The Rapid Growth of CDPAP
New York’s Consumer Directed Personal Assistance Program (CDPAP) has seen significant expansion, raising concerns for both providers and New York State (NYS). This essential Medicaid program, which empowers seniors and individuals with disabilities to hire, train, and manage their caregivers—known as Personal Assistants—has grown dramatically, from 140,000 participants in 2015 to over 250,000 today. While this growth underscores the program’s critical role, it has also led to worries about oversight, the potential for fraud, the suitability of the program, and rising costs, which now exceed $9 billion annually.
The Role of Fiscal Intermediaries
Fiscal intermediaries are crucial to the smooth operation of CDPAP. They manage payroll, ensure compliance with labor laws, handle Medicaid billing, and provide ongoing support to consumers and their assistants. However,The recently approved New York State Budget for Fiscal Year 2025 introduces significant changes to the Consumer Directed Personal Assistance Program (CDPAP), which will notably impact fiscal intermediaries (FIs) across the state. The most significant change is the consolidation of the multiple FIs into a single, statewide fiscal intermediary selected through a competitive procurement process by the New York State Department of Health (NYSDOH)
Summary of FY 2025 Changes and Their Impact
- Single Statewide Fiscal Intermediary: Starting April 1, 2025, CDPAP will transition to a single fiscal intermediary model. This selected Statewide FI will be responsible for overseeing the program and subcontracting with other entities to ensure coverage and service delivery across various regions.
- Subcontracting Requirements: The legislation mandates that the Statewide FI must subcontract with at least one service center for independent living and entities within each Managed Care region that have a proven track record of delivering services to individuals with disabilities and the elderly. These subcontractors must comply with all federal and state regulations, demonstrating cultural and linguistic competency to serve diverse populations effectively.
- Rationale and Controversy: The state’s move aims to streamline operations and reduce fraud, waste, and abuse within CDPAP, with an estimated $200 million in Medicaid savings projected from these changes. However, this shift has raised concerns among providers and stakeholders about potential disruptions to care and the administrative complexities involved in transitioning to a new system. Critics argue that the state could have pursued alternative measures to address fraud without overhauling the current structure so drastically.
- Community Impact: The elimination of numerous existing FIs may lead to a loss of localized knowledge and relationships that these intermediaries have built within their communities. This could impact the quality and continuity of care for CDPAP participants, many of whom rely on trusted local providers to manage their care effectively.
Future Directions for Fiscal Intermediaries
Governor Kathy Hochul has emphasized the necessity of these changes as part of a broader effort to ensure efficient use of state resources and enhance oversight within CDPAP. The budget also includes provisions to support other healthcare initiatives, such as increasing the minimum wage for home care workers and boosting Medicaid rates for various care facilities.
Industry leaders and advocacy groups, while acknowledging the need to address inefficiencies, caution that the rapid implementation of such sweeping changes could pose significant challenges. They stress the importance of maintaining adequate support for consumers and caregivers during the transition period to prevent any lapses in service delivery.
The upcoming changes aim to enhance the program’s efficiency and integrity through a new structure involving a single state-wide Fiscal Intermediary (FI). While the transition may bring new dynamics, the primary goal is to streamline and improve service delivery across the state.
Streamlined Operations and Enhanced Efficiency
The transition to a single state-wide FI is designed to streamline administrative processes, allowing for more consistent and effective management of services across New York State. This presents an opportunity for existing FIs to align with best practices and enhance their service offerings.
Opportunities in a Competitive Landscape
The selection process for the state-wide FI and its subcontractors is expected to be competitive, emphasizing the need for high standards of compliance, cultural and linguistic competency, and a strong track record. This competitive environment encourages FIs to showcase their strengths and unique capabilities, focusing on the quality and reliability of their services.
Alignment with New Standards
For FIs that become subcontractors, aligning with the new state-wide FI will involve adapting to new protocols and directives. This is an opportunity to refine operational practices, ensuring they not only meet but exceed regulatory requirements. Embracing these changes can enhance an organization’s role in delivering high-quality, consumer-directed care.
Emphasis on Compliance and Transparency
The renewed focus on compliance and transparency is designed to strengthen CDPAP. Enhancing operational protocols, such as cost reporting, labor practices, and verification systems, will increase accountability and ensure the program’s sustainability. These changes aim to improve the overall trust and efficacy of the services provided.
Financial Stability Through Direct Payment Models
The restructuring may require some FIs to adjust their financial management practices. However, the introduction of a direct payment model aims to simplify revenue flows, reducing administrative burdens and enhancing financial stability for subcontracted FIs.
Specialization and Strategic Partnerships
The new structure encourages FIs to specialize in areas where they have established expertise, particularly in serving specific populations or regions. This specialization can make FIs indispensable partners in the new system. Additionally, forming strategic partnerships can enhance service capabilities and compliance, positioning FIs favorably within the restructured framework.
The Path Forward
Amid these transformative changes, it is crucial to ensure the ongoing independence of participants and caregivers. This involves advocating for enhanced benefits and support systems within any new framework that emerges from Governor Hochul’s budget proposals. Despite the uncertainties these changes may bring, organizations like Consumer Directed Choices are committed to defending the core values of CDPAP by engaging directly with policymakers and collaborating with advocacy groups. Through joint efforts and determination, we will navigate this evolving landscape with a firm commitment to achieving positive outcomes for the CDPAP community. By prioritizing the needs and voices of program participants and caregivers, we aim to shape a future that not only maintains autonomy but also enhances the well-being of all involved. This essential program is too important to relinquish.
What You Can Do
If you’re feeling overwhelmed by this situation, remember you are not alone! We must collectively urge the Governor and Legislature to understand the high stakes and act decisively to maintain a system that honors the dignity and autonomy of all New Yorkers. By uniting and voicing our concerns, CDPAP participants, caregivers, and advocates can potentially shape the outcome and ensure our voices are heard.
Contacting Elected Officials
The first step is to reach out directly to our elected officials and urge the New York State Legislature to heed the voices of their constituents. Emphasize the importance of maintaining the right to choose a fiscal intermediary under CDPAP. Make it clear that consolidating into a single agency monopoly would endanger the autonomy and quality of care that New Yorkers depend on.
Contact Information:
- 📞 Governor Kathy Hochul: 518-474-8390
- 📞 Senate Majority Leader Andrea Stewart-Cousins: 518-455-2585
- 📞 Assembly Speaker Carl Heastie: 518-455-3791
Let’s unite to protect CDPAP and ensure that New York’s healthcare system remains supportive, inclusive, and empowering for everyone.
Fred Polsky is a seasoned administrator with over a decade of dedicated experience in Home Care, specifically in CDPAP (Consumer Directed Personal Assistance Program), Managed Long Term Care, and various other Medicaid products in the State of New York. With a humble approach, Fred Polsky has assisted numerous consumers and caregivers in navigating the complexities of home care assistance, ensuring they receive the support they need with compassion and expertise.
