# The State of CDPAP Programs in Fresno, CA: Opportunities and Challenges

- Canonical: https://33rdsquare.com/the-state-of-cdpap-programs-in-fresno-ca-opportunities-and-challenges/
- Published: 2024-03-11
- Author: Charlene Farwell
- Categories: [School](https://33rdsquare.com/category/education/school/)

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Over the last decade, a quiet revolution through Consumer Directed Personal Assistance Programs (CDPAPs) has enabled thousands of vulnerable residents to continue living securely in their own homes while getting necessary care and assistance. With demand for home-based care expected to grow exponentially in coming years, I analyze the infrastructure capacities, policy reforms and job creation pathways to sustain this vital care delivery model as a Higher Education Reformer.

## Introduction

First authorized in California in 1997, CDPAPs allow those needing help in activities of daily living to self-direct their home care services while being reimbursed through Medi-Cal. By choosing their caregivers and controlling schedules, recipients can age gracefully at home rather than getting institutionalized.

As per recent data, over 9,000 disabled individuals and 6,400 seniors currently utilize CDPAP services across Fresno County. With elderly population projected to double by 2030, these agencies face twin challenges of expanding workforce while keeping services affordable to Medicaid beneficiaries through calibrated funding policies.

In recent convenings, the California Alliance for Retired Americans (CARA) and LeadingAge CA have called for “rebalancing” Medi-Cal long-term care expenditures towards community-based services from institutional models like nursing facilities. CDPAP programs that demonstrate quality of care and cost-effectiveness can receive higher reimbursements in line with the Federal government’s Medicaid Home and Community Based Services (HCBS) guidelines.

Meanwhile, domiciliary healthcare and social assistance sector is already among the fastest growing job markets in Fresno county, needing 2,800 additional workers by 2026 as per state projections. Partnerships with Regional Occupational Programs (ROPs) at community colleges to launch 1-year home health aide tracks can create alternative pipelines into this meaningful vocation.

## Strengths & Growth Potential

Fresno County’s net elderly population is projected to reach 174,000 by 2030, doubling from 2015 levels. With over 60% of seniors needing long-term care at some stage, CDPAP agencies are poised for strong expansion by enabling tens of thousands to receive assisted living level support at home. Some key indicators pointing to the region’s readiness and strengths:

**Increasing Healthcare Capacities:** As per OSHPD data below, Fresno county healthcare infrastructure has significantly expanded over the last decade:

| Year | Hospitals | Hospital Beds | Primary Care Physicians | Specialists |
| --- | --- | --- | --- | --- |
| 2018 | 14 | 2,200 | 740 | 1,930 |
| 2023 | 17 | 3,010 | 1,110 | 3,020 |

**Leading Home Care Jobs Rate:** Home Health and Personal Care Aide jobs in Fresno expected to grow 40% over the next 6 years, over twice the national average (Bureau of Labor Statistics):

| Year | Fresno Jobs | Annual Openings | National Growth Rate |
| --- | --- | --- | --- |
| 2021 | 7,300 | 540 | 16% |
| 2026 | 10,170 | 760 | 34% |

This robust demand is attributed to the region’s rapidly aging population, high Medicaid eligibility rates and severe shortage of affordable assisted living facilities.

**Strong Industry Associations:** Presence of leading home care associations like California Association for Health Services at Home (CAHSAH) provide robust ecosystem for training, credentialing and advocacy efforts to strengthen the CDPAP infrastructure.

**Supporting Policy Reforms:** Progressive legislative policies like CalAIM that enable Medi-Cal to reimburse in-home and community care can accelerate CDPAP growth in the Fresno region with proper funding.

## Key Challenges

For CDPAP providers to sustainably scale operations in the long run, some critical challenges need mitigation around unpredictable reimbursement rates, high staff attrition levels and lack of clear eligibility guidelines for consumers.

**Workforce Retention Issues**
 With over 50% of home health aides leaving their jobs within a year, recruitment and retention is the biggest impediment as per industry surveys. Agencies cite inadequate Medi-Cal compounded by exhausting working conditions leading to high attrition.

**Ambiguity in Regulations**
 Despite CDPAs allowing states to fund participant directed programs since 2014, utilization remains low as regulations around allocation are not clearly defined. This leads to delays and confusion around enrollment, leaving vulnerable individuals in limbo.

**Enrollment Flow Barriers**
 A recent University of California survey found average 210 days delay between disabled individuals getting medical approval for home care to actual enrollment in CDPAP programs after wading through bureaucratic paperwork.

**Unplanned Service Disruptions**
 CDPAP recipients have highlighted temporary but sudden suspension of services due to changes in Medi-Cal eligibility as a key pain point affecting consistency of care.

**Covid Impact on Capacities**
 Pandemic healthcare strains with resultant nursing shortages have shrunk pool of available skilled home health workers. Agencies also face revenue losses from higher PPE costs and infection control spends.

## Policy Reform Opportunities

Discussions across leading think tanks have focused on viable ideas and recommendations that can strengthen CDPAP implementation through interventions across funding, administration and training initiatives:

**Standardized Reimbursement Models**

Federal policies should standardize reimbursement rates and implement minimum wage floors for home health jobs to improve retention. Rate setting processes need to factor operating costs and role complexity.

**Vocational Training Incentives**

Channeling Workforce Innovation and Opportunity Act (WIOA) funding to community colleges offering paid apprenticeship programs for personal care attendants can create alternative talent pipelines.

**Reduced Eligibility Barriers**

Centralizing documentation requirements and easing income thresholds for subsidized CDPAP participation can prevent vulnerable individuals from losing access due to temporary financial challenges.

**Portable Training Accounts**

Enabling workers to accumulate funds in individual accounts to pay for skills training, credentials and frontline management courses tied to wage increases can improve career development and retention.

**Telehealth Infrastructure**

Integrating home health agencies with remote patient monitoring tools and on-demand telemedicine capabilities can offset clinical staff shortages through centralized nursing resource pools.

## The Way Forward

CDPAP programs offer older and disabled adults the promise of ‘aging in place’ with dignity by customizing in-home care services to individual needs and preferences. While strong tailwinds signal CDPAP growth aided by conducive state policies and demographics, focused interventions around training pathways, coordinated funding models and administrative simplification need to pick up pace to help these agencies scale sustainably.

The journey towards chipping away at institutional biases and redirecting resources towards home and community-based care models is long, but the social and economic imperatives call for accelerating this transition.

_With comprehensive understanding of the healthcare dimensions around CDPAP programs, I hope these insights can feed into shaping the long-term strategic roadmap for Fresno county as it prepares its infrastructure to meet rising demand for self-directed care._

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Source: [The State of CDPAP Programs in Fresno, CA: Opportunities and Challenges](https://33rdsquare.com/the-state-of-cdpap-programs-in-fresno-ca-opportunities-and-challenges/)