A Stronger CDPAP Is Here.
A very small but very loud group is working hard to undermine New York’s Consumer Directed Personal Assistance Program (CDPAP) transition, clinging to a broken system that rewarded noncompliance, raised administrative costs, and failed the people it was supposed to serve. But let’s be clear: the new system is working. With a single entity now accountable for delivering results, New York is ensuring continuity of care for consumers, real benefits – like paid time off and health care benefits – for workers, and reduced costs for taxpayers. This comes at a time when Medicaid programs are most in need of efficiency and sustainability.
As the sole fiscal intermediary (FI) for CDPAP, Public Partnerships LLC (PPL) has completed one of the largest home care transitions in U.S. history, delivering on our commitment to the hundreds of thousands of New Yorkers who rely on this vital program.
The shift to a single FI was a necessary course correction and essential to protecting the program’s sustainability. Under the old model, any company could enroll as an FI, which led to more than 600 entities using inconsistent practices and policies, many of which did not report to the State. To put this in perspective: most states with similar self-direction programs have fewer than three FIs. Many have shifted to just one.
The financial consequences of the old system were also staggering. Some FIs charged administrative fees of up to $1,050 per member per month – 14 times the national average of $75 – pocketing unfair profits off taxpayer funds. Last year, the Department of Justice indicted eight people for defrauding Medicaid out of $68 million using CDPAP funds – just one example of the kind of abuse that existed under the old model. Meanwhile, there was no way to guarantee consumers were getting the care they needed or caregivers were being paid properly. For example, without a unified system for tracking hours, there was nothing to prevent – and plenty of evidence suggesting – abuse of the program, such as personal assistants (PAs) billing for consumers who were out of the country or even deceased.
By 2024, utilization of New York’s CDPAP had grown by 1,200 percent, creating an $11 billion taxpayer burden. This compelled Governor Hochul and the State Legislature to address the chaos. Through legislative action, CDPAP was consolidated under a single FI, with PPL – the largest FI in the country, serving over 20 states – selected through a fair and competitive bidding and evaluation process. Since then, we’ve delivered oversight, structure, and savings.
Gone are the days of $1,050 administrative fees. Now, it’s $68.50 per member, saving the State of New York millions without reducing care. Full-time CDPAP workers now have access to employer-provided health insurance, holiday pay, and a 401(k) plan.
Additionally, consumers are now properly reviewing and approving PA timesheets. Since PPL began oversight of CDPAP, consumers have worked with us to catch and correct inaccuracies in over 74,000 timesheet submissions and communicate those resolutions directly to PAs.
As the single FI, we have a holistic view of the program that makes detection of suspicious behavior much quicker and more effective. We now have a centralized data system that allows us to identify common cases of confusion and root out instances of fraud and abuse.
Educating consumers and PAs on CDPAP program rules has been a cornerstone of this transition. For example, we’ve identified 62,000 time entries where multiple PAs were working for the same consumer at the same time without authorization, and another 59,000 where a single PA was working for three or more consumers simultaneously. Both practices have always been prohibited, and PPL is working proactively to educate consumers and PAs to prevent these issues going forward. Meanwhile, PPL, the New York State Department of Health, and our health plan partners are all actively reviewing these cases – at best to ensure adherence to program rules, and at worst to prevent abuse of the program.
All these measures help ensure the quality care that older New Yorkers and individuals with disabilities rely on and deserve. For the first time, consumers, workers, and taxpayers can be confident that the system is delivering on its promise. This is a stronger, smarter, and more accountable CDPAP.
Transitions like this are complex but necessary. From day one, we’ve worked closely with CDPAP consumers and caregivers to ensure services and payments aren’t interrupted, processing over $2 billion in payroll for more than 230,000 PAs to date. And in a survey completed by 52,000 consumers, their designated representatives, and caregivers, the overwhelming majority reported a positive experience with PPL, with an average score of greater than 4 out of 5 during the transition process.
New York took a bold step to fix a broken system. It’s working. Together, we’re delivering better care and protecting workers through accountability and fairness. We’re proud to be leading this effort, and we won’t let misinformation stop the future New Yorkers deserve.
Patty Byrnes is the Vice President of Government Relations for Public Partnerships LLC (PPL).
