With consistent oversight, New York’s CDPAP is stronger than ever
It’s been several months since Public Partnerships LLC (PPL) officially became the sole fiscal intermediary (FI) for New York’s Consumer Directed Personal Assistance Program (CDPAP). As I reflect on how far we’ve come, it’s important to remember that this wasn’t just a simple switch from one organization to the next. Streamlining the program from more than 600 FIs was one of the most complex transitions in Medicaid history.
Hundreds of thousands of New Yorkers depend on CDPAP to live safely and independently in their own homes, supported by people they trust. Unfortunately, in the years leading up to the single FI transition, aspects of the program had simply gotten out of hand. More than 600 FIs were scattered across the state, which made it challenging to manage the program and consistently enforce its rules. As a result, essential mechanisms to ensure a thriving CDPAP dissipated.
When PPL assumed our current role, one of our primary goals was to implement the oversight that the program lacked. We wanted to ensure that resources and taxpayer dollars were going toward those they were intended to support, and that the New Yorkers who rely on CDPAP as a lifeline could count on it to deliver the highest quality care.
A central tenet of our work is keeping the consumer at the heart of self-directed care. That’s why we’ve enhanced a key aspect of CDPAP: consumer control. Under the prior system, basic procedures, such as ensuring the consumer verifies and signs off on the accuracy of timesheets before payments are issued to personal assistants (PAs), were sporadically enforced. Our approach validates the accuracy of reported work time and, importantly, allows us to work with the consumer and PA to remedy any discrepancies.
Since requiring this practice across the board, we have identified nearly 120,000 hours that went unapproved for 30 or more days, meaning PAs logged time that was not approved by the consumer. That time amounts to more than $4 million annually, saving taxpayer dollars by centering consumer controls.
More broadly, our centralized system features unique PA identifiers, electronic visit verification (EVV), comprehensive validation of program rules, streamlined timekeeping processes, and systemic validation of time against approved service authorizations. These capabilities help ensure CDPAP is sustainable for the long term and that its resources go directly to those who need them. They also enable us to manage the program responsibly and put an end to practices that previously placed PAs and consumers at risk and strained the entire CDPAP system.
For example, using these tools, we identified PAs who were working unsustainable hours, jeopardizing the health and safety of themselves and the consumers they serve. By reviewing timesheets, we found over 1,000 PAs who submitted more than 20 hours per day for 3-9 consecutive days, as well as at least 60 PAs who logged over 20 hours daily for at least 10 consecutive days. In the most extreme cases, these patterns may also reflect abuses of the system, which we have been able to flag and investigate in partnership with the New York State Department of Health.
Additionally, under longstanding CDPAP rules, PAs are not permitted to submit overlapping work hours for multiple consumers. However, under the previous structure, some PAs bypassed this requirement. This went undetected because they worked for consumers who had different health plans and FIs. Once again, PPL’s centralized oversight allows us to ensure that this practice does not continue, and that every consumer receives the one-on-one care the program promises.
Above all, we are committed to the health and safety of both consumers and their caregivers. One way we’re upholding this promise is by ensuring that every PA completes an annual health assessment — a safeguard that has long been required by New York State. Previously, this was not well enforced by the hundreds of prior FIs, and many PAs were unaware of this requirement. This raises additional questions about how many other program rules were overlooked by the old Fiscal Intermediaries.
Each of these measures have given us a clear, data-driven picture of how CDPAP functioned in the past and how we could improve it. That understanding has been invaluable — allowing us to refine processes, close long-standing gaps, and build a stronger foundation for the future. We’re proud of the progress we’ve made and the standards we continue to uphold today.
Change — especially of this scale — takes time, and a new system will never be perfect overnight. But since April 1, 2025, PPL has brought increased consistency, transparency, and accountability to this crucial program. By enhancing oversight of CDPAP, we’re improving it for the many thousands of New Yorkers who currently depend on it to deliver-high quality care, while also making sure it’s available to future generations.
Miki Kapoor is CEO of Public Partnerships LLC (PPL).
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