New York’s CDPAP Reform Is Delivering Results for Patients, Workers and Taxpayers
Major reforms are never easy — especially when they involve a program as important as New York’s Consumer Directed Personal Assistance Program (CDPAP). There are hundreds of thousands of New Yorkers, many living with complex chronic illnesses, who rely on CDPAP to ensure they can receive vital home care services in a familiar environment, delivered by the people who know their needs best — a family member, friend, or trusted aide. As it became clear this important program wasn’t sustainable without major reforms, Governor Kathy Hochul and lawmakers courageously passed legislation replacing a patchwork of hundreds of fiscal intermediaries with a single organization that more efficiently manages key aspects of the program.
Today, nearly a year later, the data and real-world experience reveal the transition is working, despite strong opposition from those who stood to benefit from the old system. Patients are getting the care they need. Workers are seeing stronger support and benefits. And New York taxpayers are saving billions.
Governor Hochul deserves enormous credit for leading this effort. For years, CDPAP operated through a fragmented network of more than 600 fiscal intermediaries. Oversight varied widely, costs grew rapidly, and accountability was inconsistent. The transition to a single fiscal intermediary created uniform standards, strengthened oversight, and modernized systems that consumers and workers rely on every day. Most importantly, it protected continuity of care while putting the program on a sustainable path forward.
The financial impact alone is significant. The transition is on track to save New York taxpayers more than $1 billion. Those savings are being achieved by eliminating waste, reducing excessive administrative costs, and strengthening program integrity — not by reducing services for people who depend on care. That is exactly how government should work: protecting essential services while ensuring taxpayer dollars are used responsibly.
At the same time, patients and families continue to receive the support they need. Today, more than 200,000 consumers and more than 260,000 personal assistants participate in CDPAP across New York. The transition replaced inconsistent systems with a single, accountable structure designed to ensure care is delivered safely, reliably and transparently.
Recent survey results reinforce that progress. A January 2026 statewide survey — the largest since the transition — collected feedback from nearly 95,000 consumers, designated representatives and personal assistants. Overall satisfaction with the statewide fiscal intermediary rose to 4.31 out of 5, up from 4.04 in 2025. Satisfaction with timekeeping systems increased as well, reflecting improved transparency, easier scheduling and clearer visibility into hours and authorizations.
Equally important, the transition has strengthened support for the caregiving workforce. Under the previous system, benefits varied widely and were often unavailable. Today, personal assistants have access to standardized benefits, including paid time off, holiday pay, training opportunities and access to health insurance and retirement options. For many caregivers, this is the first time these benefits have been available. Supporting caregivers helps stabilize the workforce and ensures patients can rely on consistent, high-quality care.
Survey responses also highlighted how much has improved. Personal assistants reported stronger communication, easier-to-use technology and clearer program requirements. Consumers reported better access to information and more consistent oversight. These are meaningful improvements for people who depend on CDPAP every day.
Critics of the transition raised concerns early on. Large-scale changes are always challenging, and we listened carefully throughout the process. But the results are clear. The transition preserved care, strengthened program integrity and improved the experience for consumers and workers alike. The alternative — maintaining a fragmented system with inconsistent oversight and rising costs — was simply not sustainable.
New York is committed to ensuring CDPAP remains strong for the long term. We will continue listening to participants, making improvements where needed and ensuring the program meets the needs of the people it serves.
This transition shows what is possible when government takes decisive action to strengthen essential programs. By modernizing CDPAP, New York has improved care delivery, supported workers and protected taxpayer dollars — while ensuring that people who rely on home care services can continue to live safely and independently in their communities.
Dr. James McDonald, New York State Commissioner of Health
