Complete the CDPAP form below to determine eligibility and start the Medicaid approval process for the CDPAP program. Providing accurate information will ensure a smooth process.

Please note that the patient requiring assistance must be 21 years or older and have a long-term health condition or disability requiring assistance with daily living activities.

We prioritize our client’s privacy and confidentiality and use this information solely to determine eligibility for CDPAP.

After submitting the CDPAP form, we will contact you to discuss your application status, outline the following steps, and answer any questions.

If you have any questions or need help filling out this form, contact us at 718-395-6329 or contact@cdpaphc.com.


id number
The Medicaid Client ID number (CIN) is preferred and can be located on the patient’s NYS EBT card or with the SSN.