New York Medicaid Consumer Directed Personal Assistance Program (CDPAP) Under the Community First Choice Option (CFCO)

Last updated: April 20, 2021

 

Overview of the Community First Choice Option / Consumer Directed Personal Assistance Program (CFCO / CDPAP)

New York’s Community First Choice Option (CFCO) Program is a suite of long-term services and supports that are provided for state residents who require a nursing home level of care. Intended to prevent and delay nursing home placement of the elderly and disabled, assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs) is provided. This includes assistance with bathing, dressing, mobility, eating, preparing meals, light housecleaning, and laundry. To promote independent living, personal emergency response systems and home modifications are also available benefits. Program participants must reside in their own home or the home of a friend or relative. It is thought that services can also be provided in assisted living residences, but not in adult foster care homes.

The services offered under this program may be provided by licensed care workers or program participants have the option to self-direct their personal care services via the Consumer Directed Personal Assistance Program (CDPAP). CDPAP is an option that allows the hiring of a relative or friend to provide care. Relatives, such as adult children, can be hired to provide care, but spouses cannot. A fiscal intermediary handles the financial aspects of employment responsibilities such as tax withholding and caregiver payments.

The Community First Choice Option is a Medicaid state plan option that was created by the Affordable Care Act (ACA). It is a 1915(k) State Plan Amendment. CFCO services are an entitlement, which means meeting the state’s Medicaid eligibility requirements guarantees one will receive benefits. Put differently, there is never a wait list to receive Community First Choice benefits. In New York, this suite of services is available via the state’s regular Medicaid program (which is covered on this page) and the state’s Managed Long Term Care Program.

 What is the Community First Choice Option?
The Community First Choice (CFC) Option allows states to provide limited home and community based services (HCBS), such as personal care assistance, via their state’s regular Medicaid program. Previously, states mainly provided HCBS via 1915(c) Medicaid Waivers, which limit the number of participant enrollment slots. Therefore, wait lists commonly exist. In contrast, CFC benefits are available via a state’s regular Medicaid program, which does not limit the number of program beneficiaries. This means the availability of home and community based services via the CFC Option is open to anyone who meets the eligibility criteria.

 

Benefits of CFCO / CDPAP

Follows is a list of potential home and community based services and benefits available via Community First Choice Option. An individual care plan will determine which services and supports a program participant will receive.

– Assistive Technology
– Community Transitional Services – provides security deposit and utility set-up fees for persons transitioning from a nursing home into a personal home
– Consumer Directed Personal Assistance Services – allows program participants to hire their own caregiver
– Home Delivered Meals / Congregate Meals
– Home Health Aides
– Home Modifications – for safety and accessibility
– Homemaker Services – light housecleaning, laundry, shopping for essentials, preparing meals, etc.
– Moving Assistance – assistance with moving one’s belongings from an unsafe living environment to a safe one
– Personal Care Assistance – assistance with bathing, grooming, personal hygiene, etc.
– Personal Emergency Response System (PERS)
– Skill Acquisition, Maintenance and Enhancement (SAME)
– Transportation Assistance – Non-emergency medical & social
– Vehicle Modifications

Services are offered in one’s personal home or the home of a family member. While it is thought that CFCO services and supports can be provided in assisted living residences, the cost of room and board is not covered.

 

Eligibility Requirements for NY’s CFCO / CDPAP

The CFCO suite of services is for New York residents who are eligible for the state’s Medicaid plan. The information below is relevant for the elderly (65+ years of age) and disabled.

 The American Council on Aging now offers a free, quick and easy NY Medicaid eligibility test for seniors that require long term care.

 

Financial Criteria: Income, Assets & Home Ownership

Income
In 2021, the individual applicant income limit is $884 / month, and the couple income limit with both spouses as applicants is $1,300 / month. When only one spouse is an applicant, the individual income limit of $884 / month is used. Stated differently, the income of the non-applicant spouse is not counted towards the income eligibility of his/her spouse. Furthermore, monthly income from the applicant spouse can be transferred to the non-applicant spouse as a spousal income allowance, also called a monthly maintenance needs allowance. In New York, this is called a community spouse monthly income allowance (CSMIA) and allows an applicant spouse to bring his / her non-applicant spouse’s monthly income up to $3,259.50. The maximum amount that can be transferred is $3,259.50 / month and is intended to ensure the non-applicant spouse has a minimum monthly income of this amount. Non-applicant spouses who have their own monthly income equal to or greater than $3,259.50 are not entitled to a spousal income allowance. Furthermore, it is requested that non-applicant spouses with monthly income greater than $3,259.50 contribute 25% of the “excess” towards the applicant spouse’s care costs.

Assets
In 2021, the asset limit is $15,900 for a single applicant. For married couples, with both spouses as applicants, the asset limit is $21,400. When only one spouse is an applicant, the assets of both the applicant and non-applicant spouse are limited, though the non-applicant spouse is allocated a larger portion of the assets to prevent spousal impoverishment. (Unlike with income, Medicaid considers the assets of a married couple to be jointly owned). In this case, the applicant spouse can retain up to $15,900 in assets and the non-applicant spouse can keep up to $130,380. This larger allocation of assets to the non-applicant spouse is called a community spouse resource allowance.

Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.

Assets should not be given away or sold under fair market value prior to applying for long-term care Medicaid. This is because NY Medicaid is implementing a 30-month look back rule for applicants of long-term home and community based services. Once implemented, violating this rule will result in a penalty period of Medicaid ineligibility.

 To determine if you might have assets over Medicaid’s countable limit, and if so, receive an estimate of the amount, use our free spend down calculator.  

Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take their home. Fortunately, for eligibility purposes, New York Medicaid considers the home exempt (non-countable) in the following circumstances.

– The applicant lives in the home or has “intent” to return to the home and his / her home equity interest is no greater than $906,000. Home equity interest is the current value of the home minus any outstanding mortgage.
– A non-applicant spouse lives in the home.
– The applicant has a disabled child living in the home.
– The applicant has a minor child (under 21 years old) living in the home.

To learn more about the potential of Medicaid taking the home, click here.

 

Medical Criteria: Functional Need

An applicant must require a nursing facility level of care (NFLOC) to be eligible for CFCO services. An in-home, face-to-face functional needs assessment (FNA) is completed to make this determination. The Uniform Assessment System (UAS-NY) FNA tool is completed by a registered nurse. To meet the functional need requirement, hands on assistance with three activities of daily living (i.e., bathing, dressing, mobility, etc.) is required. An exception exists for persons with Alzheimer’s Disease or a related dementia; physical assistance is not required. Instead they must require supervision of two activities of daily living.

 For more information about long-term care Medicaid in New York, click here

 

Qualifying When Over the Limits

Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for Medicaid. There are a variety of planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.

When persons have income over the limit, Pooled Income Trusts can help. “Excess” income is deposited into the trust, no longer counting as income. NY also has a Medicaid Spend-Down Program that permits applicants to spend “excess” income on medical bills each month to meet the income limit. The amount that must be paid can be thought of as a deductible. Once one’s “deductible” has been paid for the month, New York Medicaid will pay for services and supports.

When persons have assets over the limits, one option is to “spend down” assets. Examples include paying off debt, making home improvements, such as updating heating and plumbing, and purchasing pre-paid funeral and burial expense trusts called Irrevocable Funeral Trusts. Medicaid Asset Protection Trusts are another option in which assets are placed in trusts and are no longer considered countable assets. There are many other options when the applicant has assets exceeding the limit.

Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid planners are educated in the planning strategies available in the state of New York to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. There are also planning strategies that not only help one meet Medicaid’s financial criteria, but also protects assets from Medicaid’s estate recovery program, preserving them for family as inheritance. Historically, NY has not had a Medicaid look-back period for Medicaid long-term home and community based services. However, the state is in the process of implementing a 30-month look back period, and certain planning strategies will violate this rule. Therefore, these strategies should be implemented well in advance of the need for long-term care. However, there are some workarounds, and Medicaid planners are aware of them. For these reasons, it is highly suggested one consult a Medicaid planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s). Find a Medicaid planner.

 

How to Apply for NY’s CFCO / CDPAP

Before You Apply

Prior to submitting an application for CFCO services, applicants need to ensure they meet the New York Medicaid eligibility criteria. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a free Medicaid eligibility test to determine if one might meet Medicaid’s eligibility criteria. Take the Medicaid eligibility test.

As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security and Medicare cards, previous bank statements, proof of income, copies of life insurance policies, property deeds, and pre-need burial contracts. Unfortunately, a common reason applications are held up is required documentation is missing or not submitted in a timely manner.

 

Application Process

To apply for CFCO services, applicants must be eligible for New York Medicaid. Seniors should apply via their county Department of Social Services office. Contact information can be found here. Alternatively, persons can call the Medicaid Helpline at 1-800-541-2831. Persons already enrolled in NY Medicaid should contact their care manager. Applicants will undergo a functional needs assessment as part of the application process for CFCO benefits.

For additional information about the Community First Choice Option, click here.

The New York State Department of Health (DOH) administers the state’s Medicaid program and the Department of Social Services (DSS) office determines eligibility.

 

Approval Process & Timing

The Medicaid application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed even further. In most cases, it takes between 45 and 90 days for the Medicaid agency to review and approve or deny one’s application. Based on law, Medicaid offices have up to 45 days to complete this process (up to 90 days for disability applications). However, despite the law, applications are sometimes delayed even further.

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