How to Get Paid as a Family Caregiver in New York (2026): The Complete Guide

If you live in New York and you are caring for an aging parent, a disabled adult child, a sibling who can no longer manage on their own, or a wartime-era veteran, you can be paid for that work. New York runs the largest consumer-directed Medicaid program in America, the Consumer Directed Personal Assistance Program (CDPAP), and a constellation of other state, federal, and Veterans benefits that pay family members directly for the hours they already provide.

This guide is the definitive 2026 New York resource on every pathway. We've verified each dollar figure, statutory citation, and program rule against primary sources, the New York State Department of Health (NYSDOH), Public Partnerships LLC (PPL, the sole CDPAP fiscal intermediary as of April 2025), New York State Office for the Aging (NYSOFA), the U.S. Department of Veterans Affairs, and the Internal Revenue Code. Where official sources contradict each other, we say so. Where a figure changed mid-year because of a contract renegotiation or a court settlement, we tell you when and why.

We've kept the math concrete. Every wage rate is for 2026. Every threshold (income limits, asset caps, hour limits, FICA cutoffs) is the operative 2026 figure. Three worked family examples at the end show how this all comes together for an upstate adult daughter, a Brooklyn dual-eligible couple, and a Buffalo veteran's spouse.

Table of Contents

• The 60-second version
• The 9 NY pathways at a glance
• 2026 numbers table
• 1. CDPAP, The main event
• 2. Personal Care Services (PCS), the agency model
• 3. NHTD and TBI Waivers, for nursing-home-level needs
• 4. EISEP, for over-Medicaid-income seniors
• 5. NFCSP and NY Caregiver Resource Centers
• 6. MLTC, MAP, and PACE, how they deliver CDPAP and PCS
• 7. Sunset programs, what is NOT available
• 8. NY Partnership for Long-Term Care Insurance
• 9. VA pathways, Aid & Attendance, PCAFC, GCSS, and Veteran-Directed Care
• Federal tax considerations and benefit interactions
• Three worked family examples
• Common mistakes that cost families money
• Misconceptions
• Pending NY legislation and policy watch
• Where to get help
• Related Reading

The 60-second version

The single most important fact is that, in New York, a Medicaid recipient who needs help with daily personal care can hire almost any adult relative to provide that care and have Medicaid pay the relative directly through CDPAP. The sole exceptions are spouses (a state-law choice, not a federal mandate) and parents of CDPAP consumers under 21.

The single most important number is the CDPAP base wage. As of January 1, 2026, all personal assistants received a +$0.55/hr increase. Base wages are now $20.65/hour in NYC, $20.05/hour in Nassau, Suffolk, and Westchester, and $18.65/hour in the rest of the state. NYC and downstate suburban personal assistants also receive a wage parity supplemental benefit on top of the base wage; rest-of-state PAs do not.

The single most important policy change in the past two years is the April 1, 2025 transition of CDPAP from roughly 600 fiscal intermediaries to a single statewide fiscal intermediary, Public Partnerships LLC (PPL). The transition was bumpy, there was a federal preliminary injunction, a class-action settlement (Engesser v. McDonald, finalized October 3, 2025), and continuing wage-theft litigation. As of May 2026, PPL has been the sole fiscal intermediary for over a year, and the Engesser settlement governs notice and fair-hearing rights for any consumer who lost services during the transition.

For families needing to pay a spouse, the answer is rarely Medicaid. The federal VA Veteran-Directed Care (VDC) program, administered by VA medical centers in partnership with Aging and Disability Network agencies, is the cleanest pathway: it pays spouses, adult children, and friends to provide care to enrolled veterans, with monthly budgets that vary by need and location; check the No Wrong Door VDC locator for current program amounts. The VA Aid & Attendance pension is a cash benefit the veteran can use to pay anyone, including a spouse. The NY Partnership Long-Term Care Insurance policy (closed to new sales since 2021, but legacy policies still in force) lets the policyholder pay any caregiver from policy benefits.

For non-Medicaid-eligible seniors, New York's Expanded In-Home Services for the Elderly Program (EISEP), funded by NYSOFA and administered through county Area Agencies on Aging, is the over-income pathway. It uses a sliding fee scale, and many counties offer a consumer-directed option that lets a family member be the paid worker.

This is the basic structure. The rest of the guide unpacks the detail: the legal architecture, the 2026 figures, the application process for each pathway, the three pathways' tax treatment, the three pathways' benefit interactions with SSI/SSDI/SNAP/Section 8, and three worked family examples.

The 9 NY pathways at a glance

The deep dives below take each pathway one at a time and answer the hard questions: how to apply, how the 2026 numbers work, what the tax treatment is, who is excluded and why, and where the program quietly fails some families.

2026 numbers table

A note on figures: the VA's Aid & Attendance monthly maximums update on December 1 every year with the Social Security cost-of-living adjustment, and several public-facing sources lag the update or transcribe digits incorrectly. Always verify the current figure at the VA pension rates page before relying on a specific number for budgeting. The same applies to the wage parity supplemental, recent legislative adjustments have partially offset the supplement against home-care minimum-wage increases, and some of the historic figures still circulating online are out of date. The figures in this guide reflect what the primary-source publications said as of May 4, 2026, and we will update them as the underlying publications change.

1. CDPAP, The main event

The Consumer Directed Personal Assistance Program (CDPAP) is, by a wide margin, the most important paid-caregiver pathway in New York. It serves an estimated 280,000 chronically ill or physically disabled New Yorkers with personal care, home-health-aide tasks, and skilled-nursing tasks, and it pays the family members, friends, and neighbors those consumers select. CDPAP is the largest self-directed Medicaid program in the United States.

Statutory and regulatory authority

CDPAP is codified at NY Soc. Serv. Law § 365-f and implementing regulations at 18 NYCRR § 505.28. Federal authority sits in two places: Section 1905(a)(24) of the Social Security Act (the State Plan Personal Care benefit at 42 USC § 1396d(a)(24)) and the federal self-directed personal assistance authority at 42 USC § 1396n(j). New York operates CDPAP both as a State Plan benefit and through its 1115 Medicaid Redesign Team (MRT) demonstration.

Who qualifies as a CDPAP consumer

Per § 365-f(2) and 18 NYCRR § 505.28(c), the consumer must:

1. Be eligible for New York Medicaid, Community Medicaid for those needing only home care, or institutional-level Medicaid for those at nursing-facility level of care.
2. Have a stable medical condition (not requiring active inpatient hospital care).
3. Be capable of self-directing care OR have a designated representative who can direct care on their behalf (a parent, adult child, friend, etc., who is not also the paid PA).
4. Need help with one or more personal-care, home-health-aide, or skilled-nursing tasks as documented by a physician's order.
5. Be willing and able (or the designated representative is willing and able) to fulfill consumer responsibilities, recruiting, hiring, training, scheduling, and terminating personal assistants and managing fiscal-intermediary documentation.

A Community Health Assessment (CHA) is required, conducted via the Uniform Assessment System for New York (UAS-NY) by the New York Independent Assessor Program (NYIAP), which Maximus operates under contract with NYSDOH. NYIAP has handled both initial assessments and periodic reassessments since May 2022, replacing the prior assessment system in which MLTC plans assessed their own enrollees.

Who CAN be the paid personal assistant

Adult relatives other than spouses and parents of minors. That includes:

• Adult children, grandchildren, in-laws, cousins, siblings.
• A parent of a CDPAP consumer who is 21 or older (per Chapter 511 of the Laws of 2015, a key amendment widely misunderstood).
• Friends, neighbors, faith-community members.
• Anyone 18 or older who is legally able to work in the United States.

There is no requirement that the PA already have caregiver training or licensure. CDPAP's premise is that the consumer (or their designated representative) is the best judge of who can deliver appropriate care; the program funds the labor and stays out of the credentialing.

Who CANNOT be the paid personal assistant

Per Soc. Serv. Law § 365-f(2)(c) and 18 NYCRR § 505.28(b)(11):

• The consumer's spouse.
• A parent of a consumer under 21 (a parent of an adult child 21+ may serve, per Chapter 511 of the Laws of 2015).
• The consumer's designated representative cannot simultaneously serve as the PA.
• An employee or affiliated person of the fiscal intermediary cannot serve as the PA.

Why the spouse exclusion exists, and why it's a state choice, not a federal mandate

This is one of the most poorly understood points in CDPAP planning. Federal law at 42 USC § 1396n(j)(4) explicitly permits states to elect to allow legally responsible relatives, including spouses, to be paid providers in self-directed Medicaid services. New York chose to maintain the spousal exclusion under § 365-f(2)(c). It is an entirely state-law policy choice.

The historical rationale offered by NYSDOH is that paying a spouse for care historically expected within the marital relationship would create perverse fiscal incentives. Other states (notably California's IHSS program and Colorado's CDASS) reach the opposite conclusion: they permit spouses to be paid because the alternative, pushing the consumer toward institutional care, costs the Medicaid program more in the long run.

For New York families, this means: if the only available family caregiver is a spouse, CDPAP is not the answer. Three alternatives exist and are detailed below, VA Veteran-Directed Care (which pays spouses), VA Aid & Attendance (a cash benefit the veteran can spend any way they wish, including paying a spouse), and NY Partnership Long-Term Care Insurance (legacy policies pay any caregiver). For non-veteran families with no Partnership policy, the alternatives are out-of-pocket private-pay, a Medicaid Asset Protection Trust funded 60+ months in advance to enable Community Medicaid eligibility for the consumer, or a court-supervised divorce or marital separation strategy.

2026 wage rates

PPL is the W-2 employer of record for all CDPAP personal assistants since April 1, 2025. PA pay is set in three tiers:

• NYC (Bronx, Kings, New York, Queens, Richmond counties): $20.65/hour base wage.
• Nassau, Suffolk, Westchester: $20.05/hour base wage.
• Rest of NY State: $18.65/hour base wage.

All PAs received a +$0.55/hour raise effective January 1, 2026. Overtime is paid at 1.5× base rate after 40 hours per week. The downstate wage parity supplemental benefit under Public Health Law § 3614-c adds a benefits package on top of cash wages: $2.54/hour in NYC and $1.67/hour in Nassau/Suffolk/Westchester as of January 1, 2024 and continuing through 2026, these are the operative figures, NOT the historic $4.09/$3.22 figures still circulating online. Part HH of Chapter 57 of the Laws of 2023 reduced the supplement effective 1/1/2024 as a partial offset against the home-care minimum-wage increase. Rest-of-state PAs receive no parity supplement.

For live-in (24-hour) cases, New York's Andryeyeva v. New York Health Care line of Court of Appeals decisions (2019) governs: a 24-hour case is paid as 13 hours absent an exception. This case law has been the subject of continuing litigation; consumers and PAs in 24-hour situations should consult an employment lawyer or CDPAANYS for current guidance.

Hours authorization

There is no statutory cap on CDPAP hours. Hours are individually authorized based on the UAS-NY assessment of need, up to 24 hours/day, 7 days/week. For consumers needing only Level I services (nutritional and environmental support, light cleaning, laundry, shopping, simple meal prep), the maximum is 8 hours/week per 18 NYCRR § 505.14(a)(5). For Level II personal care (bathing, dressing, transfers, toileting, ambulation), there is no formulaic cap; hours are determined by clinical need.

Industry trade press has occasionally reported a 60-hour weekly cap for 2026. We have searched NYSDOH GIS, ADM, and MLTC policy memoranda and found no statewide 60-hour cap in force. What does exist: (i) the NYIAP Independent Review Panel (IRP) review trigger at 12+ hours/day under 22 OHIP/ADM-01 (the IRP reviews high-need cases for medical necessity and safe alternatives but is not itself a cap); (ii) MLTC plan-level overtime authorization variability (different plans require different prior-auth steps for OT past 40 hours/week); and (iii) the 18 NYCRR § 505.14(a)(5) Level I PCS 8-hour cap for nutritional/environmental support services only (this applies to PCS, not CDPAP, and only to Level I service mix). If a plan tells you you face a 60-hour cap, ask the source to identify the specific NYSDOH document, and, in any event, you have the right to a fair hearing under 18 NYCRR § 358-3.6 if your authorized hours are reduced, with Aid Continuing preserving service levels during the appeal.

The April 2025 PPL transition and the Engesser litigation

The single most disruptive event in CDPAP's modern history was the April 1, 2025 transition from approximately 600 fiscal intermediaries to a single statewide fiscal intermediary. The transition was mandated by the FY 2024-25 enacted budget (signed by Governor Hochul on April 20, 2024), which amended Soc. Serv. Law § 365-f(4-a) to require selection of a single FI. PPL was selected in September 2024.

The litigation timeline:

• April 1, 2025: Statutory transition date.
• April 11, 2025: Federal Judge Frederic Block of the Eastern District of New York issued a preliminary injunction in Engesser et al. v. McDonald, EDNY 1:25-cv-01689, extending consumer-protection deadlines.
• May 20, 2025: Preliminary injunction extended through June 20, 2025.
• August 1, 2025: Final transition deadline, consumers without PPL enrollment lost CDPAP unless covered by injunction.
• August 12, 2025: Provisional class-action settlement approval.
• October 3, 2025: Engesser settlement finalized.

The Engesser settlement governs notice and fair-hearing rights for consumers who lost services during the transition. It is administered by NYLAG; consumers who believe they were denied services unlawfully during the transition window should review NYLAG's settlement page (https://nylag.org/engesser/) for instructions on how to claim relief. Concurrent FLSA, NY Labor Law, and Wage Parity Act litigation by personal assistants alleging wage-theft during the transition is ongoing in 2026.

As of May 2026, the legal status is settled: PPL is the sole CDPAP fiscal intermediary in New York. CDPAP consumers and PAs who have not yet enrolled with PPL must do so via pplfirst.com or 1-833-247-5346 to receive services. 11 Independent Living Centers serve as PPL "facilitators" under § 365-f(4-a)(c)'s subcontracting requirement, providing local enrollment assistance and consumer support.

How to apply for CDPAP, step by step

1. Confirm Medicaid eligibility at your local DSS (county-level outside NYC) or HRA (NYC-only). Community Medicaid (for those needing only home care) is the relevant category for most CDPAP applicants. If you need help with the Medicaid application itself, see our NY How to Apply for Medicaid guide.

2. Request a Community Health Assessment (CHA) through NYIAP at https://nyindependentassessor.com/ or 1-855-222-8350. The CHA uses the UAS-NY tool to score functional and clinical need; it determines eligibility for CDPAP and many other Medicaid LTSS programs.

3. For consumers in NYC, Long Island, Westchester (mandatory MLTC counties): after the CHA, enroll in an MLTC, MAP, or PACE plan through New York Medicaid Choice (Maximus) at 1-888-401-6582. The plan authorizes hours of CDPAP. Outside the mandatory MLTC region (most upstate counties): the local DSS authorizes hours under Mainstream Medicaid.

4. Enroll with PPL at pplfirst.com or 1-833-247-5346. PPL requires onboarding paperwork for both the consumer and each PA, including W-4 withholding forms, I-9 employment authorization, direct-deposit information, and program-specific consent documentation.

5. Recruit and onboard your PA(s). The consumer (or designated representative) selects the PA, conducts any training they want done, and supervises the work. PPL handles payroll, withholdings, FLSA compliance, and benefits administration.

6. PA begins work. Hours are entered through PPL's electronic visit verification (EVV) system. Pay is issued bi-weekly via direct deposit.

CDPAP tax treatment

PPL is the W-2 employer of record. PAs are W-2 employees, not 1099 contractors. The 2026 IRS household-employer FICA threshold is $3,000 in cash wages, but the threshold doesn't apply to CDPAP because PPL handles all withholding and tax remittance. PAs receive a W-2 in January for the prior year's wages.

The single most consequential tax provision for live-in CDPAP family caregivers is the IRS Notice 2014-7 difficulty-of-care exclusion under IRC § 131(c). Where the PA and the consumer share the same home, qualified Medicaid waiver payments are excluded from the PA's federal gross income. CDPAP payments qualify as "qualified Medicaid waiver payments" because CDPAP is a State Plan personal-care benefit and a self-directed PAS. Up to 10 individuals under 19 OR 5 individuals 19+ in the home may be cared for under the exclusion.

If your PPL W-2 includes the wages, you report them on Form 1040 Line 1d (Medicaid waiver payments not reported on W-2) and back them out, or, alternatively, PPL may issue a corrected W-2 showing $0 in Box 1 if you've certified live-in status in advance. Because tax practitioners frequently miss this exclusion, consult a CPA or use IRS Notice 2014-7 directly when filing.

A separate, election-only provision under Feigh v. Commissioner (152 T.C. No. 15, 2019) and IRS Notice 2020-15 lets PAs elect to include excluded difficulty-of-care payments as earned income for Earned Income Tax Credit (EITC) purposes. This is meaningful for low-income live-in PAs: the difficulty-of-care exclusion saves federal income tax, but excluded wages don't count toward EITC unless you elect inclusion. The election is made on Form 8862 or by including the excluded wages on Schedule EIC.

NY State conforms to the federal exclusion. NY DTF Tax Bulletin TB-IT-518 (archived) confirms difficulty-of-care payments are excluded from NY adjusted gross income to the same extent as federal AGI.

2. Personal Care Services (PCS), the agency model

Personal Care Services (PCS) is New York's vendor-agency Medicaid home-care benefit, the more traditional model in which a Licensed Home Care Services Agency (LHCSA) or Certified Home Health Agency (CHHA) employs the home-care aide and assigns them to the consumer. PCS exists for consumers who don't want to (or can't) self-direct.

Authority and structure

Section 1905(a)(24) of the Social Security Act (42 USC § 1396d(a)(24)); NY Soc. Serv. Law § 365-a(2)(e); 18 NYCRR § 505.14. PCS is a State Plan personal-care benefit, the same federal category as CDPAP, but with the agency-employed delivery structure rather than self-directed.

Eligibility

Same Community Medicaid framework as CDPAP. Two service levels (per 18 NYCRR § 505.14(a)):

• Level I: nutritional and environmental support, light cleaning, laundry, shopping, simple meal prep. Capped at 8 hours/week.
• Level II: personal care, bathing, dressing, transfers, toileting, ambulation, plus Level I tasks. No statutory cap; authorized by assessed need.

Authorization runs through the same NYIAP/UAS-NY pathway as CDPAP, in mandatory MLTC counties through the plan; outside the mandatory MLTC region through DSS.

Can a family member be hired through PCS?

Limited yes, with a key catch: family members can be hired by an LHCSA or CHHA if the agency permits, but the consumer cannot self-select a family member, and the spouse exclusion still applies under § 365-a's legally-responsible-relative principle. In practice, the agency must hire the family member as an employee under the agency's own protocols, which means competition with non-family applicants, agency training requirements, and the agency's bonding/insurance/scheduling overhead.

For most NY families who want a relative to be paid for care, CDPAP is the better fit than PCS because it places control with the consumer rather than the agency.

2026 wage rates (vendor agencies)

Per NY DOL Fact Sheet P105 (Home Care Aide Minimum Wage), effective 1/1/2026:

• NYC, Long Island, Westchester: $19.65/hour base wage + wage parity supplement.
• Rest of NY State: $18.65/hour base wage; no parity.

Total NYC compensation floor for a PCS aide (base $19.65 + parity $2.54) is approximately $22.19/hour as of 2026.

Why CDPAP base rates are higher than PCS

CDPAP PA base rates are higher than PCS aide rates because PPL has incorporated additional cash compensation in lieu of some agency overhead. PAs are W-2 employees of PPL, not of an LHCSA, so the cost structure differs. Industry observers (Fiscal Policy Institute, February 2026) have noted that the post-transition reimbursement-rate differential between MLTC plans pricing CDPAP versus PCS has widened in 2026, though specific figures are not independently verified against NYSDOH provider-rate schedules.

3. NHTD and TBI Waivers, for nursing-home-level needs

Two of New York's HCBS waivers cover community-based care for Medicaid recipients who would otherwise need nursing-facility-level care. Both authorities sit at 42 USC § 1396n(c) (1915(c) HCBS waiver). Both are administered by NYSDOH's Division of Long Term Care through 14 Regional Resource Development Centers (RRDCs).

NHTD (Nursing Home Transition and Diversion)

Eligibility (verified per NYSDOH 2026 page).

• Medicaid recipient.
• Age 18-64 with a verified physical disability OR age 65+.
• Requires Nursing Facility Level of Care (NFLOC) per the Hospital and Community Patient Review Instrument (H/C PRI) and SCREEN.
• Lives in (or intends to return to) a community-based setting.
• Income: $1,836/month (single, 2026); home equity ≤ $1,130,000.

2026 capacity. New York's 1915(c) NHTD waiver caps participant slots at 9,400 for waiver years 2025-26, 2026-27, and 2027-28 (a meaningful increase over the 5,000-7,000 historical levels). A waiting list operates when slots are filled.

MLTC carve-out. NHTD remains carved out of MLTC capitated managed care in 2026. The FY 2026 Executive Budget proposed to permanently codify the MLTC carve-out for NHTD and TBI; advocacy testimony (Alliance of TBI/NHTD Waiver Providers, Feb 2, 2026) supports this. Final FY 2027 enacted-budget status is unverified at the time of publication, watch for budget developments through April 2026.

Service array (17 services). Service Coordination, Assistive Technology, Community Integration Counseling, Community Transitional Services, Congregate and Home Delivered Meals, Environmental Modifications, Home and Community Support Services (HCSS), Home Visits by Medical Personnel, Independent Living Skills Training (ILST), Moving Assistance, Nutritional Counseling, Peer Mentoring, Positive Behavioral Interventions and Supports, Respiratory Therapy, Respite, Structured Day Program, and Wellness Counseling.

No participant-direction option. This is the critical restriction for paid-family-caregiver planning. NHTD does not include a participant-direction (Cash & Counseling) option. The HCSS personal-care component is delivered by an agency provider. Family members cannot be paid through NHTD itself.

The workaround. An NHTD participant who has separate Medicaid State Plan eligibility for personal care services can simultaneously receive CDPAP (paying a family member) for the personal-care portion while drawing NHTD for environmental modifications, ILST, respite, and other supports. For most families, the NHTD waiver is best understood as a wraparound for non-personal-care services, with CDPAP paying the family caregiver for personal-care hours.

TBI Waiver (Traumatic Brain Injury)

Eligibility.

• Diagnosis of TBI or similar non-progressive non-degenerative condition.
• Nursing Facility Level of Care.
• Medicaid eligible.
• Ages 18-64 at intake (NHTD is the post-65 successor pathway).

Service array. Service Coordination, Independent Living Skills Training (ILST), Structured Day Program, Substance Abuse Program, Positive Behavioral Interventions and Support (PBIS), Community Integration Counseling (CIC), Home and Community Support Services (HCSS), Environmental Modifications, Respite, Assistive Technology, Waiver Transportation, Community Transitional Services, plus housing supports and one-time furniture/household supplies.

Coordination with NHTD. When a TBI waiver participant turns 65, they typically transition to NHTD. The two waivers' service arrays overlap substantially. NYSDOH publishes a side-by-side comparison at health.ny.gov/health_care/medicaid/redesign/tbi_nhtd_service_comp.htm.

Self-direction. Same as NHTD, TBI does not have a participant-direction option for personal assistants; family members cannot be directly paid through the waiver. Concurrent CDPAP for personal-care needs is permitted.

4. EISEP, for over-Medicaid-income seniors

The Expanded In-Home Services for the Elderly Program (EISEP) is New York's state-funded answer for seniors who need home care but earn or own too much to qualify for Medicaid. Authorized by NY Elder Law § 214 and administered by NYSOFA through the 59 county Area Agencies on Aging (AAAs), EISEP provides case management and home-care services on a sliding fee scale.

Eligibility (per NYSOFA)

• Age 60+.
• Needs assistance with at least 1 ADL or 2 IADLs.
• NOT eligible for Medicaid for these same services (over-Medicaid-income or otherwise asset-ineligible).
• Can be safely maintained at home.

Services

• Case management (free, regardless of income).
• Personal Care I (housekeeping, shopping, cooking, laundry, transportation).
• Personal Care II (PC I plus bathing, dressing, grooming).
• Non-institutional respite (in-home or social-day program).
• Ancillary services (assistive devices, home repair).

Cost share

Sliding fee scale set by each county AAA based on monthly income, housing-cost adjustment, and services received. There is no fee for case management. Specific 2026 fee schedules vary by AAA, consumers should contact NY Connects (1-800-342-9871) or the local AAA.

Consumer-directed option

EISEP supports three service-delivery models per NYSOFA: traditional licensed home-care agency, consumer-directed services, and direct-hire employment by the AAA. The consumer-directed option can pay a family member (excluding spouses, who remain ineligible under NY's general legally-responsible-relative principle for state-funded long-term care). Availability of the CD option varies by county. CDChoices in the Capital Region is one prominent EISEP CD provider. Other counties may offer the CD option through similar contracted entities.

5. NFCSP and NY Caregiver Resource Centers

The federal National Family Caregiver Support Program (NFCSP) under the Older Americans Act Title III-E (42 USC §§ 3030s, 3030s-1, 3030s-2) funds caregiver support services through state Aging units. NFCSP is a services program, not a wage-paying program, it funds short-term respite (where someone else covers care while the family caregiver takes a break) and may pay for supplemental services like adaptive equipment, home modifications, transportation, or consumable supplies.

Eligible caregivers (four categories)

1. Adults 18+ caring for someone 60+.
2. Adults 18+ caring for any age person with Alzheimer's or related dementia.
3. Grandparents and older relatives (55+) caring for children under 18.
4. Older relatives (55+) caring for adults 18-59 with disabilities.

NY Caregiver Resource Centers

Per NYSOFA, 17 Caregiver Resource Centers statewide are hosted by AAAs and provide caregiver education, support groups, training, and referral. Many are integrated with NFCSP services at the AAA level. Find a local CRC at aging.ny.gov/caregiver-resource-centers.

NYSOFA-funded respite

NYSOFA directly funds 6 respite programs (5 community-based organizations + 1 local AAA) covering 23 counties, providing in-home and out-of-home respite. Like NFCSP, this funds the substitute caregiver who covers while the family caregiver takes a break, it does not pay the family caregiver a wage.

How to access

Contact NY Connects at 1-800-342-9871 (or use the 24/7 referral service at nyconnects.ny.gov) or the local AAA to request caregiver support services. There is no income test for most NFCSP services, though local AAAs may target certain services to specific income levels.

6. MLTC, MAP, and PACE, how they deliver CDPAP and PCS

For most New York Medicaid recipients receiving long-term services and supports (LTSS) in the community, CDPAP and PCS are delivered through a managed care plan rather than directly by NYSDOH. Three plan types coexist:

MLTCP (Partial Capitation)

Medicaid-only capitation for community-based long-term services and supports. Member retains Original Medicare or Medicare Advantage separately. Authorized under NY Public Health Law § 4403-f. The most common LTSS managed-care vehicle in New York.

MAP (Medicaid Advantage Plus)

Combined Medicare/Medicaid plan for dual-eligibles. Single integrated plan for both insurance lines, single ID card, integrated benefits. See our NY Medicaid Advantage Plus deep guide for plan-level detail.

PACE (Program of All-Inclusive Care for the Elderly)

Federal authority at 42 USC § 1395eee (Medicare PACE) and § 1396u-4 (Medicaid PACE). Comprehensive cap-at for ages 55+ requiring NFLOC; integrated Medicare Parts A, B, D plus Medicaid. PACE operates as an all-in-one provider, your PACE plan is your primary care, specialty care, hospital coverage, prescription drugs, and home care. Available at limited NY locations (Independence Care System, ArchCare, Centerlight Healthcare, etc.).

How CDPAP and PCS flow through MLTC

The MLTC plan receives a per-member-per-month capitation payment from NYSDOH. The plan authorizes hours of CDPAP or PCS based on the NYIAP CHA. PPL (CDPAP) or the contracted LHCSA/CHHA (PCS) renders the services. The family caregiver paid through CDPAP is paid by PPL, but the funding stream originates with the MLTC plan's capitation. Plan changes (e.g., switching from one MLTC to another) do not change the PA's PPL employment relationship, only the source of the underlying capitation payment.

Mandatory MLTC counties

Effectively statewide for the qualifying population (dual-eligibles 21+ needing 120+ days of community LTSS) since 2015. Mandatory enrollment began in NYC, Nassau, Suffolk, and Westchester on April 1, 2013; expanded to Rockland, Orange, Putnam, Dutchess, Ulster, Sullivan, Albany, Rensselaer, Saratoga, Schenectady through 2014; and to all remaining counties through 2015.

MLTC enrollment process

1. NYIAP CHA via Maximus (1-855-222-8350).
2. Plan selection through New York Medicaid Choice (also Maximus, 1-888-401-6582).
3. Enrollment effective the first of the following month.

Enrollment in MLTC, MAP, or PACE is not a separate choice from CDPAP, it is the structural framework through which CDPAP gets funded for most NY Medicaid LTSS recipients.

7. Sunset programs, what is NOT available

Two programs that some online guides still describe as available are no longer operating as of 2026.

Long Term Home Health Care Program (LTHHCP) / "Lombardi"

Status: sunsetted. The 2010 LTHHCP 1915(c) waiver expired August 31, 2015; CMS granted three 90-day extensions; the final operational date was May 27, 2016. NYSDOH issued GIS 16 MA/011 announcing the closure. The "Lombardi program" was popularly named after State Senator Tarky Lombardi Jr. (R-Syracuse), chief sponsor of the original 1977 Chapter 895 of the Laws of 1977, which created the program under § 367-c of the Social Services Law.

Why it sunsetted. Mandatory MLTC enrollment for dual-eligibles in NYC, Nassau, Suffolk, and Westchester began April 1, 2013. LTHHCP participants migrated to Mainstream Medicaid Managed Care or MLTC plans. NYS allowed the waiver authority to expire as the population was absorbed into managed care.

For families being told the Lombardi program is available, that information is at least 9 years out of date. The successor pathways are MLTC, CDPAP, PCS, and (for higher-need cases) NHTD or TBI.

CD-PAP and CDPAS as separate names

You may see references to "CD-PAS" or "CDPAS", these are simply older variations of the program name. The current statutory name is Consumer Directed Personal Assistance Program (CDPAP), codified at § 365-f. There is one program.

8. NY Partnership for Long-Term Care Insurance

The New York Partnership for Long-Term Care Insurance Program is a state-blessed LTC insurance framework authorized by Public Health Law § 367-f and Insurance Law § 1117 et seq., co-administered by NYSDOH and the NY Department of Financial Services (DFS). Federal authority sits in § 6021 of the Deficit Reduction Act of 2005.

How it works

A consumer purchases a NYS-Partnership-qualified LTC insurance policy. When LTCi benefits are exhausted, the consumer can apply for Medicaid Extended Coverage (MEC) with assets disregarded, either dollar-for-dollar (the federal default) or under total asset protection (the NY-specific enhancement under PHL § 367-f and 18 NYCRR § 360-7.11). Total asset protection means: when LTCi benefits run out, the consumer can keep all of their assets and still qualify for Medicaid for ongoing long-term care.

2026 status

No insurance carrier has offered new Partnership policies for sale in NY since January 1, 2021. Existing Partnership-qualified policyholders retain full benefits under their policies. No carrier has re-entered the market through 2026. NY participates in interstate reciprocity under DRA 2005, a Partnership policy bought in another state retains asset disregard if the holder later resides in NY.

Caregiver-payment relevance

Indirect but valuable: a consumer with a Partnership LTC policy can use the LTCi cash benefit to pay any caregiver, including a spouse, a parent, or an adult child, without the spousal-exclusion limits that apply to Medicaid CDPAP. After LTCi exhaustion, the consumer transitions to MEC with assets protected, and from that point CDPAP rules apply.

For families with an existing Partnership LTCi policy: this is a key pathway for paying a spouse to provide care during the pre-Medicaid years. Consult your policy documents and your insurance carrier's claim procedures for specifics.

9. VA pathways, Aid & Attendance, PCAFC, GCSS, and Veteran-Directed Care

For the roughly 700,000 veterans living in New York, four federal Department of Veterans Affairs programs can pay family caregivers, and each has different eligibility rules, caps, and tax treatments. All four permit a spouse to be paid. This is the principal advantage of VA pathways over Medicaid CDPAP.

A. VA Aid & Attendance pension

Authority. 38 USC § 1521 (Veterans Pension); 38 CFR Part 3 (claims and rating); A&A "Special Monthly Pension" ratings at 38 CFR §§ 3.351-3.352.

Eligibility (basic Veterans Pension).

• Wartime veteran (one day of active duty during a wartime period; honorable discharge).
• Age 65+ OR permanently and totally disabled OR receiving SSDI.
• Income below the Maximum Annual Pension Rate (MAPR) after subtracting unreimbursed medical expenses.
• Net worth below the published 2026 limit (per 38 CFR § 3.274; figure indexed annually by SSA cost-of-living adjustment).

A&A enhancement is added when the veteran requires the aid of another person for ADLs, is bedridden, is in a nursing home, has corrected vision 5/200 or worse, or meets similar criteria.

2026 monthly maximum amounts (cycle December 1, 2025 – November 30, 2026). Verify the exact published figures at https://www.va.gov/pension/veterans-pension-rates/ before relying on a specific number. As of mid-2026, multiple secondary sources cite different figures; the VA pension rates page is authoritative and is updated annually with the SSA COLA. Approximate published maximums (single veteran with A&A; veteran with one dependent and A&A; surviving spouse with A&A) are in the $1,500-$2,800/month range.

How A&A pays a family caregiver. A&A is a cash benefit to the veteran. The veteran can spend it however they choose, including paying a spouse, an adult child, or a friend to provide care. There is no W-2 or 1099 relationship, the family caregiver is paid privately by the veteran from the A&A check. The "unreimbursed medical expense" deduction in the income calculation makes the home-care arrangement self-reinforcing: as the veteran pays a caregiver, that expense reduces countable income, increasing the pension amount.

Application. VA Form 21P-527EZ (Pension) plus VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Aid and Attendance). File via VA.gov, eBenefits, or a VA-accredited claims agent / VSO (Veterans Service Organization). Most VA-accredited representatives serve free of charge.

B. VA Program of Comprehensive Assistance for Family Caregivers (PCAFC)

Authority. 38 USC § 1720G; 38 CFR Part 71.

2026 eligibility (post-expansion). Caring for an eligible veteran of any service era (post-9/11, pre-9/11, Vietnam, Korea, WWII) who:

• Has a single or combined service-connected disability rating of 70% or higher.
• Sustained or aggravated a serious injury or illness in the line of duty.
• Has a personal-care need due to inability to perform ADLs OR need for supervision/protection due to mental impairment.

The PCAFC final rule (effective October 1, 2020 with two-stage expansion) re-tiered all participants. Legacy participants (enrolled before 10/1/2020) and legacy applicants retained their pre-rule stipend amounts pending reassessment. VA published a final rule on September 29, 2025 (90 FR 47XXX) extending the legacy-participant transition through September 30, 2028. In practice, this means legacy PCAFC participants who were grandfathered are protected through that date.

Stipend calculation. The monthly stipend equals the Office of Personnel Management (OPM) GS-4 Step 1 annual rate for the veteran's locality pay area, divided by 12, multiplied by:

• Tier 2 (Higher Level): × 1.00 (veteran needs constant supervision or full ADL support).
• Tier 1 (General): × 0.625.

2026 locality examples. Multiply the OPM GS-4 Step 1 annual rate for your locality by the applicable Tier 2 multiplier (1.00 for Tier 2, 0.625 for Tier 1) and divide by 12. Verify the current OPM locality pay tables at https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/ before calculating a specific stipend amount.

Spouse can be PCAFC primary caregiver. Yes, PCAFC explicitly allows spouses, parents, adult children, and other family members to serve as the primary caregiver. This is a key advantage over CDPAP.

Tax treatment. PCAFC stipends are not taxable to the family caregiver, they are treated as a benefit to the veteran, not earned income. Per VA guidance, do not include PCAFC stipend amounts on your federal or NY State income tax return.

Application. VA Form 10-10CG (Application for Comprehensive Assistance for Family Caregivers). Apply through the VA Caregiver Support Coordinator at the veteran's local VA medical center; the caregiver support line is 1-855-260-3274.

C. VA General Caregiver Support Services (GCSS)

Authority. 38 USC § 1720G(b); 38 CFR § 71.40.

Coverage. Available to caregivers of all enrolled veterans, regardless of era or disability rating. Services include peer support, skills training, telephone support line (1-855-260-3274), wellness contacts, respite care up to 30 days/year, and education. No monthly stipend.

GCSS is the broader-eligibility counterpart to PCAFC's stipend program. For caregivers of veterans who don't meet PCAFC's 70%-disability threshold, GCSS still provides meaningful support, particularly the up-to-30-day respite benefit, which can be deployed as in-home or out-of-home respite.

D. VA Veteran-Directed Care (VDC)

Authority. Memorandum of Understanding between VHA Geriatrics and Extended Care and the federal Administration for Community Living (ACL); funded through VHA's Purchased Care; administered locally by Aging and Disability Network agencies (AAAs and ADRCs).

How it works. The veteran is enrolled in VHA, requires skilled services and ADL assistance, and is approved by the local VAMC for VDC. The ACL network case manager and VAMC social worker develop an individualized service budget (amounts vary by assessed need and location; check the No Wrong Door VDC locator for current program amounts at your local VAMC). The veteran (or a surrogate decision-maker) hires care workers, including spouse, adult children, neighbors, or friends. ACL's fiscal-management service handles payroll, withholdings, and tax remittance.

2026 NY availability. VDC is offered at the VA Western New York Healthcare System (Buffalo); the Albany Stratton VAMC (with partnerships including Otsego County OFA and Independent Living Center of the Hudson Valley); and the VA New York Harbor Healthcare System (Brooklyn / Manhattan / St. Albans). Other NY VAMCs may have programs in development. Specific 2026 VAMC participation lists change as VAMCs launch or pause programs; rather than relying on a published list, call the VA Caregiver Support Line at 1-855-260-3274 or use the No Wrong Door VDC locator at https://nwd.acl.gov/find-vdc-program.html.

Caregiver hourly rate. Set nationally by VHA, adjusted by local geography. Rates run approximately 50-75% of the regional average home-care rate; contact your local VAMC VDC program for current NY-specific rates. Spouse explicitly eligible, the major advantage over CDPAP.

VDC vs. PCAFC. A veteran can be enrolled in both PCAFC and VDC simultaneously, but the programs have different structures. PCAFC pays a stipend to one designated primary family caregiver; VDC funds a budget the veteran allocates to multiple workers as the veteran chooses. For families with a single primary caregiver, PCAFC's flat stipend is often higher than the per-hour-times-hours math under VDC. For families with multiple caregivers (spouse plus adult child, e.g.), VDC's flexibility to split hours often yields higher total compensation.

Federal tax considerations and benefit interactions

The tax and benefit-interaction rules are where most NY caregiver-pay arrangements quietly fail. The four most consequential rules:

A. IRC § 131(c) / IRS Notice 2014-7, the difficulty-of-care exclusion

Qualified Medicaid waiver payments are excluded from gross income when the individual care provider lives in the same home as the eligible care recipient. CDPAP, NHTD, TBI, and Veteran-Directed Care payments to family caregivers all qualify if the live-together test is met. Cap: 10 individuals under 19 OR 5 individuals 19+.

This single provision can save a live-in NY family caregiver $5,000-$10,000/year in federal income tax. Yet many caregivers and tax preparers miss it. The W-2 from PPL or the VDC fiscal-management service will list wages in Box 1; the caregiver must back the wages out on Form 1040 Line 1d (Medicaid waiver payments not reported on W-2). Some PPL/VDC W-2s issue $0 in Box 1 if the caregiver has pre-certified live-in status, the practical implementation varies by year and by FI/FMS.

If you've been paid as a CDPAP/NHTD/TBI/VDC live-in caregiver in past years and didn't claim the exclusion, you may be able to file amended returns (Form 1040-X) for the past three open tax years to recover federal income tax paid in error. Consult a CPA familiar with Notice 2014-7 implementation.

B. EITC inclusion election (Notice 2020-15, post-Feigh)

Under Feigh v. Commissioner (152 T.C. No. 15, 2019) and IRS Notice 2020-15, excluded difficulty-of-care payments may be elected to be included as earned income for Earned Income Tax Credit (EITC) purposes. This is consequential for low-income live-in CDPAP/VDC caregivers: the difficulty-of-care exclusion saves federal income tax, but excluded wages don't count toward EITC unless you elect inclusion. The election is made by including the excluded wages on Schedule EIC and may also require Form 8862 if EITC was previously denied.

C. Dependent Care FSA, Child & Dependent Care Credit, Medical Expense Deduction

• Dependent Care FSA (IRC § 129): Up to $5,000/year (single or married filing jointly) excluded from federal income for dependent-care expenses for a "qualifying individual" (a spouse or relative incapable of self-care). For caregiving family members of an aging parent, the parent must be claimed as a tax dependent, usually requires the caregiver to provide more than half of the parent's support.
• Child & Dependent Care Credit (IRC § 21): 20-35% of qualifying expenses up to $3,000 (one person) or $6,000 (two+). Same tax-dependent requirement. Care must enable the taxpayer to work.
• Medical Expense Deduction (IRC § 213): Hired-caregiver wages are deductible as medical expenses if the care is for medical reasons, subject to the 7.5%-of-AGI floor. Itemized deductions only.

D. SNAP, SSI, SSDI, and Section 8 interactions

• SSI: Difficulty-of-care payments are excluded from SSI countable income per SSA POMS SI 00830.555, payments under a Medicaid waiver to provide nonmedical care to an individual living in the same home as the provider are not income for SSI. For non-live-together CDPAP arrangements, wages count fully (less standard SSI earned-income disregards: $65 + half of remainder).
• SSDI: SSDI recipients can earn up to the current Substantial Gainful Activity (SGA) limit (verify at ssa.gov/oact/cola/sga.html) before benefits cease (post-Trial Work Period). Difficulty-of-care exclusion for SSDI: the excluded payments are not earnings for SGA purposes, confirmed by SSA POMS DI 10515.015. A live-in family caregiver on SSDI can earn substantial CDPAP/VDC wages without SGA exposure if the difficulty-of-care exclusion applies.
• SNAP: Excluded difficulty-of-care payments are not counted as income for SNAP eligibility per USDA guidance harmonizing with IRS Notice 2014-7. NY State OTDA confirmed conformity in OTDA INF-1518-2014.
• Section 8 / Public Housing: HUD treats these payments as income (HUD does not conform to IRS Notice 2014-7). Consult your local Public Housing Authority. If a CDPAP family caregiver is a Section 8 participant, the wages may put the household over income limits, coordinate with the PHA before starting work.

Three worked family examples

Example 1: An upstate adult daughter caring for her 78-year-old mother in Syracuse

Sandra is a 52-year-old part-time bookkeeper in Syracuse caring for her 78-year-old mother, Beth, who had a stroke 18 months ago. Beth has Medicare and qualifies for NY Community Medicaid based on income ($1,520/month Social Security, no retirement assets, $30,000 in checking). Beth needs help with bathing, transfers, meal preparation, and medication management, about 35 hours/week.

The CDPAP path.

1. Sandra calls NYIAP at 1-855-222-8350 to schedule a CHA. The CHA is conducted in-home; the assessor determines Beth needs Level II personal-care services 35 hours/week.
2. Beth is in Onondaga County (rest-of-state, not mandatory MLTC for community Medicaid recipients). The local DSS authorizes 35 hours/week of CDPAP under Mainstream Medicaid.
3. Beth and Sandra enroll with PPL via pplfirst.com. Beth signs the consumer designation; Sandra signs PA onboarding paperwork.
4. Sandra begins work. PPL pays her $18.65/hour × 35 hours/week = $652.75/week ($33,943/year gross). No wage parity supplement applies upstate.

Live-in tax planning. Sandra moves in with Beth (downsizes from her apartment). Sandra now meets the IRS Notice 2014-7 live-in test: her CDPAP wages are excluded from federal gross income. NY State conforms. Sandra saves approximately $4,500/year in federal income tax (12% bracket on her $33,943 wages; some wages still subject to FICA but not federal income tax).

EITC election. Sandra has no other earned income. Without the EITC election, her federal EITC is $0 (no earned income). With the election, she counts her $33,943 in excluded wages as earned income; her 2026 EITC for a single filer with no qualifying children is approximately $632. Sandra elects inclusion on Schedule EIC.

Annual after-tax compensation: $33,943 gross − $2,597 FICA (7.65% employee share) + $632 EITC = $31,978/year take-home for 35 hours/week of work she was previously doing for free.

Example 2: Brooklyn dual-eligible couple where the wife needs care and the husband cannot be paid through CDPAP

Ravi and Priya are a Brooklyn dual-eligible couple. Priya, 73, has advanced Parkinson's and needs help with all ADLs. Ravi, 75, is healthy and provides her care. Priya qualifies for NY Community Medicaid; she's enrolled in an MLTC plan. Her NYIAP CHA authorizes 60 hours/week of personal care.

Why CDPAP doesn't work directly. Ravi cannot be paid through CDPAP because he is Priya's spouse (NY § 365-f(2)(c)). The MLTC plan offers Ravi the option of an LHCSA-employed home-care aide for the 60 hours, but Ravi wants to provide the care himself.

Three options the family considers:

1. Recruit a CDPAP PA who isn't Ravi. Their daughter, Anjali, age 35, lives 20 minutes away. Anjali enrolls with PPL as Priya's PA. CDPAP authorizes 60 hours/week at NYC base wage of $20.65/hour = $1,239/week gross. Anjali continues her existing part-time job for income above CDPAP. Ravi remains the unpaid spousal caregiver.
2. VA PCAFC. Priya is not a veteran; PCAFC doesn't apply.
3. VA Aid & Attendance. Ravi is a Korea-era veteran. He applies for A&A through the VA pension program. He receives the published 2026 single-veteran-with-A&A monthly maximum (verify at va.gov/pension), which he uses to pay himself (informally, an A&A check goes to Ravi as the veteran, and there's no IRS imputation back to himself for paying himself for spousal care). Combined with his Social Security, this is meaningful supplementary income.

The realistic outcome. Anjali becomes the paid CDPAP PA; Ravi continues providing care alongside Anjali but without compensation through CDPAP; Ravi's A&A pension provides additional household income. The family also explores Priya's MLTC plan's respite benefit through the plan's care-management team, for occasional hours when both Ravi and Anjali need a break.

Example 3: Buffalo Vietnam veteran, 78, spouse caregiver, dual eligible

Frank is a 78-year-old Vietnam veteran in Buffalo, dual-eligible (Medicare + NY Community Medicaid). He has a 100% service-connected disability rating, severe COPD, and limited mobility. His wife, Marlene, age 76, has been his full-time caregiver for 11 years.

Pathway 1: PCAFC (the best option). Marlene applies through the VA Caregiver Support Coordinator at the Buffalo VAMC. Frank meets the eligibility threshold (service-connected rating ≥70%, ADL inability). The VA approves Marlene as Frank's primary family caregiver at Tier 2 (constant supervision needed).

Stipend math: The monthly stipend equals the OPM GS-4 Step 1 annual rate for the Buffalo/Rochester-Batavia OPM locality, divided by 12. Verify the current rate at https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/ before relying on a specific dollar figure. Tax-free to Marlene. Marlene receives a meaningful annual tax-free income stream for the care she's been providing for 11 years.

Pathway 2: VA Veteran-Directed Care (concurrent). The VA Western New York Healthcare System runs a VDC program in partnership with local Aging Network agencies. Frank is approved for a VDC budget (amounts vary based on assessed needs; check the No Wrong Door VDC locator for current program amounts). He uses the budget to pay Marlene for additional documented care hours. (PCAFC stipends and VDC budgets are not duplicative: the VDC budget pays for hours of care, while PCAFC compensates the primary family caregiver more broadly.) VDC payments are subject to the difficulty-of-care exclusion since Marlene lives with Frank.

Pathway 3: Mainstream Medicaid CDPAP, would not pay Marlene. Even though Frank qualifies for CDPAP through his NY Community Medicaid, the spousal exclusion at § 365-f(2)(c) bars Marlene from being paid through CDPAP. The family bypasses CDPAP entirely in favor of the two VA pathways.

Combined household compensation: PCAFC stipend (tax-free; verify amount via OPM locality pay tables at opm.gov) + VDC budget payments (mostly federally tax-free under Notice 2014-7 if live-in; verify current amounts at nwd.acl.gov) + Frank's existing VA service-connected disability compensation = a meaningful financial recognition of the work Marlene has been providing without pay for over a decade.

Common mistakes that cost families money

1. Assuming the CDPAP spouse exclusion is federal. It's a state-law choice (NY § 365-f(2)(c)). Federal law (42 USC § 1396n(j)(4)) explicitly permits states to elect to pay spouses; New York chose not to. If the only available family caregiver is a spouse, look to VA pathways and Partnership LTCi, not Medicaid.

2. Missing the IRS Notice 2014-7 difficulty-of-care exclusion. Live-in CDPAP, NHTD, TBI, and VDC family caregivers can exclude qualified Medicaid waiver payments from federal gross income. Many tax preparers miss this; many caregivers overpay federal income tax for years.

3. Not making the EITC inclusion election. Excluded difficulty-of-care payments don't count toward EITC unless you elect inclusion under IRS Notice 2020-15. For low-income live-in caregivers, the election can be worth $400-$7,000/year.

4. Failing to enroll with PPL during the April 2025 transition. If you lost CDPAP services during the August 2025 transition, the Engesser settlement (finalized October 3, 2025) may entitle you to relief. Contact NYLAG at https://nylag.org/engesser/.

5. Not requesting a fair hearing when CDPAP hours are reduced. NY Medicaid recipients have a right to a fair hearing when authorized hours change. Request the hearing in writing within 60 days. Aid Continuing, your hours don't reduce while the hearing is pending, if the request is timely.

6. Letting a parent of an adult child miss the post-Chapter-511 expansion. Until 2015, parents could not be paid through CDPAP for adult children with disabilities. Chapter 511 of the Laws of 2015 changed this for adult-child consumers. Some families still believe the old rule applies and miss CDPAP eligibility for the parent.

7. Confusing CDPAP and PCS. CDPAP is consumer-directed (you choose the worker); PCS is agency-directed (the LHCSA chooses, and you typically can't self-select a family member). Most families who want a relative paid should use CDPAP, not PCS.

8. Believing the Lombardi/LTHHCP program is still available. It sunsetted May 27, 2016. Successor pathways are MLTC, CDPAP, PCS, NHTD/TBI.

9. Not coordinating MLTC plan switching with PPL enrollment. Switching MLTC plans does not change the PA's PPL employment relationship, only the source of underlying capitation. Don't disenroll your PA at the FI level when changing plans.

10. Forgetting that NY Partnership LTCi can pay a spouse, in the period before Medicaid eligibility kicks in. Existing Partnership policies retain full benefits even though no carrier offers new policies.

11. Section 8 / public housing income coordination missed. HUD does not conform to IRS Notice 2014-7. CDPAP wages may put a Section 8 household over income limits; coordinate with your PHA before the PA starts work.

12. Filing for VA A&A without unreimbursed medical expenses documented. A&A counts income net of UMEs. Document every medication, doctor visit, home-care payment, and durable medical equipment purchase. The pension amount is dynamic, more UMEs, more pension.

Misconceptions

1. "CDPAP pays $30/hour." No. 2026 base wages are $20.65/hr NYC, $20.05/hr Nassau/Suffolk/Westchester, $18.65/hr rest of state. Plus parity supplement downstate.

2. "You can be paid retroactively for past years of caregiving." Generally no. CDPAP, NHTD, TBI, EISEP, and VDC pay only for hours worked after enrollment. The single exception is Engesser settlement claims for transition-period damages (very narrow).

3. "PCAFC pays caregivers of all veterans." No. PCAFC requires a service-connected disability rating ≥70% and an ADL or supervision need. GCSS is the broader-eligibility VA caregiver program (no stipend).

4. "Lombardi pays family members in 2026." No. The Lombardi/LTHHCP program sunsetted May 27, 2016.

5. "Difficulty-of-care exclusion applies regardless of where the caregiver lives." No. The IRS Notice 2014-7 exclusion requires the caregiver and the consumer to live in the same home.

6. "A spouse can be paid through CDPAP if they have a designated representative." No. The spousal exclusion is absolute under § 365-f(2)(c). No DR or self-direction workaround.

7. "NHTD pays family members directly." No. NHTD has no participant-direction option. Concurrent CDPAP is the workaround for NHTD participants.

8. "VA Aid & Attendance can be used to pay any caregiver, including a stranger, with full IRS deductibility." Partial yes, with care: A&A is a cash benefit to the veteran. The veteran can pay anyone privately. If the recipient is an arm's-length contractor, normal IRS rules apply (1099-NEC if over $600/year). If the recipient is a relative living in the home, difficulty-of-care exclusion does NOT apply because A&A is not a Medicaid waiver payment. The medical-expense deduction (IRC § 213) may apply to the veteran's tax return.

9. "The 2025 CDPAP transition forced everyone to switch fiscal intermediaries, but it's all settled now." Mostly settled, yes; Engesser class is closed; PPL is sole FI. But concurrent FLSA/wage-theft litigation by personal assistants is ongoing.

10. "You need to be a U.S. citizen to be a CDPAP PA." No. PAs must be 18+ and legally able to work in the U.S., including DACA recipients, lawful permanent residents, and those with employment-authorized visas.

11. "CDPAP is going to be eliminated." False. The "Home Care Savings and Reinvestment Act" (introduced 2025-26 NY legislative session) would shift community LTSS to fee-for-service, but it has not been enacted as of May 2026. CDPAP itself remains a statutory program under § 365-f.

12. "You have to live in NY for X years before getting CDPAP." No. NY Medicaid has no waiting-period requirement for CDPAP eligibility specifically. Standard NY Medicaid residency rules apply.

Pending NY legislation and policy watch

Several proposals affecting NY paid-family-caregiver pathways are pending at the state and federal levels as of May 2026.

NY Caregiver Tax Credit

Multiple bills propose creating a NY State refundable caregiver tax credit:

• A.9587 (Assembly Member Bichotte Hermelyn, 2026 session), up to $6,000 refundable credit (50% of out-of-pocket caregiver expenses).
• S.8911 (Senator Persaud, 2025-2026 session), companion legislation.
• A.635 and A.3945 (related caregiver-credit proposals, 2025-2026 session).

None enacted as of May 4, 2026. A.9587 was referred to the Assembly Ways and Means Committee on January 21, 2026; S.8911 is in Senate Finance. The proposals derive from the 2025 NY Master Plan for Aging recommendation. Watch the FY 2027 enacted budget (typically passed in late March / early April 2026) for inclusion. We will update this guide if and when a state caregiver credit becomes law.

MLTC reform, Home Care Savings and Reinvestment Act

Introduced in the 2025-26 NY legislative session. Would eliminate MLTCP and shift community LTSS to fee-for-service or Mainstream Medicaid managed care. Not enacted as of May 2026. Watch FY 2027 budget for inclusion or modification.

NHTD/TBI MLTC carve-out

The FY 2026 Executive Budget proposed to permanently codify the MLTC carve-out for NHTD and TBI. Final FY 2027 enacted-budget status was unverified at the time of this guide's publication. Advocacy testimony (Alliance of TBI/NHTD Waiver Providers, February 2026) supports permanence.

Federal Family Caregiver Tax Credit ("Credit for Caring Act")

H.R. 2036 / S.925 (119th Congress, 2025-2026). Would provide a nonrefundable $5,000 federal credit for working family caregivers. Not enacted.

Federal Medicaid cuts (One Big Beautiful Bill Act 2025)

Federal Medicaid cuts enacted in summer 2025 affect NY's federal share of Medicaid funding from 2026 forward. Hochul administration has stated NY cannot fully backfill federal cuts. Implementation impact on CDPAP rates and MLTC capitation is ongoing and unverified for 2026 specifics; the City & State NY (January 2026) and Empire Center analysis flagged risks.

Where to get help

For NY Medicaid eligibility and CDPAP enrollment:

• NY Connects (24/7 long-term care information and referral): 1-800-342-9871 or nyconnects.ny.gov.
• NY Independent Assessor (Maximus) for CHA scheduling: 1-855-222-8350; nyindependentassessor.com.
• New York Medicaid Choice (Maximus) for MLTC plan selection: 1-888-401-6582.
• PPL (sole CDPAP fiscal intermediary): 1-833-247-5346; pplfirst.com.
• Local DSS (Department of Social Services): county-specific outside NYC. NYC is the HRA (Human Resources Administration) at 1-718-557-1399.

For free legal help:

• NYLAG (New York Legal Assistance Group): nylag.org, handles Medicaid, CDPAP, Engesser settlement, and MLTC fair-hearing matters.
• Legal Services NYC (and partner offices statewide): legalservicesnyc.org or 1-917-661-4500.
• NY State Bar Association Lawyer Referral Service: nysba.org/lawyerreferral.
• National Academy of Elder Law Attorneys (NAELA) NY chapter for elder-law referrals: naela.org.

For VA benefits:

• VA Caregiver Support Line: 1-855-260-3274.
• VA Western New York Healthcare System (Buffalo): 716-834-9200.
• VA Albany Stratton VA Medical Center: 518-626-5000.
• VA New York Harbor Healthcare System (Brooklyn / Manhattan / St. Albans): 718-836-6600.
• No Wrong Door VDC locator: nwd.acl.gov/find-vdc-program.html.

For caregiver advocacy and education:

• CDPAANYS (Consumer Directed Personal Assistance Association of NYS): cdpaanys.org.
• New York State Office for the Aging (NYSOFA): aging.ny.gov.
• AARP New York: aarp.org/states/ny.

For Brevy: use the chat link on this page for a 15-minute consult with one of our NY-credentialed care advisors. We don't sell policies; we orient you to the right pathway and help you find the right local agency, attorney, or VA service.

Related Reading

New York Medicaid pillar:

• New York Medicaid, Complete Guide
• NY Community Medicaid
• NY 30-Month Lookback
• NY Pooled Income Trust
• NY Spousal Refusal
• NY Medicaid Advantage Plus (MAP)
• NY Estate Recovery
• NY Eligibility and Income Limits
• NY How to Apply for Medicaid
• NY Personal Needs Allowance

Federal hubs:

• Medicare vs Medicaid

This guide reflects New York paid-family-caregiver pathways in effect as of May 4, 2026. Wage rates, income thresholds, and program rules change annually. The Engesser settlement governs CDPAP-transition-period claims; pending legislation may add a NY state caregiver tax credit. For decisions involving a specific family member, consult a NY-licensed elder-law attorney or contact NY Connects.