About two months into the controversial rollout of the state’s new payment system for its popular Medicaid-funded home care program, some data has rolled in, but questions remain about the success of the transition.
Gov. Kathy Hochul’s administration has been in the process of consolidating the consumer-directed personal assistance program, which allows individuals to hire friends or family members as caregivers. The policy change aimed to transition hundreds of thousands of home care workers in the program to a new payroll system administered by state contractor Public Partnerships LLC – a job previously held by 600 companies – in an effort to rein in ballooning costs.
The transition has been marked by ongoing litigation, lobbying and concerns from advocates that the change will disrupt both care for those who use the program, as well as the financial security of the many low-income workers who fuel it.
Crain’s pulled together what we know, and what we don’t, about how the overhaul is going.
How many people are using the program now?
More than 212,000 consumers have transitioned to the state’s new home care system managed by PPL, according to Cadence Acquaviva, a spokeswoman for the Department of Health. That figure is less than the approximately 280,000 individuals enrolled in the program before the transition, as many opted to switch to another program to stay with their current administrator.
Roughly 77,000 individuals, or 25% of enrollees, switched into an alternative home care program known as personal care services since the overhaul, Acquaviva said, allowing them to continue receiving services through a licensed home care agency rather than shifting to PPL. The churn represents a significant shrinking of the program after years of growth in enrollment and costs.
The program’s growing enrollment led the state to lose track of how many workers served CDPAP consumers, but advocacy groups estimated that roughly 300,000 personal assistants were working prior to the transition.
It’s not clear how many caregivers are working currently, but payment data offers some clues. PPL paid 210,000 home care workers as of May 30, though only 188,000 submitted timesheets in the latest pay period, company data shows.
The number of workers who submit timesheets fluctuates every week, a trend that is consistent with consumer-directed programs across the country, according to PPL spokeswoman Lacey Hautzinger.
How is the new payment system working?
Though the number of workers registered with PPL has increased, the company’s payments to personal assistants have been met with mixed reactions. The state and PPL have lauded a 99% payment rate to all workers who submit timesheets, yet experts say the amount of money spent on wages seems small, which may spell shrinking enrollment.
PPL said that it spent $880 million on workers’ wages since April 1, or approximately $110 million per weekly pay period. Considering that the state spent $9 billion on the program last year, the first eight weeks of pay should amount to nearly $1.4 billion, according to Michael Kinnucan, a senior health policy fellow at the left-leaning think tank the Fiscal Policy Institute.
“What’s clear is that the transition dramatically shrank the program,” Kinnucan said. “What’s not clear is whether there is going to be a continued decline.”
Acquaviva said that it’s inaccurate to compare last year’s costs to current spending on wages, as fewer people are enrolled in the program. She added that the analysis does not take into account administrative costs that increased last year’s spending estimate.
Aside from big-picture spending questions, personal assistants have also filed a class-action lawsuit against PPL, alleging that the company has committed wage theft, as they say workers are having trouble clocking in to the company’s timekeeping app and some have been automatically clocked out during overnight shifts. The plaintiffs have since expanded their allegations, accusing PPL of unlawfully reducing their pay to provide an insurance plan that is expensive yet offers minimal coverage, according to the lawsuit.
What’s happening in the courts?
The class-action wage theft suit is not the only ongoing litigation against the state related to the home care transition. Consumers filed a federal lawsuit in March aiming to delay the transition because they were struggling to sign up due to the company’s technical challenges. That lawsuit has since delayed the state’s deadline to complete the transition by more than two months, and attorneys are aiming to extend that deadline even further.
A temporary restraining order issued by a Brooklyn federal judge in April allowed consumers to continue using their previous home care agencies for the short term instead of transitioning to PPL, aiming to ensure that workers continued to get paid. The Department of Health did not answer a question from Crain’s about how many home care users and workers are continuing to use the old payment system under the order.
What’s the next key deadline?
Under the temporary restraining order, personal assistants have until June 20 to sign up with PPL’s payment system. Attorneys with the New York Legal Assistance Group, which represents consumers in the federal lawsuit, are pushing to extend that deadline until August to give home care users more time to ensure their workers get paid. The litigation is ongoing.
