Consumer Directed Personal Assistance Association of New York State
New York should offer Cash and Counseling
as a self-directed option
New York State became a national trendsetter in 1980 when it passed a pilot program to explore a
consumer directed personal assistance (CDPA) program. That program became statewide in 1997 and
now represents one of the fastest growing areas of community-based long-term care. In the time CDPA
has been running, many other states and New York’s Office for People with Developmental Disabilities
(OPWDD) have explored another means of self-direction based on the principal of “cash and
counseling.” This model uses a formula driven by the assessment to develop a budget that the consumer
is in charge of implementing. This provides the highest degree of independence and control possible for
those who want it. New York should add this model to its Medicaid program as another self-directed
option that exists in conjunction with CDPA.
CDPA has provided individuals in need of community-based long-term care with the ability to control
their lives by recruiting, hiring, training, supervising and, if necessary, terminating their own workers.
Taking on this responsibility not only provides consumers with greater independence in how they live
their lives, it provides them with increased confidence and strength that only a program based on the
dignity of risk can.
CDPA has proven successful in a multitude of ways. The service has provided care at the same or higher
levels than traditional models of home care while eliminating problems such as language and ethnic
barriers that have plagued the healthcare system for decades. CDPA improves consumer satisfaction
because consumers are in control of their services. The power of determining who touches your body,
and when, should never be underestimated. Finally, the program is documented at saving tremendous
amounts of money. Based on DOH estimates, it saved the state over $75 million in 2015.
Given these facts, it makes sense to expand this program at this time. Cash and counseling would allow
consumers the power to control more of their health care services in this manner. By providing a service
budget based on an assessment driven formula, consumers would determine what services they need,
the priority level of each, and who provides them. With the exception of exemptions already in law from
CDPA, services requiring a specific professional would still require that status; however, the consumer
would be able to mix their services across multiple agencies based upon their needs and wishes.
Cash and counseling is not only the next logical step from CDPA, it is a step that is
necessary to provide Medicaid recipients with the most choice and control possible as we
implement dramatic new programs such as community first choice, and bring other
programs such as the traumatic brain injury waiver into managed care. It provides the
individualized control and independence that will continue to promote the Triple Aim
while promoting independence, individual control and cost-effectiveness.
For more information on this topic, please contact Bryan O’Malley at the Consumer Directed Personal Assistance Association
of New York State (CDPAANYS) at 518-813-9537 or [email protected].