The “Consumer Directed Personal Assistance Program” (CDPAP) is a program in New York State funded by Medicaid that allows individuals with disabilities or chronic illnesses to hire and manage personal assistants themselves, and even hire family members as care aides. Therefore, this program is widely used in the Chinese community, commonly known as the “family caregiver plan”.
In the past, patients needed to manage CDPAP services through Fiscal Intermediary Agencies (FIs), which were responsible for payroll, tax processing, and insurance matters to ensure the compliant operation of the program. However, due to long-standing allegations of abuse, the state government passed a reform in the 2024 state budget bill, citing annual CDPAP spending exceeding $9 billion. Starting from April 1, all over 600 FIs would be integrated into a single entity named Public Partnerships LLC (PPL), claiming that this consolidation could save $500 million in Medicaid funds annually.
However, the monopolistic model of PPL has sparked widespread concerns, especially in the Chinese community. Many are worried that with the disappearance of market competition, the quality of nursing services may decline, administrative costs may increase, and there is a risk of entering an inefficient operational model akin to the Metropolitan Transportation Authority (MTA). Currently, the “family caregiver plan” is in a transitional phase, and the Chinese-American Planning Council reminds all participants to complete re-registration by March 28.
In response to PPL’s monopoly, New York State Senator Chen Xueli supports Bill S1189 proposed by State Senator Gustavo Rivera. The bill aims to abolish the PPL monopoly model and establish a new FI licensing mechanism so that existing nursing companies can continue to operate. Bill S1189 is currently at the second reading stage in the Senate Health Committee and has garnered support with 37 senators co-signing the bill.
The core content of Bill S1189 includes restructuring the FI licensing mechanism to allow multiple institutions to compete and ensure the flexibility and service quality of the CDPAP program, abolishing the exclusive financial intermediary model of PPL to avoid market monopolies leading to administrative inefficiencies, and safeguarding the rights of registrants and nursing staff while reducing uncertainty and potential impacts during the policy transition period.
During the public hearing on the 2025 executive budget proposal held on February 12, State Assemblywoman Anna Kelles asked Helen Schaub, Vice President of 1199SEIU Nurses Union, “Do we have evaluation criteria? Are there data showing which FIs have misused funds?”
Schaub responded, “There are currently strict review mechanisms. PPL will be responsible for payroll, but the original FI will act as a ‘facilitator’ to assist consumers. The facilitator’s role is limited, and we do need to reassess these institutions based on their new roles.”
She further stated that many problems stem from FIs, so the state government has significantly reduced their number.
State Senator Gustavo Rivera pointed out that there is a discrepancy between him and the 1199SEIU Home Care Nurses Union on this issue: “I am concerned that the transition of PPL will be more challenging than anticipated by the administration. If issues arise, we should advocate for change.”
The CDPAP reform involves the rights of thousands of low-income families and nursing staff. Whether Bill S1189 can successfully prevent PPL’s monopoly is still unknown. The bill still needs to pass the third reading, and if it garners enough support, it may change the future operation model of CDPAP. With the effective date of the reform looming on April 1, this policy game is still developing. ◇