CDPAP and home health aides are the two main paths to Medicaid-funded care at home in New York and they work very differently.
CDPAP (the Consumer Directed Personal Assistance Program) lets the care recipient hire and direct their own caregiver, including most family members, who get paid through the program — now administered through New York State’s single statewide fiscal intermediary rather than through home care agencies.
Home health aides (HHAs) are trained, certified professionals employed and supervised by a licensed agency, with nurse oversight, guaranteed backup coverage, and no employer-style responsibilities for the family. The right choice depends on one core question: do you want to run the care yourself, or have professionals run it with you?
When it comes to finding the right type of home care services, two popular options are the Consumer Directed Personal Assistance Program (CDPAP) and Home Health Aides (HHA). In this article, we compare both honestly, including what changed in how CDPAP works, to help your family make an informed decision.
Key Takeaways
- CDPAP’s defining feature is who provides the care: the consumer chooses and directs their own caregiver: including most family members, who are paid for the care they give.
- The trade-off is responsibility: in CDPAP, the family effectively manages the care, scheduling, training, and finding coverage when the caregiver is sick all fall on the household.
- CDPAP is no longer run through home care agencies: since 2025, it’s administered through New York State’s single statewide fiscal intermediary. Agencies, including All Heart Homecare, now focus on professional agency-model care.
- Agency home health aides bring what self-direction can’t: certified training, nurse supervision, immediate caregiver replacement, and zero administrative burden on the family.
- The honest answer to “which is better”: neither, universally, CDPAP fits families with a willing, capable caregiver in the household; agency care fits everyone who wants trained professionals and reliability handled for them.
What Is CDPAP and How Does It Work Now?
CDPAP is a New York State Medicaid program that provides individuals with the opportunity to choose their own caregivers. The consumer or their representative has control over their care, including the selection of their caregiver, who can be a family member or friend, and the direction of daily support. Caregivers are paid for the hours they provide.
One important update for anyone researching this in 2026: CDPAP is no longer administered through home care agencies. New York transitioned the program to a single statewide fiscal intermediary, which now handles caregiver payroll and enrollment for all CDPAP consumers.
Families interested in CDPAP enroll through that state-designated channel, not through agencies like ours. (Verify the current NYSDOH page and enrollment details at publish; program administration continues to evolve.)
CDPAP’s Genuine Strengths
- Flexibility: Consumers have the flexibility to choose when and how their caregiver will assist them with daily tasks. This can be particularly beneficial for those who have unique needs or preferences.
- Continuity of care: Since the consumer or their representative selects the caregiver, there is a greater likelihood of a consistent caregiver-patient relationship, beneficial for individuals who require long-term care or have complex conditions.
- More control: The consumer directs their own care and can train their caregiver to meet their specific needs.
- Getting paid: Family members can become paid caregivers, which can help ease financial burdens.
CDPAP’s Honest Trade-Offs
- The family runs the show: recruiting, scheduling, training, and directing the caregiver are the consumer’s responsibility, rewarding for some households, exhausting for others.
- No built-in backup: when the caregiver is sick, traveling, or quits, there’s no agency bench behind them, coverage gaps land on the family.
- No professional supervision: no nurse oversight, no formal training requirement, and no clinical eye reviewing how the care is going.
- Administrative reality: enrollment, eligibility, and payroll now run through the statewide intermediary, and families navigate that process themselves.
What Are Home Health Aides (HHA)?
HHA care is a home care service provided by trained professionals who assist with activities of daily living. These professionals work under the supervision of a licensed healthcare provider, such as a home care agency and this is the model All Heart Homecare provides across NYC.
The Agency Advantage
- Home care expertise: HHAs are qualified and certified, highly empathetic individuals who are trained to provide the most individualized healthcare services and support required to remain comfortable within a patient’s home.
- Medical coordination: Medication reminders, aid in carrying out the doctor’s directives, and ensuring the prompt relaying of any report-worthy incident to the designated health care provider.
- Companionship: HHAs can provide companionship to patients; engaging them in activities, providing emotional support, and promoting overall well-being.
- Professional supervision: HHAs work under the supervision of a licensed healthcare provider. This means that patients have access to professional medical advice and support as needed.
- Abundant choice of caregivers: If for any reason the assigned caregiver is not able to come to work, or the patient would like to change the caregiver, a replacement is available right away — so the client never stays without a caregiver.
- Zero employer burden: The agency handles hiring, screening, training, payroll, insurance, and scheduling, the family’s only job is being family.
CDPAP vs Home Care: The Side-by-Side
| CDPAP | Agency home health aide | |
| Who provides the care | A caregiver the consumer chooses, including most family members | A certified, agency-trained professional matched to the client |
| Who runs the care | The consumer/family directs everything | The agency manages care under a supervising nurse, with family input |
| Training & supervision | No formal training requirement; no clinical oversight | Certified training + ongoing nurse supervision |
| When the caregiver is out | The family finds coverage | Immediate replacement from the agency’s staff, no gaps |
| Admin & payroll | Through NY’s statewide fiscal intermediary; family navigates enrollment | The agency handles everything |
| How it’s funded | Medicaid (for eligible consumers) | Medicaid, private pay, or long-term care insurance |
| Best fit | A willing, capable caregiver already in the household and a family ready to manage the care | Families who want trained professionals, reliability, and no administrative burden |
Which Should Your Family Choose?
The honest answer: it depends on who’s available in your household and how much you want to manage.
- CDPAP makes sense when a family member or trusted friend is genuinely willing and able to provide the care, the consumer wants to direct it themselves, and the household can absorb the scheduling and coverage responsibilities. For those families, enrollment runs through New York State’s designated CDPAP channel.
- Agency care makes sense when no family caregiver is available (or the available one is already burning out), when needs call for trained, supervised professionals, when reliable coverage matters: vacations, sick days, and turnover included, and when the family wants care handled, not managed.
And it’s worth naming a pattern we see constantly: many families start with the family-caregiver model and transition to agency care as needs grow beyond what one person can sustainably provide. Neither choice is permanent, and neither is failure.
Where All Heart Homecare Fits: Professional Care, Every Path
All Heart Homecare focuses on what we do best: professional, agency-model home care with trained HHAs, nurse supervision, and guaranteed coverage. We do not administer CDPAP; that program now runs through the state’s designated intermediary. What we provide, we provide completely:
- Private pay home care: the fastest, most flexible path: no eligibility process, care starting within days, your choice of caregiver, and schedules from a few hours a week to around-the-clock support . For families who don’t qualify for Medicaid, or don’t want to wait, private pay is how professional care begins this week.
- Home health care services: the full agency model: certified HHAs, personal care, companionship, and coordination with your loved one’s medical team, plus licensed private duty nursing where the care plan calls for the clinical layer.
If you’re still unsure about which home care path is right for your loved one, All Heart Homecare Agency is here to help — we’ll give you the honest picture for your situation, including when CDPAP through the state might genuinely be your better fit.
Contact us today at 888-388-8989, and if you’re comparing agencies, our guide to choosing a home care agency gives you the ten questions to ask anyone — including us.
Frequently Asked Questions About CDPAP vs Home Health Aides
What is the difference between CDPAP and home health aides?
CDPAP lets the care recipient choose and direct their own caregiver — including most family members, who are paid through the program, with the family managing scheduling, training, and coverage. Home health aides are certified professionals employed by a licensed agency, with nurse supervision, guaranteed backup when a caregiver is out, and all administration handled by the agency. Self-directed control versus professionally managed reliability is the core trade.
Can a family member get paid to provide home care in New York?
Yes; through CDPAP, most family members (spouses excluded, with limited exceptions) can be paid caregivers for an eligible Medicaid recipient. Since 2025, CDPAP enrollment and caregiver payroll run through New York State’s single statewide fiscal intermediary rather than through home care agencies. Check the NYSDOH CDPAP page for current enrollment steps and eligibility.
Does All Heart Homecare offer CDPAP?
No and as of the program’s statewide transition, no home care agency administers CDPAP; it runs through New York’s designated fiscal intermediary. All Heart Homecare focuses on professional agency-model care: Medicaid home care with certified HHAs, private pay home care with flexible scheduling, and licensed private duty nursing. If CDPAP is the right fit for your family, we’ll tell you honestly and point you to the state’s enrollment channel.
Is CDPAP or an agency home health aide better?
Neither is universally better. CDPAP wins when a willing, capable family caregiver is already in the household and the family can manage the responsibility. Agency care wins on professional training, nurse supervision, immediate backup coverage, and zero administrative load and it’s the sustainable choice when no family caregiver is available or the current one is burning out. Many families use one, then the other, as needs evolve.
How do I get home care without going through Medicaid or CDPAP?
Private pay home care; arranged directly with a licensed agency, with no eligibility process, no waiting, and full control over hours and caregiver matching. Care can typically start within days, scale from a few hours weekly to 24/7, and long-term care insurance often reimburses it. It’s the fastest path to professional care, and for many families the bridge while Medicaid eligibility is being established.
