently Asked Questions

Where to Go Next

For the deep-dive walkthrough of CDPAP itself, the New York CDPAP guide covers the regulatory architecture, the Engesser settlement, and the PPL transition in more detail. The Managed Long Term Care guide walks through the MLTCP, MAP, and PACE choice that gates CDPAP delivery. The How to apply for Medicaid in New York guide covers the underlying community Medicaid application that is a prerequisite for CDPAP. The pooled income trust guide explains the spend-down mechanism for applicants over the income limit.

For families weighing facility care instead of in-home paid caregiving, the assisted living in New York guide covers the ALR, EALR, SNALR, and ALP pathways, and the PACE in New York guide covers the integrated alternative for nursing-home-eligible community dwellers. For the broader caregiver-pillar map, the New York caregiver programs guide summarizes every state and federal caregiver program operating in the state.

Find personalized help navigating CDPAP and New York caregiver programs at brevy.com.