New York’s Health Department passed a critical deadline last week — and kept going.
April 1 marked the official switchover date in a major restructuring of the state’s Consumer Directed Personal Assistance Program, or CDPAP. But with thousands of New Yorkers who take care of friends or family members at home still unregistered with the new contractor, the Hochul administration extended a one-month grace period and called in volunteers from within the department and its affiliated agency, Health Research Inc., to help with the backlog.
This is how government should work in a crisis: with urgency, flexibility and a willingness to go beyond the original plan when real people are at risk of losing care. It’s a sign that the state is taking seriously the need to fix this program — not by abandoning it, but by working overtime to preserve what works and overhaul what doesn’t.
The CDPAP allows individuals with long-term health needs to choose and train their own caregivers — often family members — and has helped hundreds of thousands of New Yorkers avoid institutional care. But in the decade since eligibility rules were relaxed in 2015, the program has grown unsustainably fast. What cost the state $219 million in 2014 is projected to cost $12 billion in 2025.
That’s not just inflation. A big chunk of the growth comes from the rise of nearly 700 intermediary companies that sprang up to handle the administrative work — and collect a cut of caregiver wages along the way. A 2018 federal audit identified $75 million in fraudulent CDPAP claims over a four-year period, much of it blamed on the lack of oversight among the sprawling number of fiscal middlemen. Gov. Kathy Hochul’s plan — in the works since last summer — is to replace the patchwork of intermediaries with a single contractor: Georgia-based Public Partnerships LLC. It’s a dramatic shift and a logistical headache, especially given the sheer size of the program, with roughly 250,000 people receiving care and another 300,000 providing it. Other states have stumbled during similar transitions. When Massachusetts moved to a single administrator in 2022 for a far smaller program, thousands of caregivers missed paychecks, and call centers were swamped. An error rate that affected 10% of the workforce there would translate into 60,000 people in New York. But so far, New York’s Health Department is doing the hard work to prevent that kind of failure. The one-month extension is a practical decision that prioritizes people over process. Some critics call this a crisis the state should have seen coming, and maybe they’re right. But that doesn’t change the reality: This was a well-intentioned program that veered off track, and Hochul inherited it mid-spiral. She deserves credit for taking the risk of reform, rather than letting the costs — and opportunities for abuse — continue to mount. U.S. Health and Human Services Secretary Robert F. Kennedy Jr. has taken notice, citing CDPAP’s cost growth in an April 5 post on X and announcing a 90-day federal review. This is a moment for close scrutiny and bold correction, not bureaucratic paralysis. CDPAP’s mission — helping New Yorkers live with dignity and independence — is worth fighting for. It’s also good for the economy, providing paid work for thousands of people and keeping thousands more out of state institutions. But it must be financially sound, legally accountable, and administratively functional. The state still has a lot to prove. But in pushing forward with care, urgency and creativity, it’s showing that it hasn’t given up.
