How to Get Paid as a Family Caregiver in New York (2026)

If you are caring for an aging parent, a disabled adult child, or a wartime veteran in New York, you can get paid as a family caregiver. CDPAP lets a New York Medicaid recipient hire and pay almost any adult relative, and Veteran-Directed Care can pay a spouse. This guide walks through every 2026 pathway with verified wages and primary-source citations.

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.1 (Our New York CDPAP program guide covers the program itself, eligibility through enrollment; this page is about getting paid.)

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 12 NY pathways at a glance
• 2026 numbers table
• 1. CDPAP: how most New York families get paid as a family caregiver
• 2. Personal Care Services (PCS), the agency model
• 3. NHTD and TBI Waivers, for nursing-home-level needs
• 4. EISEP: getting paid as a New York caregiver when you earn too much for Medicaid
• 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 and Attendance, PCAFC, GCSS, and Veteran-Directed Care
• 10. NY Paid Family Leave: the 12-week bridge for a working caregiver
• 11. Spousal refusal: the indirect Medicaid pathway for married couples
• 12. Adult Day Health Care: daytime relief that frees the family caregiver's other hours
• 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
• Learn More

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 21.1

The number that matters most is the CDPAP wage floor: the NY DOL home-care-aide minimum wage, which effective January 1, 2026 is $19.65/hour in NYC, Long Island, 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 cash wage (confirm the current supplement amount with PPL); rest-of-state PAs do not.1

The biggest policy shift of 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.1

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 12 NY pathways at a glance

New York's paid-caregiver menu is bigger than CDPAP alone. Three pathways pay the caregiver real wages or a stipend; one replaces the caregiver's own wages while they take leave; two are Medicaid-qualification tools that unlock CDPAP; and the rest fund services that relieve the caregiver. Here is the whole stack.

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.1,2,3

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 publication, and we will update them as the underlying publications change. The New York Medicaid income, asset, Community Spouse Resource Allowance, and home-equity figures in this table are the 2026 non-MAGI long-term-care standards operative once the 2026 Federal Poverty Levels were applied (GIS 26 MA/05), and the NHTD participant cap reflects the CMS waiver amendment accepted May 15, 2026, and the A&A maximums are the 2026 MAPR figures effective December 1, 2025. The NY Paid Family Leave rate, weekly cap, and duration are the 2026 figures the Workers' Compensation Board set for the January 1, 2026 program year.1,4,5,6,2

1. CDPAP: how most New York families get paid as a family caregiver

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.1

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.1

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, the spouse cannot be the paid CDPAP worker, but CDPAP can still be part of the answer. Two moves solve the two halves of the problem. First, a different relative, an adult child, a sibling, an in-law, or a hired aide, can be the paid PA while the spouse continues providing care alongside them. Second, if the couple's income or assets sit above the Community Medicaid limits, spousal refusal (see section 11) is the NY-specific tool that qualifies the recipient spouse for Medicaid so those CDPAP hours open up in the first place. Where the spouse must be the one paid, three other pathways reach them directly, all 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 and no path to Medicaid, the remaining options are out-of-pocket private-pay or a Medicaid Asset Protection Trust funded 60+ months in advance to enable Community Medicaid eligibility for the consumer.1,3

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, Long Island, and Westchester: $19.65/hour minimum wage.
• Rest of NY State: $18.65/hour minimum wage.1

These are the NY DOL home-care-aide minimum wage tiers effective January 1, 2026, the legal floor for CDPAP pay. Overtime is paid at 1.5x the regular 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 for NYC and Nassau/Suffolk/Westchester PAs; the supplement amount has been amended more than once in recent years, so confirm the current figure with PPL rather than relying on any fixed number circulating online (including the historic $4.09/$3.22 figures). Rest-of-state PAs receive no parity supplement. Be cautious with marketing pages quoting a three-tier "$20.65/$20.05/$18.65 base wage" schedule; it is not the DOL wage floor.1

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 that 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.1

The April 2025 PPL transition and the Engesser litigation

The 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

Most families want the practical sequence, not the regulatory walk. Starting from scratch, a family member should plan on roughly 60 to 90 days from Medicaid application to first paycheck; a consumer already on Medicaid and already enrolled in a plan can compress that to about 4 to 6 weeks. Here is the order the steps actually happen in.

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 (the cash-wages level, $3,000, at which Social Security and Medicare withholding kicks in for a family that directly employs a caregiver) doesn't apply to CDPAP, because PPL, not the family, is the employer and handles all withholding and tax remittance. PAs receive a W-2 in January for the prior year's wages.7

The 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 zero wages 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.1

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.1

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.1

The NYC compensation floor for a PCS aide is the $19.65/hour minimum wage plus the wage-parity supplemental benefit (confirm the current supplement amount with the agency or PPL).1

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 ≤ $1,130,000.4

2026 capacity. New York's 1915(c) NHTD waiver participant maximum was first set at 9,400 (amendment approved December 23, 2025) and then raised to 14,079 participants for waiver years 2025-26 through 2027-28 (amendment accepted May 15, 2026). Because the program has reached its approved maximum, NYSDOH is not currently processing additional NHTD referrals and closes new referrals by letter. Applicants affected by the NHTD cap should ask about the Community First Choice Option (CFCO), a Medicaid State Plan benefit with no waiver cap or waiting list that can serve as a fallback.5

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: getting paid as a New York caregiver when you earn too much for Medicaid

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.1

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 other older relatives (55+), excluding the child's parents, who live with and care for a child under 18.
4. Older relatives (55+), including parents, who live with and care for an adult aged 18-59 with disabilities. A relative caring for someone 60 or older uses category 1 instead.

Both older-relative categories require co-residence with the person you care for. And to receive respite or supplemental services, the care recipient must additionally be determined functionally impaired: unable to perform at least two activities of daily living without substantial assistance, or needing significant supervision because of a cognitive or mental impairment that poses a health or safety risk.

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.1

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.1

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.1

9. VA pathways: Aid and 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 (rate year effective December 1, 2025). The Maximum Annual Pension Rate (MAPR) with Aid & Attendance for 2026 is $29,093/year (about $2,424/month) for a single veteran, $34,488/year (about $2,874/month) for a veteran with one dependent or spouse, and $18,697/year (about $1,558/month) for a surviving spouse with A&A. The MAPR is a ceiling: the actual payment equals the MAPR minus countable income after deducting unreimbursed medical expenses, so the amount is individual. Because these figures update every December 1 with the SSA cost-of-living adjustment, confirm the current numbers at the VA pension rates page before budgeting.6

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 (VA also requires at least six months of continuous, in-person personal care and enrollment in VA health care).8

The PCAFC final rule (effective October 1, 2020 with two-stage expansion) put legacy participants (enrolled before 10/1/2020) and legacy applicants on a separate stipend schedule, not simply on hold. VA published a final rule on September 29, 2025 (90 FR 46477) extending the legacy-participant transition through September 30, 2028. In practice, this means legacy PCAFC participants who were grandfathered are protected through that date, and until then their stipend is set by the legacy schedule below rather than by the current-program rule.8

Stipend calculation. The stipend is not an hourly wage. It starts from the Office of Personnel Management (OPM) GS-4 Step 1 annual rate for the veteran's locality pay area, divided by 12. That monthly base is then multiplied by one of four values, and which one applies depends on how the veteran qualifies, per 38 CFR 71.40(c)(4)(i):8

• Veteran qualifying under the current program (38 CFR 71.20(a)): × 0.625, or × 1.00 where VA determines the veteran is "unable to self-sustain in the community." That is a clinical finding VA makes at the assessment, so if the veteran cannot safely be left alone, ask the assessor to address self-sustainment on the record.
• Legacy participant or legacy applicant (38 CFR 71.20(b) or (c)): the multiplier comes from the sum of the veteran's 2019 clinical ratings, and no self-sustain determination is required on this route. A sum of 21 or higher pays × 1.00; 13 to 20 pays × 0.625; 1 to 12 pays × 0.25.
• Both routes at once (38 CFR 71.40(c)(4)(i)(C)): a veteran who satisfies both 71.20(a) and 71.20(b) or (c) is paid whichever of the two amounts is higher, so qualifying under the current criteria can never reduce a legacy household's stipend.
• The legacy floor (38 CFR 71.40(c)(4)(i)(D)): a legacy participant under 71.20(b) is paid not less than what the caregiver was eligible to receive the day before October 1, 2020, so long as the veteran still resides at the address on record with PCAFC on that date.

The legacy schedule runs for eight years beginning October 1, 2020, so it lapses October 1, 2028.8

What that means in dollars. For 2026 the New York–Newark locality GS-4 Step 1 annual rate is $42,907, a monthly base of about $3,576. In that locality the four multipliers work out to roughly $3,576 at 1.00, $2,235 at 0.625, and $894 at the legacy 0.25 rung. Read that in both directions: a legacy household rated 1 to 12 that assumed 0.625 is budgeting around about two and a half times what it will receive, while a legacy household rated 21 or higher that was told the self-sustain determination is the only route to the full rate is underestimating by about 1.6 times and may never ask for money it already qualifies for. Veterans outside the New York–Newark locality, including Buffalo, Rochester, Syracuse, and Albany, compute from a different GS-4 Step 1 annual rate, so verify the current OPM locality pay tables at https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/ and ask your Caregiver Support Coordinator which multiplier VA applied.8

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.8

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 and adjusted by local geography, then paid from the veteran's individualized VDC budget; 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, the PCAFC monthly stipend is often higher than the per-hour-times-hours math under VDC, though that comparison depends on which of the four PCAFC multipliers the household lands on: at the legacy 0.25 rung a VDC budget may well pay more. For families with multiple caregivers (spouse plus adult child, e.g.), VDC's flexibility to split hours often yields higher total compensation.1

10. NY Paid Family Leave: the 12-week bridge for a working caregiver

Not every caregiver wants to leave their job to be paid through Medicaid. For the daughter who wants to keep her career but needs to be at her mother's side through a hospitalization, a post-surgical recovery, or a final illness, New York Paid Family Leave (PFL) replaces most of her paycheck while she takes the time off, without her having to quit. Enacted in 2016 and codified at New York Workers' Compensation Law Article 9, PFL is funded entirely by a small employee payroll deduction and covers nearly every private employer in the state regardless of size, unlike the federal Family and Medical Leave Act, which is unpaid and reaches only employers with 50 or more workers.

In 2026, PFL provides up to 12 weeks of leave in any 52-week period at 67% of your average weekly wage, capped at 67% of the New York State Average Weekly Wage. Because the 2026 State Average Weekly Wage is $1,833.63, the maximum weekly benefit is $1,228.53. You qualify after 26 consecutive weeks of employment if you work 20 or more hours a week, or after 175 days worked if you work fewer than 20 hours a week. The leave can be taken to care for a family member with a serious health condition, a spouse, domestic partner, child, parent, parent-in-law, grandparent, grandchild, or sibling, defined at Workers' Compensation Law § 201 as inpatient care or continuing treatment by a health-care provider.2

PFL is not a caregiver wage; it is wage replacement on your own job, so it stacks with the pathways above rather than competing with them. Two situations make it especially valuable. The first is an acute stretch, a parent's surgery or hospice window, when a working caregiver needs concentrated weeks at the bedside. The second is the CDPAP onboarding gap: because a from-scratch CDPAP application can take 60 to 90 days before PPL pay begins, a family caregiver who must leave an existing job early can use PFL to bridge the income until the CDPAP paycheck starts. The exact weekly cap is reset each year by the Workers' Compensation Board and published at paidfamilyleave.ny.gov; confirm the current figure before you budget around it.2

11. Spousal refusal: the indirect Medicaid pathway for married couples

Spousal refusal does not pay a caregiver a dime directly. What it does is quietly decisive: it is the tool that qualifies a married New Yorker for Community Medicaid when the couple's combined assets sit above the limit, and Community Medicaid is the door to CDPAP hours. For a couple where one spouse needs care and the other has savings, this is often the difference between a family member drawing a CDPAP paycheck and no one being paid at all.

Spousal refusal is a practice grounded in New York Social Services Law § 366(3)(a), under which the community (well) spouse formally refuses to make their own income and resources available toward the applicant spouse's long-term-care costs, a move long nicknamed "just say no." Be precise about what § 366(3)(a) actually does, because the paperwork below depends on it: the statute directs the agency to furnish medical assistance where a responsible relative's income and resources are not available because that relative refuses to provide the necessary care and assistance. It does not confer a personal right on the well spouse. Once the refusal is on file, Medicaid may determine the applicant spouse's eligibility without counting the refusing spouse's income and resources, and on the income side that generally holds: the State Department of Health's current notice cites § 366(3)(a) and instructs that Medicaid must be provided if the community spouse fails or refuses to contribute their income toward the cost of care. The rest of the federal machinery sits at 42 USC § 1396a(a)(17)(D), which bars a state from counting one person's income against another applicant except a spouse or a minor or disabled child, the narrow window spousal refusal operates inside. New York is one of a small number of states that still honor refusal in this form, and it remains available in 2026: § 366(3)(a) is live law, and the Department of Health's current notice cites it and tells districts to apply it.3

The resource half of that result is conditional, not automatic, and this is where families get denied. Per the NYS DOH Information Notice to Couples with an Institutionalized Spouse, a spouse "will not be determined ineligible for Medicaid because the community spouse refuses to make their resources in excess of the community spouse resource allowance available" only "if" that spouse "executes an assignment of support from the community spouse in favor of the social services district," or is "unable to execute such assignment due to physical or mental impairment." The federal statute sets the same condition at 42 USC § 1396r-5(c)(3). Treat the assignment of support as a required step of the filing, not a formality: without it, and absent a qualifying impairment, the refusal does not shelter the well spouse's resources and the application can be denied outright. New York publishes that instruction in a notice written for couples with an institutionalized spouse, so when you file a refusal on the community-Medicaid side, ask your local DSS (or HRA in NYC) which assignment-of-support form the district requires and get it signed and filed with the application.3

Two catches matter. First, refusal is not secrecy: the community spouse must still cooperate by disclosing resource information, and a refusal to provide the information (as opposed to a refusal to contribute) is grounds to deny the applicant. The way out of that denial is narrow and cumulative, not a general hardship waiver: Medicaid "shall be authorized" only where denial would work an undue hardship on the applicant spouse and an assignment of support is executed (or cannot be, because of physical or mental impairment). And "undue hardship" is itself a defined term in the DOH notice requiring all three of (1) a community spouse who fails or refuses to cooperate in providing information about their resources, (2) an applicant spouse who is otherwise eligible for Medicaid, and (3) an applicant spouse who cannot obtain appropriate medical care without Medicaid, plus at least one of four further conditions: the community spouse's whereabouts are unknown; the community spouse is incapable of providing the information due to illness or mental incapacity; the community spouse lived apart from the applicant spouse immediately prior to institutionalization; or, through the community spouse's action or inaction, the applicant spouse would need protection from actual or threatened harm, neglect, or hazardous conditions if discharged from an appropriate medical setting. Every one of those has to be satisfied, so plan on disclosing the resource information rather than on qualifying for the exception. Second, the state keeps a right of recovery. Furnishing Medicaid this way creates an implied contract under § 366(3)(a), and before any court referral Medicaid will typically request a contribution of 25% of the community spouse's otherwise-available income above the minimum monthly maintenance needs allowance; at its option the agency may later refer the matter to court to review the community spouse's ability to pay or to recover what Medicaid spent. And spousal refusal removes only the refusing spouse's assets from the math, the applicant spouse must still meet New York's own Non-MAGI resource and income limits on their separate countable assets.3,4

Once the recipient spouse qualifies, that spouse enrolls in MLTC and receives CDPAP hours, with a non-spouse relative, an adult child, sibling, or in-law, serving as the paid PA (the spouse themselves remains barred under § 365-f). Spousal-refusal letters are technical and the recovery exposure is real, so this is one pathway worth an elder-law attorney's hand; our NY Spousal Refusal guide walks through the mechanics.3

12. Adult Day Health Care: daytime relief that frees the family caregiver's other hours

Adult Day Health Care (ADHC) does not pay the family caregiver, but for a household where the paid PA also has a job, or simply cannot be awake around the clock, it can be the piece that makes the rest of the arrangement survivable. Licensed under New York Public Health Law Article 36 and 10 NYCRR Part 425, ADHC is a Medicaid-funded day program that provides medical supervision, nursing, help with activities of daily living, social activities, meals, and transportation, and it is delivered through MLTC plans for community-Medicaid recipients.

Many CDPAP households use ADHC as a daytime supplement: the day program covers the middle of the day, and the family PA is authorized and paid for the nights, weekends, and the drop-off and pickup around it. Because ADHC hours and CDPAP hours are authorized separately, a family can often layer both, using the day center for structured daytime care while the relative continues to be paid for the personal-care hours outside program hours. Ask the MLTC plan's care manager whether an ADHC program near you has openings and how it coordinates with your authorized CDPAP hours.

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 thousands of dollars a 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 zero wages in Box 1 if the caregiver has pre-certified live-in status, the practical implementation varies by year and by FI/FMS.1

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 the annual IRS Dependent Care FSA limit 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, which usually requires the caregiver to provide more than half of the parent's support.
• Child & Dependent Care Credit (IRC § 21): a percentage of qualifying expenses up to the IRS per-dependent caps. 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 IRS adjusted-gross-income 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 the standard SSI earned-income disregards.
• 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.1

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 (her Social Security is below the 2026 Community Medicaid income level of $1,836/month for a single applicant, and her assets are within the $33,038 limit). Beth needs help with bathing, transfers, meal preparation, and medication management, about 35 hours/week.4

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.1

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, so she saves the federal income tax she would otherwise owe on those wages (the difficulty-of-care exclusion removes the wages from federal gross income; FICA still applies).1

EITC election. Sandra has no other earned income, so without the EITC election her federal Earned Income Tax Credit would be nothing. With the election under IRS Notice 2020-15, she counts her excluded wages as earned income and can qualify for the EITC as a single filer with no qualifying children. Sandra elects inclusion on Schedule EIC.1

The bottom line: Sandra is now paid roughly $34,000/year gross for 35 hours/week of care she was previously providing for free, most of it free of federal income tax under the difficulty-of-care exclusion.1

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 the NYC minimum wage of $19.65/hour, about $1,179/week gross before overtime pay and the wage-parity supplement. 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. The 2026 single-veteran-with-A&A maximum is a MAPR of $29,093/year (about $2,424/month), reduced by his countable income after unreimbursed medical expenses; the money goes to Ravi as the veteran, and there's no IRS imputation for a veteran paying his own spouse for care. Combined with his Social Security, this is meaningful supplementary income.1,6

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.1

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.8

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 of 70% or higher, at least six months of continuous in-person care, VA health-care enrollment, ADL inability). Frank enrolled after October 1, 2020, so he is judged under the current program, and the VA approves Marlene as Frank's primary family caregiver at the 1.00 multiplier because it determines Frank is unable to self-sustain in the community. Had Frank instead been a legacy participant, that determination would not have been the question: his multiplier would have come from the sum of his 2019 clinical ratings instead.8

Stipend math: the monthly stipend starts from the OPM GS-4 Step 1 annual rate for the veteran's locality pay area, divided by 12, and is then multiplied by 0.625 or 1.00 under the current program, or by 1.00, 0.625, or 0.25 on the legacy 2019-rating-sum schedule (section 9B). Frank is in the Buffalo locality, not New York–Newark, so verify his GS-4 Step 1 annual rate at the OPM salary tables before relying on a specific dollar figure, and confirm with the Caregiver Support Coordinator which multiplier VA applied. The stipend is tax-free to Marlene, a meaningful annual income stream for the care she's been providing for 11 years.8

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.1

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 the Earned Income Tax Credit unless you elect inclusion under IRS Notice 2020-15. For low-income live-in caregivers, the election can be worth a meaningful credit that would otherwise be lost.

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.1

Misconceptions

1. "CDPAP pays $30/hour." No. The 2026 wage floor is the DOL home-care-aide minimum: $19.65/hr in NYC, Long Island, and Westchester and $18.65/hr in the rest of the state, plus the wage-parity supplement downstate.1

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 of 70% or higher and an ADL or supervision need. GCSS is the broader-eligibility VA caregiver program (no stipend).8

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 (a 1099-NEC once payments cross the annual reporting threshold). 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.1

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), a refundable credit for a share 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 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.1

Where to get help

For NY Medicaid eligibility and CDPAP enrollment:

For free legal help:

For VA benefits:

For caregiver advocacy and education:

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.1

Learn More

Not sure which pathway fits your family? Brevy can help you orient. Use the chat link on this page for a free 15-minute consult with a New York care advisor, or explore the full library at brevy.com. We do not sell anything; we help you find the right local agency, attorney, or VA service.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.