Kathy Hochul isn’t a doctor, but her diagnosis and prescription for New York State’s finances are correct: The state’s Medicaid program covering home care must be reformed.
We must move ahead with an impending transition to a single statewide fiscal intermediary for the Consumer Directed Personal Assistance Program (CDPAP). Whether that means sticking to the April 1 implementation deadline now on the books is another question.
CDPAP lets members who are eligible for home care choose and hire their own personal caregivers, often friends or family members. In theory, it’s a perfectly good thing, matching people with serious ongoing needs with those who can help them best. But in practice, it’s proven unsustainable. Expenditures have tripled since 2017, hitting $9 billion and rising on an annual basis. The lion’s share of the new jobs created in New York City of late have been in home health care. Look around America, and there’s nowhere else that even comes close to New York’s to-infinity-and-beyond growth.
Hochul’s plan, set to take effect in April, would give the state a fighting chance to start to get its arms around the problem by transitioning hundreds of CDPAP middlemen to a single intermediary — Public Partnerships LLC, or PPL. Eligibility and caregiver choices would be unchanged but a single intermediary would manage payroll and benefits, replacing middlemen who inject tons of inefficiency and unnecessary spending, including untold amounts of fraud and abuse, into the system.
At the same time, the state would get the ability to limit advertising, which is stoking growth in the sector whether or not it’s warranted, likely getting lots of people who really don’t need CDPAP providers to sign up and help get their family or friends a decent hourly wage in the process.
With the April 1 deadline to switch over to PPL, nearly 140,000 consumers and about 150,000 personal assistants have registered. But others are holdouts — in some cases just because they’re politically opposed to the reform, in other cases because there’s some very real problem that needs to be addressed before someone can safely unplug and plug back in. Though nobody’s trying to deny anyone lifesaving services, there’s no question the transition to PPL, which only started in earnest late last year, has been rushed and in some cases chaotic.
The move to a single intermediary isn’t the only or even the best way to control the growth of Medicaid home health care program. It makes sense to tighten eligibility rules so that services go to those who truly need it, not to people with relatively minor disabilities. And the state needs to do a much better job policing waste and fraud amidst all this spending.
The April 1 deadline ought not be sacrosanct. If there’s a real chance that some people with pressing health needs won’t get the assistance they need, it would be reasonable to push back the transition by some weeks to ensure an orderly handoff.
But it would be unreasonable, in fact a disaster, not to move forward with these essential reforms. CDPAP needs reform, stat.