Rollout of New York’s state Medicaid program is receiving close scrutiny from advocacy groups—and now, the federal government.
The Consumer Directed Personal Assistance Program, or CDPAP, is the state’s home health Medicaid program, which allows eligible members to hire a personal caregiver of their choice. The program provides services to chronically ill or physically disabled individuals.
Program beneficiaries and caretakers were required to enroll in the $9 billion CDPAP overhaul by April 1. In the past, the program used more than 600 facilitators to process payments, benefits and records, but under new changes, the program would now be under the control of just one Georgia-based company, Public Partnerships LLC.
Over concerns from how the shift could impact enrollees, a judge recently extended a temporary restraining order (TRO) to block the changes until April 14.
At several points since being installed as Department of Health and Human Services (HHS) Secretary, Robert F. Kennedy Jr. has posted about the program on X.
“Costs in the NY State Medicaid CDPAP program rose from $2.5B in 2019 to a projected $12B in 2025, with future projections on a steep upward trajectory,” he wrote. “New York has filed a state plan amendment related to substantial changes to this program, and we are taking a 90-day review period to assess the updates for consistency with federal law. This review allows the federal government to evaluate how the changes affect access to care and evaluate the appropriate use of federal dollars.”
Kennedy previously told the CMS to continue reviewing the program. The agency told Fierce Healthcare the program would be evaluated on program integrity, consumer choice and other program requirements.
Democratic Governor Kathy Hochul’s management of the program has drawn national criticism, including from the influential right-wing influencer account “Libs of TikTok” in viral videos on social media.
Hochul has maintained that the program’s change is crucial to crack down on waste, fraud and abuse in the Medicaid program, but Public Partnerships LLC’s involvement has been slammed by lawmakers on both sides of the aisle.
“Thousands of families who rely on CDPAP for critical healthcare face devastating disruptions due to a hastily put together enrollment period, language barriers and insufficient outreach,” said Democratic State Senator John Liu in a statement before the court TRO.
“Separately, Public Partnerships LLC, the company awarded the sole fiscal intermediary contract by the governor, has a history of financial mismanagement as well as no experience working in New York,” said Republican Representative Mike Lawler in December. “There have also been questions raised about rigging in the bidding process.”
A host of lawsuits have popped up in recent months, challenging the nature of the state’s decision to award the program solely to the out-of-state company. Home care company Freedom Care LLC, a business spurned by the state, sued the health department and said the bidding process was rigged against applicants, reported the Times-Union.
Conservative think tank The Empire Center filed lawsuits in December against CDPAP for withholding public records obtainable under the Freedom of Information Act to acquire a better sense of why the program has grown so rapidly. The program covers 250,000 members at more than $9 billion per year, the organization said.
This group said it believes the CDPAP overhaul is a plot to make it easier for the state’s home health workforce to unionize, under just one employer, through 1199 SEIU. The changes are also opposed by the New York Association on Independent Living, a disability rights group in the state.
And many caregivers would likely lose their health insurance, or pay more for worse coverage, the pro-labor think tank Fiscal Policy Institute concluded.
Public Partnership LLC and the CDPAP program have attempted to defend the changes.
“This misinformation campaign has been going on for months, ever since the legislature enacted a measure to reform CDPAP by (1) eliminating the 600+ unregulated, unmonitored, and overpaid CDPAP fiscal intermediaries and (2) replacing them, through a competitive procurement, with a single, fairly-compensated, accountable and closely-monitored statewide fiscal intermediary," Public Partnerships LLC said last month, adding the uncertainty is disrupting the transition for members.
The state said Public Partnerships LLC will relocate its headquarters to New York and create 1,200 jobs once the move takes effect.
New York’s Department of Health released a public service announcement this year, saying members will not lose access to home health care and are able to keep their current caregiver.
Gov. Hochul has criticized CDPAP and said the program needs stronger oversight to ensure caregivers are providing adequate care. The Department of Justice unsealed indictments of CDPAP intermediaries for a $68 million Medicaid kickback scheme in October. An HHS Office of Inspector General report from 2018 found the state improperly claimed nearly $75 million (PDF) in federal Medicaid reimbursement.
Since 2017, Public Partnerships LLC has faced lawsuits over underpaid or denied overtime wages.
Homecare advocacy group Consumer Directed Action of New York opposes the program takeover, pointing to news reports and analyses from other states over the years that paint the company in a negative light.