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What is Immediate Need CDPAP and How to Apply

Thursday, September 3, 2020

If you’re eligible for Medicaid in the state of New York, then you might also qualify for CDPAP (Consumer-Directed Personal Assistance Program) which allows you to hire and manage friends and family members as caregivers.


But maybe you haven’t applied for CDPAP so far because you’ve been living with your family or a friend, and you haven’t really needed care. Or, maybe you haven’t needed any help with daily living activities until now.


As we all know, sometimes life can come at you fast.


It could be that your health has suddenly deteriorated and you need someone to care for you fast.


Or perhaps you have an elderly family member who needs care, but you have to move to another city for a job within a matter of a couple of weeks.


If you find yourself, or a family member, in the need for urgent home care services, you might benefit from Immediate Need CDPAP, assuming you’re eligible.


In this article, we’ll take a closer look at the eligibility requirements for immediate need CDPAP, as well as the process and resources to get the application process started.

A Brief Overview of CDPAP


If you’re reading this article on immediate need CDPAP, then you most likely already have a basic understanding of the CDPAP program.


But just in case you aren’t entirely clear, here’s a brief overview.


As we mentioned above, CDPAP is a New York State Medicaid program that allows you to hire your friends and family members (with a few exceptions) to provide personal care and assistance.


It is meant for low-income individuals living with a disability who might need help with daily activities, including the following.



To be eligible for regular CDPAP, you need to meet the following requirements.


  • You must have (or be eligible for) Medicaid
  • You must have a long-term disability or health condition, and require home care
  • You must be able to train and direct your caregiver


But then, why the need for an expedited CDPAP program? 

CDPAP vs Immediate Need CDPAP


The only difference between the two programs is in the application process, and the time it takes to qualify and receive benefits.


In other words, you get the same benefits, but if you meet certain other requirements, you can get your CDPAP quicker with immediate need benefits.


Now that we’ve cleared that up, let’s take a closer look at immediate need CDPAP.


What is "Immediate Need" Personal Care or CDPAP?


Immediate need CDPAP was established back in 2015/2016 for people who couldn’t wait the usual amount of time that it takes to get approved.


For regular applicants, the Medicaid office has between 45 and 90 days to process the applications for home care benefits.


This could be problematic for those living with disabilities, especially if they don’t have anyone available to help them with daily activities while they’re waiting to get approved.


The delay can cause hardships both for their health and their finances. It can end up being an emotionally and financially challenging time for the person living with disabilities, as well as for their family members.


The NY health administrators recognized this issue back in 2015, and they passed a law in 2016 that allowed the approval process to be expedited for individuals who met certain requirements (more on that below).


If you qualify for immediate need, your Medicaid application could get approved in as little time as seven days. Your application for home care through Medicaid (programs like CDPAP) could get approved in twelve days.


Let’s take a look at the requirements to qualify for immediate need CDPAP. Please note that these requirements are in addition to the regular CDPAP eligibility guidelines.


Who Can Apply for Immediate Need CPAP?


These requirements may seem stringent, but that’s because immediate need CDPAP is reserved only for those who absolutely can’t go without it. 


The state of NY has limited resources as far as people who can process expedited applications, and that’s the reason why they have to keep it limited by the requirements explained here.


If you, or a family member, are in a quick need for Care Services (PCS) or Consumer Directed Personal Assistance Services (CDPAS), you are more likely to qualify if you can meet these following requirements.


No access to caregivers


You currently have no access to informal caregivers.


In other words, there is no one in your family or circle of friends who is able to help you with your daily routine activities while you wait for 45-90 days as your application gets processed. 


Even if you have a friend who is able to occasionally take you to the store or doctor’s office, or comes over to help with the chores, you can meet this requirement.


That’s because if you have a disability and aren’t able to perform daily activities, then you need consistent support.

No access to care agencies


The next thing the CDPAP administrators will check to see is if you have access to a home care agency.


Home care agencies provide nurses or personal assistants who visit you at home and assist with household activities, or even medical needs if necessary.


But if you’re applying for CDPAP, it is unlikely that you already have access to a home care agency. So most people automatically meet this requirement.


But be sure to check with your insurance and other community resources to make sure that you don’t, in fact, have access to home care before you apply for immediate need CDPAP.


If you’re currently receiving care from an adult daycare, but you need home care instead, then it won’t count against your eligibility requirements.

No coverage through third party insurance


This one goes along with the previous requirement, but you also need to make sure that you don’t qualify for home care through other local or federal programs.


For example, if you qualify for Medicare, and your plan provides personal care services, then you most likely wouldn’t qualify for immediate need CDPAP.

No supportive equipment


The final requirement is that you have no adaptive or specialized equipment or supplies that can effectively assist you with your daily living activities.


So, let’s say you have a walking aid that helps you get around the house. But it’s not sufficient to help when you need to walk up or down the stairs.


Also, you’ll need to show that you don’t have the resources or insurance to purchase adequate supportive devices.


How to Apply for Immediate Need CDPAP


Now that we’ve covered most of the information on what immediate need CDPAP is, and the eligibility requirements, let's take a look at the application process in detail.


The process will vary depending on a few different factors, and we will go through each one below.


Immediate need CDPAP only applies to people who need home care for daily activities as described above. If you need special equipment or other medical services, then you have to apply for Medicaid through the regular process.


1. You currently don’t have Medicaid Coverage


To qualify for any programs through Medicaid, such as CDPAP, the first thing you need to do is to apply for Medicaid.


You can get approved for expedited Medicaid in around seven days. But you need to meet two separate sets of requirements.


First, you need to show that you have a need for immediate care, as we outlined above. But you also need to qualify for Medicaid, which has its own requirements in the state of NY.


Medicaid in NY


As you may already know, Medicaid is a program for low-income New York residents who can’t afford medical services. 


There are a number of Medicaid services that are available depending on your age, financial situation, family, living arrangements, etc.


If you’re enrolled in Medicaid, you’ll receive a Medicaid card which will allow you to visit doctors who are approved within the Medicaid network (some of the services may have a co-payment).


Here are the basic requirements to be eligible for Medicaid in NY. Please note that these are separate from the requirements to be eligible for expedited approval.


  • You must be a resident of New York, a U.S. national, citizen, permanent resident, or legal alien
  • You must have a need for health care, insurance, or personal care services (PCS)
  • You must be considered low-income (more details below)


You must also fall within one of the following categories.


  • You’re pregnant
  • You’re the guardian of a child 18 years of age or younger
  • You’ve been diagnosed with blindness
  • You have a disability, or have a family member with a disability
  • You’re above the age of 65


Income requirements for Medicaid in NY


There are also income and asset limits to qualify for Medicaid.


To be considered low-income in the state of NY, your household income has to be under a certain limit. Also, you can only own a certain amount in assets, such as investments, cash, real estate, etc.


There are, of course, exemptions.


At the time of writing, for a single person household, your monthly income cannot exceed $825. And you can have no more than $14,850 in savings and assets. 


For a two-person household, the limits are $1209/month and $21,750 in asset sand savings


The income and asset levels are based on the FPL, or federal poverty level. Since the FPL changes year-to-year, so do the requirements to qualify for Medicaid.


For the most up-to-date financial requirements, you can refer to this guide, or call Medicaid administration in NY.


The documents required for immediate need CDPAP can also vary based on the demographics you fall under for Medicaid eligibility. 


They are categorized as MAGI and non-MAGI.


MAGI is a method of accounting that is used to determine financial eligibility for Medicaid based on family size.


Required documents for MAGI group for immediate need CDPAP


The following groups fall under the MAGI category when it comes to Medicaid. In other words, income plays a major role when determining eligibility in the following cases.


  • If you’re between the ages of 21-64 with no dependant children
  • If you’re pregnant
  • If you’re the parent or caretaker of the care recipient
  • If you’re under 21


If you qualify through this group for immediate need, then you’ll have to include the following.


Attestation of household income


When you’re applying for Medicaid through the Marketplace (NY State of Health), then you may need to attest to the amount of expected income for your household in the upcoming year. 


If there are discrepancies based on data that the NY State of Health has on file, you might be asked to provide additional information.


Residence/citizenship documents


You’ll have to provide your residence/citizenship information. If the data doesn’t match according to what they have on file, then you’ll also need to provide documentation.


Required documents for non-MAGI group for immediate need CDPAP


If you’re in the following groups then you’re considered non-MAGI, meaning you qualify for reasons other than income. But you still need to meet income/asset qualifications, nonetheless.


  • You’re over 65, have a disability, or you’re blind
  • Your resources are at or below $4,000 for one person
  • You’re an SSI (supplemental security income) recipient
  • You’re a participant in the home and community-based care waivers
  • You’re a long term care beneficiary
  • You’re a Medicare Savings Program recipients
  • You get foster care/adoption assistance
  • You were a former foster care participant as a child
  • You’re under 19 and qualify for TEFRA/Katie Beckett
  • You’ve need treatment for cervical or breast cancer


If you fall in the above category, then as a non-MAGI applicant for immediate care CDPAP, you’ll need the following.

  • Citizenship/residency information
  • Proof of age
  • Recent paycheck stubs if you’re working
  • Proof of current benefit
  • Address information
  • Any additional medical coverage documentation


How to apply for immediate need CDPAP if you don’t currently have Medicaid


Hopefully, by now you have a better understanding of the Medicaid program, and about the general requirements.


Now, let’s take a look at the different steps to apply for immediate need CDPAP if you don’t currently have Medicaid.


STEP 1: Fill out these forms


  1. The Access NY Health Insurance Application (DOH-4220).


  1. The Access NY Supplement A form if you fall under the following categories:


  • Age 65 or older
  • Certified blind or certified disabled (of any age)
  • Not certified disabled but chronically ill
  • Institutionalized and applying for coverage of nursing home care


  1. A physician's order for services; and a signed "Attestation of Immediate Need" (OHIP-0103)


STEP 2: Send in the forms


If you live in NYC, then send you application and documents to the HRA


If you live outside of NYC, but in the state of New York, then send your application to the local social services department


2. If you already have Medicaid Coverage


We’ve covered a lot of information about what to do if you don’t have Medicaid already and you need immediate care CDPAP.


As you can imagine, the process is relatively simpler if you already have Medicaid.


In this case, do the following.


STEP 1: Fill out these forms


  1. The Access NY Supplement A form if you fall under the following categories:


  • Age 65 or older
  • Certified blind or certified disabled (of any age)
  • Not certified disabled but chronically ill
  • Institutionalized and applying for coverage of nursing home care


  1. A physician's order for services; and a signed "Attestation of Immediate Need" (OHIP-0103)


STEP 2: Send in the forms


If you live in NYC, then send you application and documents to the HRA


If you live outside of NYC, but in the state of New York, then send your application to the local social services department


What Happens After I Submit the Application Package?


Here’s what happens after you send in the application for immediate need CDPAP.


  1. The social services office/HRA will double-check everything you’ve sent in to make sure you didn’t miss any forms or supporting information.
  2. If they need more information or documents, they will let you know within four days maximum,  after receiving your application/documents.
  3. You can read their letter to identify any missing information or documents you need to provide. The letter will also specify the due date by which you need to send in the additional information if you want to keep your current application valid. Otherwise, you’ll have to start the application process all over again. 
  4. After they receive complete information from you, they must let you know if you’re eligible within twelve days if you’re eligible for immediate care CDPAP.
  5. If you’re eligible, you’ll start receiving home care, or you’ll be able to hire a friend or family member for care, as quickly as possible.


If You Have Any Questions


The process to apply for Medicaid and CDPAP can be quite complex. So if you ever have any questions, please know that it is only natural, and you should never hesitate to call the health department or social services for assistance. 


Here is their information again:


Social Services in your local area


NYC HRA

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