Proposed overhaul of home care has families anxious

| Times Union

ALBANY — A planned overhaul of a Medicaid program that has allowed thousands of disabled, elderly and chronically ill New Yorkers to remain in their homes with the caregivers of their choice is causing anxiety among families that rely on the service.

Among them is Assemblywoman Melissa Miller, R-Long Island, whose 19-year-old son Oliver relies on the Consumer Directed Personal Assistance Program for in-home care by family members.

Miller’s daughter was trained through CDPAP to care for Oliver, who suffered an in utero stroke, leaving him with developmental disabilities and fully dependent on skilled care. When Oliver turns 21, Miller says she and her husband will be eligible to become paid caregivers under the program.

In his executive budget, Gov. Andrew M. Cuomo proposes shaving $75 million from the program and consolidating hundreds of non-profit organizations that process CDPAP claims, a move that Miller fears will create lapses in care.

The governor “is going to create a crisis of medically frail people going into institutions — or more likely hospitals, since many institutions no longer exist,” Miller said.

Cuomo’s office notes that the cuts are exclusively targeted to the state’s nearly 600 fiscal intermediaries, non-profits that take a percentage of disbursements paid to caregivers. Officials insist the changes will not impact consumers in any way.

The goal of the reboot is to improve oversight and accountability of CDPAP providers, according to the state’s Budget Division.

“The more than 70,000 self-directing consumers who employ their own aide, including in some cases family members and friends, will continue to receive services as they do today without any reduction in care, with no change in cost,” Budget spokesman Morris Peters said. “The program will continue to be available as it is today to new consumers.”

Miller says that the shuttering of hundreds of providers will leave thousands of caretakers scrambling to re-register for the program. If she is unable to find a nurse for Oliver because of a shortage of skilled caregivers in her community, Miller says she would have no choice but to have Oliver admitted to a hospital.

“We’ve heard this before. In reality, for those of us living this life, there are changes, there are gaps where we don’t have what we need,” Miller said. “The governor and the governor’s people don’t live this life.”

Miller said the cuts may be related to the state’s own apparent mismanagement of the program and poor oversight of the non-profits’ billing practices. A 2018 audit of the CDPAP program by the state Inspector General’s office determined that over a four-year period, the state had been overpaid $74.8 million in Medicaid disbursements associated with the program.

“The number that the state is required to reimburse the federal government is awfully coincidental to $75 million that has been cut from this highly successful CDPAP program,” she said.

In some cases, the state did not provide documentation of services claimed, billed reimbursement for services that were not authorized, or failed to submit documentation in a timely manner, according to the audit.

The inspector general’s office noted that the period covered by the audit corresponded with “high levels of change across New York’s Medicaid program and encompassed the transitioning of Medicaid beneficiaries from fee-for-service to managed long-term care plans.”

The report recommended the state improve its monitoring and guidance of CDPAP providers. The governor’s office, however, said the restructuring is unrelated to last year’s audit.

Bill Hammond, director of health policy at the Empire Center for Public Policy, said that the state has legitimate reasons for improving the way the home-care program is run and reeling in its fiscal intermediaries.

“Hundreds of these organizations have popped up in the last few years,” Hammond said. “That indicates that the program is a money-making opportunity.”

New York has long been moving away from institutionalized care for the elderly and disabled, in favor of the home-care model, but Hammond says there are also instances where the benefit is overused.

“The state is right to scrutinize this and prevent it from being abused. They have to be careful not to screw up the people who really need it,” he said.