In response to a previously published Times Union opinion piece, NYLAG’s Valerie Bogart and Rebecca Wallach wrote a letter to the editor dispelling misinformation about Medicaid’s Consumer-Directed Personal Assistance Program (CDPAP):
Greater New York Hospital Association’s commentary “CDPAP changes are necessary to get costs under control,” Feb. 7, scapegoats the Consumer-Directed Personal Assistance Program using misinformation to justify the disastrous transition to a private equity-backed single fiscal intermediary, Public Partnerships LLC. This rush to downsize 600 intermediaries to one will devastate consumers and workers with no promise of savings, especially given PPL’s history.More New Yorkers use CDPAP because of the dire shortage of agency-based home care workers and CDPAP’s flexibility. Costs have grown due to the perverse incentives in paying private managed long-term care insurance plans the same monthly premium for each enrollee while allowing those plans to decide how many home care hours to approve.
Such plans profit by rewarding their CDPAP intermediaries that recruit enrollees who need few hours of home care and denying high-hour care to members with severe disabilities. Data from the Fiscal Policy Institute shows that, in 2023, such plans gave the lowest hours of CDPAP, under 159 hours per month, to 95 percent of CDPAP recipients. That is an increase from 2018 when 76 percent of recipients saw such hours.
Meanwhile, managed long-term care insurance plans gave only 2.4 percent of CDPAP recipients more than 320 hours per month, down from a previous 3.2 percent.
We agree on needing more transparency. The state Comptroller found that the state paid $2.8 billion to managed long-term care insurance plans that provided little or no services. Instead of blaming fiscal intermediaries, many of which serve the disability community, we support S1189/A2735 to license intermediaries as well as the MLTC Data Transparency Act (S707/A700) and the Home Care Savings & Reinvestment Act (A2018) to eliminate managed long-term care insurance plans as the middlemen.
This letter was originally and exclusively published in the Times Union on Monday, March 10, 2025. Valerie Bogart and Rebecca Wallach are, respectively, of counsel and Director of the Evelyn Frank Legal Resources Program (EFLRP) at NYLAG.
