The Consumer Directed Personal Assistance Program (CDPAP) allows Medicaid long term care recipients to choose their own home care attendant, including family members, rather than hiring an aide from a home care agency.
Under the standard Medicaid process, after Medicaid approval, the recipient undergoes an assessment with a Managed Long-Term Care plan (MLTC). The assessment determines the number of hours of care Medicaid will provide. After the assessment process, the Medicaid recipient signs up with a home care agency that is under contract with the preferred MLTC. The agency sends the aides to provide the care and Medicaid covers the cost.
Home Care aides are limited to assisting patients with activities of daily living (ADLs), which include but are not limited to walking, cooking, light housekeeping, bathing, and toileting. But, aides cannot perform “skilled tasks”, such as administering medication or assisting with insulin injections. The aide can give certain cues, such as placing the medication in front of the patient indicating it is time to administer.
While many of our clients enrolled with an MLTC and home care agency are happy with the care provided, this is not the case for everyone. Some patients need an aide who performs skilled tasks. This is especially true for patients who live alone. Other patients already have a caregiver that they prefer to use instead of a home care aide they do not know.
CDPAP allows almost any individual to act as a paid caregiver, except for a legally responsible relative, such a spouse or guardian. A child, for example, who takes care of his or her parent can get paid under CDPAP. There is no prerequisite to get certified as a home health aide or a registered nurse. Training occurs at the home and the aide is not restricted to solely assisting with ADLs- but can also assist with skilled tasks.
It is important to note that under CDPAP, an aide is an independent contractor, not an employee of the agency. The patient is thus responsible for hiring the aides, scheduling the care, and ensuring the plan is carried out. Additionally, the patient cannot take advantage of some of the benefits an agency provides, such as sending in backup care if the current aide is sick or if an emergency arises.
Navigating Medicaid’s various programs can be confusing. It is important to discuss your options with an elder law attorney who has extensive Medicaid long term care experience. This way you get the best care that matches your specific needs.