An elderly woman with her adult daughter.

New York’s Consumer-Directed Personal Assistance Program (CDPAP) has enrolled, in its nearly three decades of operation, around 10,000 patients into personalized care programs, generating significant benefits for such individuals and reducing costs typically associated with such services.

Over this period, the program has witnessed significant expansion, eligible to almost anyone who is in need and eligible for Medicaid, and has consequently generated benefits through cost-savings and care-enhancements.  Seeking a more-personal, personal care system in which persons in need of care or their representatives can choose or designate their own care workers, programs such as CDPAP offer a rare combination of improvements in quality and increased fiscal responsibility.

As the Consumer-Directed Personal Assistance Associate of New York State (CDPAANYS) has stated, ‘consumer-driven models of financing and delivering services permit the person needing service greater choice and control’ while simultaneously ensuring efficient funding of these patients’ care.

Indeed, due to its unique structure, the CDPAP is not only highly personalized, and in many cases better, care; one of the reasons this program is such a celebrated innovation is because New York’s CDPAP not only does more, but ‘does more with less’.  Within this context, it is important to briefly understand the cost-effectiveness of this program as it accomplishes a rare feat of improving services as well as fiscal responsibility.

How, then, has New York managed to deliver a highly personalized, fiscally-responsible safety net for many disabled or elderly individuals? This program is highly structured and emphasizes a key set of requirements for entrants.  By utilizing federal, state, and local funds and distributing these funds as needed for each case, there have been noted savings to Medicaid funding from this program.

The Department of Health, for instance, estimated the savings in hourly costs for personal care to be $2.16, which obviously adds up quickly.  Furthermore, by eliminating ‘middle men’, ensuring personal care, and orchestrating Medicaid reimbursement, the cost-sharing within CDPAP is equitable, eliminates unnecessary agents, and, thus, benefits all parties involved.

Similarly, the NY Education Department argues that, in addition to the benefits of ‘self-direction’, decreased costs are a leading factor in the increasing emphasis on consumer-directed personal assistance programs, with lower costs per hour of service leading to New York saving Medicaid funds and consequently capable to ensuring adequate coverage across the board.

With a combination of caps on expenditures and costs to Medicaid as well as the ‘slightly lower Medicaid rate payable…than is paid to home care services agencies’, there is no doubt that New York’s CDPAP is among the stand out consumer-directed personal assistance programs in the country.

As a representative of the benefits to be derived from such programs, thus, any understanding of New York’s program can only expand the awareness and utilization of personal care programs.  Whether in New York, California, or Arkansas, consumer-directed programs which ensure personal home care in a cost-effective manner have consistently proven successful.

With growing enrolment and amidst great uncertainty surrounding the continued funding of Medicaid and similar programs, particularly at the federal level, New York’s CDPAP stands out as a distinct safety net for those in need of such personal care.  By developing a cost structure that decreases state, federal, and individual costs, the CDPAP developed by New York is effective, efficient, and fiscally responsible; few programs can claim that and even fewer can say that they, at the same time, improve patients’ quality of care.


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