Senate bill looks to repeal CDPAP reform

ROCHESTER, N.Y. (WROC) — New York is continuing to move forward with a major overhaul of a Medicaid program which allows people of all ages with disabilities to choose and receive care in their own home. The big change is the decision to shift from the more than 600 fiscal intermediaries (FI’s) down to a single operator. That contract is set to still be awarded by the state’s deadline of October 1.

Since the reforms were announced in the budget, growing efforts to stop the change have pushed forward. Now, a new piece of legislation, co-sponsored by local lawmakers, is aiming to essentially re-expand the program and create greater transparency about the process of operations in its entirety.

Senator Pam Helming represents the 54th District which encompasses Ontario, Wayne, and Livingston counties and some towns in Monroe County. She signed on to bi-partisan bill S.9901 which would repeal the current measure as it relates to licensure of the fiscal intermediary and allow for growth.

“While I think this bill is on the right track and will help us, if we can get it passed – to continue to provide good care and services to the most vulnerable New Yorkers. I still struggle with some of the bill language that would allow the Dept. of Health to decide how many FI’s we should have in the state,” says Helming.

According to the Governor’s Office, the reforms in the budget will not change the eligibility for CDPAP, nor make any new requirement to re-apply.

Governor Hochul Office Spokesperson:

“Our reforms will strengthen CDPAP, protect home care users and ensure taxpayer dollars are effectively serving the people who need them. Our plan does not change CDPAP eligibility for home care users and ensures that caregivers will continue receiving timely payment so they can keep providing the care that CDPAP users need.”

Bryan O’Malley is the Executive Director of the Alliance to Protect Home Care, or Consumer Directed Personal Assistance Program Association, which launched a multimillion dollar campaign over the summer to push back against the reforms.

O’Malley says he feels these reforms to shift from hundreds of FI’s to a single, state-run entity is detrimental to the entire healthcare system in the state. He adds, with the current timeline (contract awarded Oct. 1, changes enacted April 2025), he feels it would be nearly impossible to achieve a smooth transition without people falling through the cracks.

“Yes consumers will not have to reapply for Medicaid but there are medicals that are necessary. There are medical exams for the workers that are necessary, there is paperwork, I-9 documents, W2 documents that cannot transfer from one FI to the other and frankly unless the existing agency gets legal authorization from the consumer and the worker it’s a violation of HIPPA,” O’Malley says.

Senate bill 9901 would also give the State Comptroller the authority to audit contracts for companies serving as a fiscal intermediary, which is not permitted in the current reform.

The country’s largest health care worker union, 1199 SEIU, issued a letter in opposition to S.9901 (see below). The bill will not be heard until January when the legislative session resumes.

From the Governors office:

Re: recent claims that CDPAP home care users or caregivers could be negatively impacted by the State’s reforms:

— New York State is not ending or eliminating CDPAP for home care users and the Governor has never said that. The State’s recent reforms in the budget do not change eligibility for CDPAP. There will be no new requirement to re-apply to receive CDPAP care.

— The October 1 deadline is for selecting the Statewide Fiscal Intermediary – NOT the deadline for the State’s reforms to take effect. There will be a transition period following the selection of the Statewide FI, which will help ensure home care users and caregivers are not negatively impacted by the shift to a single Statewide FI.

— The State’s RFP to select a single Statewide FI requires it to maintain an irrevocable Revolving Letter of Credit of at least $100 million, exclusively for the purpose of meeting its obligations and responsibilities under the contract. This ensures that the Statewide FI maintains sufficient liquidity to guarantee timely and uninterrupted payment to caregivers. The RLOC is required to be furnished and maintained for the duration of the contract term plus 180 days thereafter.

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Re: the recent legislative proposal mentioned in your inquiry:

Please note that 1199 SEIU released a memo in opposition to that legislative proposal. I’m attaching their memo here. It includes a lot of relevant information regarding this issue that I’d encourage you to reflect in your reporting.

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Re: the general reason for our CDPAP reforms:

— CDPAP spending is expected to exceed $9B this year, which is not sustainable for the long term.

— The biggest threat facing CDPAP in New York right now is that there are over 600 fiscal intermediaries taking a significant cut of taxpayer dollars without providing enough value to home care users or caregivers. In fact, New York State has more fiscal intermediaries than the rest of the country combined.

— These entities are not responsible for scheduling care or for supervising caregivers to ensure quality standards are met. They essentially take money from Medicaid and then process the checks to caregivers, after taking a cut for themselves.

— We’re reining this in to focus on quality service and increase oversight of the program, so that we can make sure taxpayer money goes to pay caregivers instead of being siphoned off by middlemen.

— By October 1, the State will select a single fiscal intermediary to administer CDPAP — just as numerous other states have already done.

— Shifting from 600+ fiscal intermediaries to a single fiscal intermediary will help the State ensure that taxpayer dollars are effectively serving the home care users who need them.

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