New York is headed toward a disaster of its own making in the home care sector

By Pinny Faska | August 31, 2021

New York is headed toward a disaster of its own making in the home care sector. A shortage of workers and lack of adequate pay are leading to a sharp decline in services available to New Yorkers who need them. But equally pressing is the crisis facing hundreds of home care agencies who are being put out of business by the Department of Health.


Last February, Cuomo’s DOH decided to eliminate over 75% of providers of a popular Medicaid home care program called CDPAP, which allows home care recipients on Medicaid to hire people close to them, like family, friends, neighbors, or others to assist with daily activities. All of this is causing a sweeping dismantling of New York’s system of homecare, impacting seniors, people with disabilities and others who need assistance to remain independent in their communities. This is one of Governor Cuomo’s most lasting policy failures and Governor Hochul must turn the situation around immediately or risk presiding over what has become the worst state in the nation for home care.


CDPAP is one of the most popular home care programs in New York mostly because of how convenient it is for recipients and workers alike. The way it has worked for decades is simple. Patients or their designated representatives pick their preferred caregiver and then work with an agency to handle all the administrative tasks like bill processing through Medicaid, payroll and benefits. It serves over 139,000 people and continues to grow each year because it is the perfect option for those who want more control over their care and would rather receive assistance from someone they know. CDPAP also provides a financial lifeline to caregivers who spend time aiding a loved one but miss out on work as a result.

That’s why the State’s move to destroy hundreds of agencies who administer CDPAP it is so baffling. Prior to 2021, there were almost 500 agencies in the State approved by DOH to manage this program. But next year, if nothing is done to stop the State’s actions, that number will be slashed to only 68 agencies. With such a drastic cut, CDPAP will collapse under its own weight, abandoning home care recipients and caregivers to their own devices.


What’s worse is the State is expected to make a similar move against other home care providers called LHCSA’s which mainly serve Medicaid recipients as well. None of this serves any purpose other than to diminish home care options for people who need them.

The kicker is if the State follows through on its plans, it risks losing over $2 billion in federal Medicaid funding promised through President Biden’s COVID stimulus bill. This misguided home care policy is all loss and no gain for the taxpayers of New York.


In diminishing home care in New York, the State is putting itself behind the curve. Across the country, community-based care is recognized as the most dignified, desirable, and cost-effective way to ensure seniors, people with disabilities, or anyone else who requires assistance, can live life to the fullest. In some instances, assisted living facilities and nursing homes may be necessary, but in the instances when they are not, policymakers have a responsibility to ensure there are options available to keep people at home where they belong. New York should be supporting those opportunities, not taking them away.


The combination of uncompetitive salaries, a labor shortage, and the dismantling of entire home care programs creates an untenable situation for hundreds of thousands of New Yorkers who depend on home care. If New York continues down this path, it is relegating people who could otherwise live in the comfort of their homes to institutional settings like assisted living or nursing homes or forcing them to live without the care they need. Family members who care for loved ones will be forced to choose between returning to work or tending to the needs of their relative without compensation. This is neither acceptable nor necessary. We hope under Governor Hochul, the State restores rational thinking into its policymaking and stops abolishing home care.


The writer is a founding board member of New York Advocates for Home Care, an association dedicated to preserving the future of home care in New York State.