The state’s long-awaited and controversial overhaul of a popular Medicaid-funded home care program has nearly reached its deadline.
For the past year, Gov. Kathy Hochul has pushed to consolidate the consumer directed personal assistance program, which allows New Yorkers to hire immediate family members as home health aides. A single financial services company, Georgia-based Public Partnerships LLC, is expected to take over for the roughly 600 third-party businesses known as fiscal intermediaries that pay home health aides by the state-mandated deadline of April 1.
The governor says that consolidating the program, which serves 280,000 elderly New Yorkers and people with disabilities, is necessary to reduce its skyrocketing costs. The state spent an estimated $11.2 billion on the program last year, and Hochul hopes to save $1 billion annually after the transition.
A fast-paced transition and lagging registration numbers have set the state behind schedule in pulling off the change. One day before the deadline, here’s what we know and don’t know about the transition.
Will the transition be completed by April 1?
Though the state will effectively close all of the third-party payroll businesses by the legally mandated April 1 deadline, it’s highly unlikely that it will register all home care users and workers by that time. Nearly 165,000 transitioned to the new system as of Friday, according to the Department of Health – less than 60% of all people enrolled in the home care program.
At least 20,000 more home care users have started the process of registering with PPL and 60,000 have transferred out of the program to enroll in personal care services, an alternative home care program that does not go through PPL. That leaves at least 35,000 home care users who have yet to start registering with the new system.
Roughly 215,000 personal assistants have started or completed their registration with PPL, according to the Health Department. PPL has started paying some of those workers, but a company spokeswoman did not confirm how many workers started receiving payment.
Lagging registration numbers led the Department of Health last week to implement a late registration window, giving home care users and workers until April 30 to sign up with PPL. Health Commissioner Dr. James McDonald blamed low sign-ups on a misinformation campaign propelled by businesses that could shut down because of the transition, which he said added to confusion about whether enrollees should sign up with PPL.
The extended registration period gives the state 30 additional days to ensure that all workers are ready to be paid through the new system, though some elected officials are still skeptical.
“They still have a long way to go,” said Assemblywoman Amy Paulin, who represents parts of Westchester and chairs the health committee. “The concern is, is a month enough?”
What happens during the late-registration window?
The state is pushing to ensure that all home care users and workers register with PPL by April 30 and is offering retroactive payments to workers who render services within that timeline. Home care advocates have criticized the state’s back-pay strategy, saying that home care workers, many of whom are low-income, cannot miss a few weeks of pay.
“An I.O.U doesn’t pay for rent or groceries and it doesn’t cover late fees and overdraft fees,” said Bryan O’Malley, executive director of the Alliance to Protect Home Care, a lobbying group that represents fiscal intermediaries. “PPL has proven time and again they are not up to this task, and it is well past time the state cancels their contract.”
In the meantime, the Department of Health is soliciting employees to volunteer to work overtime so it can register remaining workers. The agency put out a call to workers last week asking them to help process paperwork to ensure home care users register by April 30. “Utilizing additional resources will help ensure that more of the highest-need CDPAP users can get registered, particularly as we enter the one-month grace period,” said agency spokeswoman Cadence Acquaviva.
The late registration window and request for additional employee volunteers raises questions about how prepared the state is to move to the new system, said Bill Hammond, senior health policy fellow at the right-leaning think tank Empire Center for Public Policy.
“I’m increasingly convinced that this was badly mishandled, that it was a train wreck slowly unfolding before us,” Hammond said. “If everything was going as smoothly as they’ve been saying all along, they would not be doing either of those things.”
What happens next?
The transition is already in motion, and it’s highly unlikely that the state will call on the fiscal intermediaries to help iron out payroll processing for the next month, Paulin said. But she is amenable to working with the governor to implement a last-minute solution to delay the transition if needed.
“We might need legislation to allow that, I don’t know,” Paulin said. “I am certainly open to doing anything as fast as we can if the governor’s office comes to us.”
