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In 1995, the state Legislature passed Social Services Law 365-f establishing the Consumer Directed Personal Assistance Program. The program permits eligible chronically ill and/or physically disabled individuals to “recruit, hire and supervise” personal assistants, who are thereby compensated through Medicaid. (See the program description here.)
The CDPAP program is subject to the same challenges confronting every entitlement program:
■ Who is eligible and who is not?
■ How are service providers paid and how much?
■ Who is responsible for regulating and auditing programs to guarantee access and prevent fraud?
That the cost of the program has been growing at an alarming rate is widely acknowledged. Although New York does not directly release figures, the Step Two Policy Project, a policy think tank, has posted a chart compared spending by CDPAP and Licensed Home Care Service Agencies.
Step Two Policy Project founder and chairman Paul Francis
The explosive growth from 2014 to 2022 is largely the result of policy changes that expanded program eligibility, the universe of individuals eligible to be service providers, and a substantial increase in what the providers are paid. As Medicaid is jointly funded by the state and federal governments, the cost of the program has caught the interest of some in Washington. Secretary of Health and Human Services Robert F. Kennedy Jr. recently posted a 2025 forecast of $12 billion.
As discussed by Step Two Policy’s Paul Francis, one approach taken by New York (both under former Gov. Andrew Cuomo and current Gov. Kathy Hochul) aimed at improving the efficiency of program delivery, particularly by reducing the number of fiscal intermediaries who have a significant financial incentive to increase program participation. As Francis observes: “The hope is that incremental measures will reduce … enrollment while preserving services for those who need them the most. No good deed goes unpunished, of course, and Gov. Hochul has paid the price for advancing this commonsense consolidation of FIs by being put on the receiving end of lawsuits and an intense advertising campaign, which seeks to portray the reform as a compassionless reduction of services to recipients.”
The complexity of the issues and the ferocity of the response to the state’s attempts at cost control has spawned a range of commentary on the issue. A useful discussion of the matter has been posted by the Empire State Center for Public Policy’s senior fellow for health policy, Bill Hammond. He casts additional light on the political dynamic—particularly the role played by the powerful Service Employees International Union, Local 1199.
In this Up for Debate, we present two opposing views on the changes made to CDPAP.
A stronger future for consumer-directed care
By Jon Wegman
New York’s transition of CDPAP from 600 fiscal intermediaries to a single statewide FI has alleviated administrative headaches, allowing everyone to focus more on what matters: providing the best care to seniors and individuals with disabilities.
How New York has failed my daughter
By Doris Behan
My daughter is one of the many that have now fallen through the cracks of this transition, despite the assurance of Gov. Kathy Hochul and the state Department of Health that this wouldn’t happen.
NYS politicians, 1199 ,and lawyers for the benefit of the patient? There is a tremendous of self-serving opportunity on the backs of those in need. That individual that really needs some assistance. This is a power, ego and money issue, first. The last item, but the founding issue, that receives any consideration is the end user who in many cases really need that type of care. That person is held up if you even attempt to disagree with the Triple Threat. (Politician/1199/attorney) A solution attempt would take more ink and paper than the Beacon will allow. But be assured of this….1199 salivating over this opportunity should give you concern,……….ah check that……is a concern!! A gargantuan clearly visible red flag!