In CDPAP, the consumer—or a designated representative—directs the personal assistant’s work. The assistant provides the authorized care. The fiscal intermediary handles payroll administration, while the Medicaid plan or local district handles service authorization. Knowing these boundaries helps a family send a problem to the office that can actually resolve it.
Checked November 5, 2026. CaringNYC provides care-resource education; it is not a care provider, enrollment agent or government office. This explanation is general information, not a decision about an individual’s eligibility or legal responsibilities.
The five roles at a glance
The division between directing care and administering payroll is established in New York Social Services Law § 365-f. Use this table to assign names to the roles in your household.
| Role | Main responsibility | What to clarify |
|---|---|---|
| Consumer | The person receiving CDPAP services; directs care when able to do so. | Who will recruit, instruct, supervise and schedule assistants? |
| Designated representative | Performs the consumer-direction responsibilities on the consumer’s behalf. | Who is formally recognized, and how can that person be reached? |
| Personal assistant | Provides care under the consumer’s or representative’s direction. | Which authorized tasks and shifts will this assistant cover? |
| Fiscal intermediary | Processes wages, benefits and required withholdings and maintains employment records. | Which registration or payroll item needs attention? |
| Medicaid plan or local district | Handles the service plan and authorization through the applicable assessment process. | What tasks, hours and authorization dates are approved? |
Consumer direction is an ongoing job
Choosing someone familiar is only the beginning. A workable arrangement needs instructions, a schedule, a way to check work and a response when the assistant is absent. A trusted relative may understand the person’s preferences but still need specific instruction about the authorized duties. Write down what should happen rather than assuming that a family relationship supplies that understanding.
For example, a fictional household might identify one person to organize the schedule and another to help read notices. That informal help does not establish either person as the designated representative. Ask the plan or district which person is recorded in that role, what documentation is required and how a change is made. Avoid an arrangement in which everyone assumes someone else approved the time record.
A representative is different from a helpful visitor
A relative who attends appointments, interprets family preferences or keeps a calendar is not automatically the CDPAP designated representative. The role concerns responsibility for directing the service. The accessible text of 18 NYCRR 505.28 describes the representative’s duties and restrictions, including that the representative cannot also be that consumer’s paid personal assistant. Confirm the arrangement with the authorizing office before assigning both jobs to one person.
What the fiscal intermediary does—and where its role ends
The Department of Health’s current CDPAP information identifies PPL as the statewide fiscal intermediary. Its public registration route is an administrative route, not an award of care hours. A facilitator may help someone navigate registration; that help should not be confused with an independent authority to approve care.
Payroll support does not transfer day-to-day management to the fiscal intermediary. The statute separates its administrative responsibilities from hiring enough assistants, scheduling them and supervising care. If an assistant calls out, a payroll representative is not the household’s replacement-staffing manager. Keep the backup plan beside the schedule, where the person directing care can use it.
Employment terminology can also be confusing. Program documents describe the consumer’s employer responsibilities, while payroll materials may use employer-of-record language. Ask PPL to explain its paperwork and the consumer agreement together. Do not infer from either label that the family can set a different payroll rule or that PPL will take over supervision.
Send the question to the right place
- “The assistant’s time entry is missing.” Start with PPL’s payroll support, with the service date and error message ready.
- “The person now needs help with an additional daily task.” Contact the plan or local district about a review of care needs and authorization.
- “Our usual assistant cannot come.” Activate the household’s backup arrangement and notify the care manager if authorized care cannot be covered.
- “Our representative can no longer manage the arrangement.” Tell the plan or district promptly and ask how to document the change.
The state CDPAP page lists PPL support at 1-833-247-5346 and also directs consumers to their managed care plan or local social services district. Keep the plan’s own member-service and care-manager contacts from current correspondence. A general website cannot see the authorization or resolve a personal payroll case.
Make a one-page responsibility map
On paper, record: consumer’s preferred way to give instructions; recognized representative, if applicable; primary and backup assistants; person who reviews time; PPL contact; plan or district contact; and where the current care plan is stored. Next to each responsibility, write one name and a backup contact method. Leave unresolved roles marked “needs confirmation,” rather than quietly assigning them.
Begin by locating the current authorization and asking who is officially recorded as directing care. For broader service terminology, read Home Care Service Terms to Clarify. Continue through the CDPAP resource page, Home Care & Senior Services or the CaringNYC home page.