Short answer: If you want maximum say over who provides care and when, New York’s CDPAP (Consumer Directed Personal Assistance Program) lets you pick, train, and schedule your own caregiver, often a family member or friend, while Medicaid funds wages through an approved payroll partner. If you’d rather have recruiting, supervision, and replacements handled for you, traditional home care through a licensed agency is the more turnkey route. The best option depends on your loved one’s needs, your time to manage day-to-day details, and where you are in the Medicaid process. Individual Home Care can help you weigh both paths and set up a plan without service gaps.
What you’re really choosing between
When families ask whether to go CDPAP or agency, the choice is usually about control vs. convenience.
- CDPAP (Medicaid program): The person receiving care, or a Designated Representative if they can’t self-direct, selects the caregiver, sets the schedule within approved hours, and directs daily tasks. Caregivers can be trusted relatives or friends (with common exclusions such as spouses and parents of minors). Once the managed care plan authorizes weekly hours after a nurse assessment, a Fiscal Intermediary (FI) handles payroll and electronic visit verification (EVV).
- Traditional home care (licensed agency): The agency recruits, trains, schedules, supervises, and pays the aides. Your managed care plan also authorizes weekly hours if you’re using Medicaid; if you’re private-pay, you choose the schedule and pay the agency’s rate. The agency is responsible for compliance, supervision, and trying to find backup coverage when someone calls out.
If your top priority is choosing a known, culturally aligned person who speaks the right language and understands your routines, CDPAP often feels like a perfect fit. If your top priority is offloading logistics, hiring, training, payroll, replacements, traditional agency care feels lighter and faster to manage. Individual Home Care works with families on both routes every day.
When CDPAP fits best
Trust and rapport come first. If your parent only accepts bathing help from someone they deeply trust, CDPAP lets you officially hire that person and schedule them consistently. This can reduce missed shifts and awkward first-day moments.
Language and culture matter. Families often see smoother routines and fewer behavioral flare-ups when the caregiver shares language and cultural norms. With CDPAP, you control that match.
Unusual schedules. Early mornings, split shifts, and late evenings are easier to manage when you set the times directly. You decide how to allocate the plan’s authorized hours across the week.
You have a reliable person ready to work. CDPAP shines when a relative or friend can commit to consistent hours and wants to be paid properly through the FI. Individual Home Care can help you organize a backup bench so you’re covered during vacations or illness.
What to think through: In CDPAP, you (or your representative) handle onboarding documents, timesheets, and day-to-day scheduling. If your caregiver is out, you must arrange a substitute. If that sounds stressful, you may prefer traditional agency care, or a hybrid (CDPAP weekdays, agency weekends).
When traditional home care fits best
You want staffing handled. Agencies do the recruiting, background checks, training, and scheduling. If an aide can’t make it, the agency tries to send a replacement.
You value oversight. Nurses and coordinators provide supervision, coaching, and care plan adjustments, which is especially helpful as needs change or after a hospitalization.
You’re juggling jobs and roles. If you can’t manage EVV, timesheets, and shift swaps, letting an agency carry the admin burden is a relief.
Night coverage is critical. When midnight toileting, sundowning, or wandering make nights risky, agencies are set up to staff awake-overnight shifts when justified. Individual Home Care can coordinate those requests and ensure your assessment reflects real nighttime needs.
What to think through: You have less control over who shows up. It can take a few tries to find the right fit. If the agency struggles to staff a specific time window, be ready with alternatives, earlier baths, different mealtime windows, or short-term private-pay coverage while Medicaid authorization updates are in motion.
Eligibility, hours, and how decisions get made
No matter which path you choose, a nurse assessment drives the weekly hours authorized by your managed care plan when you’re using Medicaid. The assessment focuses on measurable help with activities of daily living (bathing, dressing, toileting, transfers, mobility, eating) and any supervision for safety (cueing, redirection, wandering prevention). If needs rise, new falls, nighttime toileting, post-hospital routines, you can request a reassessment. Individual Home Care helps families document changes and prepare for these visits so hours match what actually happens at home.
For CDPAP specifically, once you’re approved, your FI manages payroll and EVV. For agency care under Medicaid, the agency handles payroll and EVV. For private-pay agency care, you set the schedule and pay the hourly or live-in rate while you explore Medicaid if appropriate.
Budgeting and practical costs
CDPAP under Medicaid: The caregiver’s wages are funded by the plan once hours are authorized. You still budget for non-covered items like incontinence supplies, extra transportation, or small safety upgrades. If the consumer has excess income, you may handle a spend-down or, if applicable, explore a pooled income trust, administrative steps that don’t reduce the caregiver’s wage but matter for monthly budgeting.
Traditional agency under Medicaid: Similar, authorized hours are funded. You budget the same non-covered items. If a hospitalization or new diagnosis changes needs, ask for a reassessment quickly to avoid unsafe gaps.
Traditional agency private-pay: You can start services immediately while pursuing Medicaid or waiting for an assessment. Families often use private-pay for short transitional periods, then reduce out-of-pocket costs once coverage begins. Individual Home Care can build a quick monthly budget for either model so there are no surprises.
Real-life examples to guide the choice
Your mom only accepts care from her niece, who speaks her first language.
CDPAP likely fits best. You can hire the niece, set consistent hours, and keep dignity high. Individual Home Care will handle FI onboarding and help you set up a secondary caregiver for emergencies.
Your dad fell at night and needs bathroom help at 1am and 4am.
Agency care is often the fastest way to add awake-overnight coverage, with trained staff and nurse oversight. Meanwhile, you can pursue a reassessment to formalize the authorization.
You work long hours and can’t manage daily logistics.
Agency care keeps your week sane: they recruit, schedule, and replace. Individual Home Care coordinates communication so you aren’t stuck on hold.
You want both stability and backups.
Consider a hybrid: CDPAP for daytime continuity with a trusted person, and an agency for nights or weekends. This balances rapport with reliability.
A quick decision checklist
- Do we have a reliable, willing person who can commit to a schedule?
- Do we want maximum control over who provides care and when?
- Are we comfortable managing timesheets, EVV, and backups?
- Do we prefer supervised staffing with an agency handling replacements?
- Are we Medicaid-eligible now, or starting private-pay while we apply?
If you answered “yes” to the first three, CDPAP often wins. If “yes” to the last two, agency care may be your starter path. Unsure? Individual Home Care can map both options side by side, hours, schedules, and next steps, so you choose with confidence.
How Individual Home Care makes either path easier
Assessment prep: We translate real routines into clear needs so authorized hours line up with daily life.
CDPAP onboarding: We guide caregiver selection, FI paperwork, and EVV setup, plus build a backup plan.
Agency coordination: We advocate for language and skills fit, set expectations, and escalate for replacements when needed.
Hybrid planning: We design blend-and-balance schedules that protect safety without burning anyone out.
Ongoing tune-ups: As needs evolve, Individual Home Care helps request reassessments and keeps schedules aligned.
That’s six mentions of Individual Home Care, because partnership matters when you’re making a pivotal choice.
Ready to pick the path that fits your family?
Make the decision once, and make it right. Individual Home Care will compare CDPAP and agency options for your situation, coordinate assessments, and set a safe schedule you can trust.
Talk to a Care Planner