Governor Kathy Hochul Criticizes New York’s Family Member Home Care Program Calling it a “Racket”
If you are a New Yorker, you may have seen subway ads stating “Get paid to care for your loved ones.” These ads promote New York Medicaid’s Consumer Directed Personal Assistance Program (CDPAP),) which has come under fire this week after Governor Kathy Hochul, described it as a “racket” during an interview with Bloomberg News.
CDPAP, a New York Medicaid-funded program, allows individuals to hire family members or friends as caregivers, with the intent to both compensate unpaid family caregivers and keep seniors out of more costly brick-and-mortar facilities. Despite its well-meaning goals, the program’s rapid expansion, allegations of misuse, and lack of controls have sparked significant controversy. One aspect of the program that has come under fire involves the “fiscal intermediaries” who manage administrative tasks such as payroll and are typically compensated based on the number of caregiving hours billed.
Although many fiscal intermediaries operate ethically, there is a strong incentive for some intermediaries to exploit the system by encouraging potential caregivers to seek out patients to enroll in the program and potentially coaching patients to exaggerate their symptoms to qualify for the program or to secure more care hours than medically necessary. This significantly boosts the earnings of the fiscal intermediaries, who profit from the inflated caregiving hours billed.
Governor Hochul’s critique centers on this exploitation, saying that social media ads promote the program as a “lucrative, easy job.” “I’m telling you right now, when you look on TikTok and you see ads of young people saying, ‘Guess what, you can make $37 an hour by sitting home with your grandma. You know, here’s how you sign up,’ — it has become a racket,” Hochul remarked. She further condemned the program as “one of the most abused programs in the history of New York.”
The state loosened eligibility rules for CDPAP in 2015, resulting in the number of participants soaring from 20,000 to 250,000, and causing Medicaid spending on the program to triple. This surge has also led to a substantial increase in home-health jobs, now accounting for 12% of New York City’s private-sector employment.
The rapid expansion has made it challenging to root out fraud and abuse or to provide adequate oversight. This has raised significant concerns about patient welfare due to insufficient controls within the home to verify that care is being adequately provided—or even provided at all. The lack of oversight not only allows for further misuse but also raises serious questions about the overall effectiveness and integrity of the program.
As New York grapples with the challenges of providing cost-effective care and preventing program fraud, the CDPAP program’s future hangs in the balance. Governor Hochul’s call for reform underscores the urgent need to enhance oversight and restore integrity to the program. By addressing these issues head-on, the state can ensure that CDPAP fulfills its original mission: to provide essential care to those in need while supporting caregivers who provide critical care to their loved ones.
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