Hochul admin selects statewide fiscal intermediary

ALBANY, N.Y. (NEXSTAR) — On Monday, Gov. Kathy Hochul announced that Public Partnerships LLC (PPL) will partner with New York State to deliver quality services for home care users and support caregivers through the Consumer Directed Personal Assistance Program (CDPAP). CDPAP offers sometimes life-saving home care to around 250,000 elderly and disabled New Yorkers.

CDPAP spending could hit $9 billion this year, with over 600 fiscal intermediaries (FIs) representing a significant chunk of the pie. Hochul's office said that New York cannot sustain such spending, so reforms targeted FIs. Hochul's position has been that FIs are middlemen who take fees and process payments without providing care or even supervising caregivers.

The decision drew months of criticism from disability advocates like the New York Association on Independent Living (NYAIL), Caring Majority Rising, the New York State Independent Living Council, the Center for Disability Rights, and the National Domestic Workers Alliance. They kicked off a week of action against Hochul on Tuesday, decrying the move to a single FI as a $500 million cut to CDPAP.

In both Albany and Buffalo, disability advocates delivered thousands of letters to state leaders, demanding that they invest in home care. You can see them in the video above at the Concourse of the Empire State Plaza in Albany.

But in the lead-up to that demonstration, several representatives met with Department of Health Commissioner James McDonald and Chief Disability Officer Kimberly Hill Ridley to talk about their concerns for just over an hour. The climax of that tense meeting came as McDonald tried to head to his next appointment. In the video below, Bruce Darling, 59, of Rochester, confronts McDonald about messaging from the governor's office:

The partnership starts by mid-2025, and PPL plans to move its national headquarters to New York, creating over 1,200 jobs while supporting CDPAP caregivers already working here, per Hochul. But NYAIL notes that, while those 1,200 jobs represent new positions for the out-of-state contractor, the overall job impact would see over 600 FIs—which they characterize as community-based employers—going out of business.

Approved in the 2025 State Budget, the plan won’t change who qualifies for CDPAP, won't require people to reapply, and will keep home health aides paid on time, according to Hochul's office.

Also on Monday, Hochul announced a transition process for home care services. Aiming to satisfy the needs of different cultures and languages, state officials and representatives will meet with CDPAP users, aides, and advocates over the next few months. To maintain open access to medical care, they're to work with PPL and more than 30 regional home care agencies including:

• Chinese American Planning Council (New York City, Long Island, and Westchester County)
• Concepts of Independence, Inc. (Rockland, Dutchess, and Putnam Counties)
• Angels In Your Home (Albany, Saratoga, Rochester, Buffalo, and Syracuse)
• CDChoices (Allegany, Oswego, Hamilton, and Clinton Counties)

Hochul said that officials want to support home care users and caregivers, so they'll coordinate with them and liaise with elected officials. She also said that PPL has to use clear, multilingual print, digital, and social media campaigns to keep people informed so they have the power to choose the right caregiver.

Reforms were supposed to improve the regulation of the FI system to make sure that care reached those who needed it, while taxpayer Medicaid money got used as intended. For an example of the state cracking down on fraud in the system, Hochul's office pointed out two agencies, heavily involved in CDPAP, that allegedly stole 25,000 employees' wages and defrauded Medicaid.

On Monday, New York Attorney General Letitia James and U.S. Attorney General Merrick Garland announced over $17 million in settlements with Edison Home Health Care and Preferred Home Healthcare. Still, just as the state can single out individual bad actors in the current system, advocates for that system registered their own gripes with the Georgia-based PPL. They note legal issues in other states where they operate and a potentially problematic relationship with Hochul herself.

Criticism of PPL includes allegations of mismanagement and wage theft of home care workers in other states, disrupting services, and spiking costs. According to critics:

• PPL was linked to Medicaid fraud, including a caregiver who defrauded Virginia of $350,000
• 20,000 Pennsylvania home care workers went unpaid, costing the state $7 million annually
• Workers reported payroll errors after a problematic launch in Washington
• PPL issued numerous incorrect checks in Oregon
• Individuals were denied essential services in New Jersey
• PPL delayed service in Tennessee
• PPL got the worst customer satisfaction ratings among providers in Colorado
• PPL left many caregivers unpaid in Massachusetts when transitioning into a single management system

Would contracting with PPL lead to similar negative outcomes in New York? PPL doesn't think so. "We are focused on ensuring that all consumers in the program receive the care they need," a company spokesperson said in part. "We understand there is concern about this program transitioning and want to assure CDPAP stakeholders that we will bring to the program the most knowledgeable and experienced staff and the best possible processes and technologies available anywhere."

Asked about specific issues in Pennsylvania, New Jersey, and Colorado, they said:

Regarding previous concerns, they appear to be mischaracterized. We work with New Jersey, Pennsylvania and Colorado today and are in good standing with all three states. In NJ, we serve 40,000 consumers across three programs as the sole FI. We have been operating in the state since 2016. In Pennsylvania, we serve the Office of Development Programs as the sole FI. And in Colorado, we are one of two FIs and have 80% of the consumers in this state where consumers have the choice of FIs.

Public Partnerships LLC

Hochul's move was also criticized for prioritizing private profits over local care. In November 2023, she accepted a $5,000 contribution to the Friends of Kathy Hochul campaign from PPL’s Vice President of Government Relations, Patty Byrnes. Hochul also has alleged ties to PPL through political connections with casino lobbyist Stuart Shorenstein.

The governor previously appointed his daughter, Marissa Shorenstein, to her transition team in 2021 and to the New York Gaming Commission. PPL then hired the lobbying firm Cozen O’Connor Public Strategies, which Mr. Shorenstein had cofounded.