This month marks one year since New York undertook the most ambitious Medicaid transition in U.S. history, transforming the state’s Consumer Directed Personal Assistance Program (CDPAP) into a stronger, safer, and more accountable home healthcare service.
Any reform of a program serving hundreds of thousands of people will rightfully be scrutinized. The complexity of consolidating hundreds of fiscal intermediaries into a single statewide entity, Public Partnerships LLC (PPL), raised valid concerns about continuity of care and caregiver payments.
When you look at the numbers, the CDPAP transition has been hugely successful, delivering results for New Yorkers.
A recent statewide survey conducted by PPL offers the most comprehensive look yet at consumer and caregiver experiences under the new CDPAP model. With responses from more than 38,000 consumers and designated representatives and more than 56,000 personal assistants (PAs), overall program satisfaction was 4.31 out of 5 stars. Satisfaction with timekeeping systems also increased, alongside improved ratings for customer support and communication.
The survey also reinforced the widespread inconsistency of the previous system of more than 600 CDPAP fiscal intermediaries. Before transitioning to PPL, only 40% of consumers and designated representatives reported having access to online systems that track hours and authorizations, and that same percentage said they “sometimes,” “never,” or were “unsure” whether they had to approve PA timesheets for payment — a key component of self-direction and program accountability.
For PAs, only 27% reported that their prior fiscal intermediary offered all of the benefits of PPL. Thirty-three percent reported that none of the benefits they now receive were available. Today, PPL offers more consistent and comprehensive benefits — including health coverage, paid time off, and retirement options — that were not widely available in the old system.
This centralized model has standardized processes and improved accountability, with New York projected to save more than $1 billion. Just as importantly, a single statewide structure has created clearer lines of responsibility, making it easier to identify problems and respond to concerns.
The transition faced early challenges that highlighted the importance of continued vigilance. That’s why PPL continues to support seven regional offices across the state; a diverse facilitator network offering specialized, culturally competent, and local assistance across more than 175 offices statewide; and dedicated phone lines in nine different languages to support any program participant. But most importantly, the system is more unified, measurable, and accountable to both taxpayers and the people it serves.
Self-direction programs remain a life-changing option for seniors and people with disabilities, as well as a more cost-effective option for taxpayers than agency models. Gov. Hochul and the Department of Health have guided this transition thoughtfully, and sustaining this critical program will require continued oversight, transparency, and responsiveness.
Policymakers and program administrators alike must remain focused on what matters most: ensuring that consumers receive reliable, high-quality care and that caregivers can perform their duties with the support they deserve.
One year in, that trajectory is coming into focus. New York made a big bet in reshaping CDPAP, and it’s paying off. Survey results point to a reform that is not only working, but delivering results beyond what many anticipated. The focus now should be to build on that progress and ensure the program continues to deliver for the New Yorkers who depend on it most.
Vaughn is the chief growth officer of PPL.