CDPAP Alternatives in New York: What Home Care Families Need to Know in 2026

If you or a family member relied on the Consumer Directed Personal Assistance Program — or were looking into it — you are likely aware that CDPAP has undergone significant changes in New York. State-level restructuring has reduced availability and access to the program, leaving many families searching for other ways to arrange qualified home care.

This guide covers the primary alternatives available in New York in 2026: the Personal Care Aide (PCA) program, the NHTD and TBI Medicaid waiver programs, and Managed Long-Term Care (MLTC). If you are trying to understand what your options are after CDPAP, this is a practical starting point.

What Changed with CDPAP

CDPAP allowed Medicaid-eligible individuals to hire and direct their own personal assistants, including family members. It became widely used, particularly in New York City, because of the flexibility it offered families.

New York State has significantly consolidated and restructured CDPAP administration. The state transitioned program management to a single statewide fiscal intermediary, which has resulted in disruptions for many participants and a much narrower operational footprint than the program had previously. Many home care agencies that formerly offered CDPAP no longer do so, and new enrollments have become more difficult to complete.

For families currently without a program, or whose loved one was dis-enrolled during the transition, the alternatives below represent the main paths forward under Medicaid in New York.

Personal Care Aide (PCA) Program

The PCA program is the most direct CDPAP alternative for individuals who need hands-on daily assistance but do not meet the criteria for a more intensive level of care.

Under the PCA program, a home care agency provides a trained Personal Care Aide who assists with activities of daily living (ADLs): bathing, dressing, grooming, meal preparation, mobility, and light housekeeping. The aide is employed and supervised by the agency, which handles scheduling, payroll, compliance, and backup coverage.

Who qualifies: Medicaid-eligible adults in New York who have a documented medical need for personal care assistance, assessed through a physician’s order and a Medicaid assessment.
Key difference from CDPAP: The aide is agency-employed rather than consumer-directed. Families who valued choosing their own aide — including a family member — will find this distinction meaningful. However, for families who primarily wanted a reliable, vetted caregiver rather than the administrative responsibility of directing one, the PCA model is often a simpler arrangement.

Priority Cares Home Care Services provides PCA services across New York. Our aides are trained, background-checked, and matched to clients based on schedule, language, and care needs.

NHTD and TBI Waiver Programs

For individuals with more complex needs — specifically, those transitioning from or at risk of entering a nursing facility — the Nursing Home Transition and Diversion (NHTD) waiver and Traumatic Brain Injury (TBI) waiver programs offer a broader range of services than standard personal care.

These are Medicaid home and community-based service (HCBS) waivers. They are designed to support individuals who need nursing-facility-level care but choose to live in the community. Services can include:

• Personal care and home health aide services
• Community integration counseling
• Assistive technology
• Structured day programs
• Respite care for families
• Transportation support

Who qualifies: NHTD is for adults 18 and older with a physical disability. TBI is for adults 18–64 with a traumatic brain injury diagnosis. Both programs require Medicaid eligibility, a functional needs assessment, and enrollment through the New York State Department of Health.

Enrollment takes time. Families who may qualify should begin the process as early as possible. Priority Cares can help connect families with a waiver service coordinator who manages the enrollment and service planning process.

Managed Long-Term Care (MLTC)

MLTC is a Medicaid managed care program that coordinates long-term services for individuals who need home care on an ongoing basis — typically defined as 120 days or more.

Under MLTC, a managed care plan coordinates all long-term care services, including personal care, home health aide services, adult day care, medical transportation, and nursing home care if needed. The plan authorizes services based on an assessment of the enrollee’s needs.

Who qualifies: Adults 18 and older who are Medicaid-eligible, live in the community, and require community-based long-term care services for 120 or more days.
Why families use MLTC: MLTC consolidates care coordination in one place. Rather than managing multiple service authorizations separately, the MLTC plan handles coordination across services. For families managing complex care needs, this reduces administrative burden.

Priority Cares works with MLTC-enrolled clients in New York. If your family member is currently enrolled in an MLTC plan and needs a new home care provider, we can work directly with the plan to set up services.

Get a Free Care Assessment

Navigating Medicaid home care programs in New York is not straightforward. Program eligibility, enrollment timelines, and service authorization processes vary by program and county. Families often benefit from speaking with someone who knows the system directly.

Priority Cares Home Care Services offers free care assessments to help families understand which program is the right fit. Call us or visit prioritycareshs.com to schedule a conversation with our care team. We serve clients across New York City and surrounding counties and can walk through your options at no cost or obligation.