New York’s home health care is changing: Here’s Gov. Hochul’s plan and a breakdown of what you need to know

Gov. Kathy Hochul announced more than a month ago that the state has chosen Georgia-based Public Partnerships to manage its Consumer Directed Personal Assistance Program (CDPAP) — which provides essential home care services to around 250,000 New York residents covered by Medicaid — and dozens of facilitators were recently chosen to join the revamped network.

Following the state’s decision to consolidate CDPAP management under Public Partnerships, consumers, providers and disability rights advocates have raised concerns about relying on a single statewide fiscal intermediary, fearing it could lead to job losses for local providers and disrupt essential services for CDPAP clients.

Given the size and continued growth of the program, implementing the new proposal could be challenging without impacting services, according to Elite Choice, a company that exclusively services clients who use CDPAP for self-directed home health care.

Hochul, however, said that CDPAP eligibility for home care recipients will remain unchanged, with no need for current users to reapply, and that the initiative is designed to ensure timely caregiver payments and uninterrupted services.

With changes to home health care underway in New York, set for full implementation by April 1, here are answers from the state to key questions:

What will be the role of Georgia-based Public Partnerships as the new lead partner for New York’s CDPAP? What does it entail?

Public Partnerships will serve as the statewide fiscal intermediary for CDPAP, operating the contract from New York while relocating its headquarters to the state. Specifically, Public Partnership will:

• Help individuals register for the program
• Provide training and education to consumers
• Collaborate with state and health plan case managers to support consumers
• Work as a joint employer with consumers to support caregivers (personal assistants)
• Issue payroll to personal assistants
• Ensure compliance with Medicaid and program requirements
• Identify and address fraud, waste, and abuse in collaboration with the state
• Handle taxes and required reporting

The state’s Health Department has conditionally approved additional partners for New York’s statewide CDPAP partnership. What is their role, how does it differ from Public Partnerships’s?

The 24 new organizations in the network are called CDPAP facilitators. They will help consumers and personal assistants register with Public Partnerships, and support consumers with training, education and customer service. Both Public Partnerships and their facilitator partners will provide multi-lingual, accessible support that is culturally and disability competent.

While both Public Partnerships and their partners will provide registration and customer service support, Public Partnerships is the only entity that will be issuing payroll, handling the billing, and reporting requirements of the contract.

What will happen to the more than 600 “fiscal intermediaries” (home care agencies) currently managing tasks like payroll and acting as a liaison between Medicaid and service providers? What other roles did they have?

Some of the current fiscal intermediaries will become partners with Public Partnerships, known as CDPAP facilitators. These facilitators will help consumers and personal assistants get registered with Public Partnerships and support consumers with training, education, and customer service.

Public Partnerships is hiring over 1,200 New Yorkers to help operate the program, specifically seeking individuals with prior CDPAP experience, including staff who may be transitioning from other fiscal intermediaries.

Will the current model, where individuals with long-term health needs receive in-home care from a caregiver of their choice, often a family member or friend, remain the same or change?

The model will remain the same. CDPAP eligibility for home care users will stay unchanged, and consumers will continue to have the same caregiver choices and access to program services.

What was the overall motive of the change in CDPAP?

With over 600 fiscal intermediaries, New York had more than all the other states combined.

“It was simply not possible for the State to perform the oversight needed to ensure CDPAP was delivering value to every home care user and that this Medicaid-funded program was financially sustainable,” Sam Spokony, spokesperson for Hochul, said.

He added that the lack of centralized oversight for CDPAP in New York led to skyrocketing administrative costs.

Total spending on CDPAP nearly quadrupled in the past five years, rising from $2.5 billion in 2018 to over $9 billion last year. More than 328 million hours of home care were provided through the program last year, reflecting a 262% increase since 2018.

The increase in spending outpaced the growth in hours — indicating higher costs associated with the program.

“If the program were to face a financial collapse due to ballooning costs and failure for spending to keep pace, that would be devastating for people who rely on CDPAP,” Spokony said. “The State’s reforms will directly address these problems while ensuring that CDPAP services remain the same for the New Yorkers who rely on it.”

Hochul told Bloomberg News that the home health aide program is being exploited.

Just last week, the State Comptroller found that New York State paid $14.5 billion for Medicaid home care services without verification that the services actually took place.

And last month, eight people were charged with defrauding New York’s Medicaid home care program by allegedly stealing $68 million through a bribery and kickback scheme.