Testimony: Consumer Directed Personal Assistance Program (CDPAP)

Testimony to the New York State Senate Standing Committee on Health and Senate Standing Committee on Investigations and Government Operations

Public Hearing: August 21, 2025

Thank you for the opportunity to submit written testimony on the public hearing pertaining to the Consumer Directed Personal Assistance Program (CDPAP) and CDPAP’s transition to a single statewide fiscal intermediary under contract with Public Partnerships LLC (PPL).

The Center for Elder Law & Justice (CELJ) has been serving the Western New York region for over 40 years, providing free civil legal services to older adults, persons with disabilities, and low-income families. CELJ’s primary goal is to use the legal system to ensure that individuals may live independently and with dignity. CELJ also advocates for policy and systems change, particularly in the areas of elder abuse prevention, nursing home reform, consumer protection, and housing reform. Currently, CELJ provides full legal representation in ten counties of Western New York. CELJ’s Free Senior Legal Advice Helpline is available throughout New York State.

When New York State (NYS) made the decision to move from 600+ Fiscal Intermediaries to one, we were concerned and joined with others in urging caution and for more time should the move to a single Fiscal Intermediary (FI) proceed. Unfortunately, and expectedly, our concerns became reality. Since the transition we have received calls from clients who had challenges enrolling, personal assistants (PAs) being paid, language barriers and more. These issues have not stopped and continue today.

A person’s ability to age with independence and dignity is directly dependent on a variety of interconnected components, referred to as health-related social needs. These include accessible housing, financial security, access to quality health care, and access to long-term services and supports. When one component fails, the others often follow, leading to direct harm to the person who now faces increased likelihood of homelessness and institutionalization in a nursing home.

For example, we have a client who is a double hand amputee and a diabetic, who uses the CDPAP for his home care. For years he has been able to live independently in an apartment with the help of his PAs. However, even he went through the registration process with his PAs and thought they were properly registered, this was not the case. The result: the PAs stopped showing up as they were not being paid. Without their essential support, our client was unable to meet his care needs and the condition of his apartment deteriorated. As a result, his MLTC had to bring in a cleaning company, and the client private paid his PAs. The client is now facing an eviction proceeding from his apartment. The transition to PPL as the sole FI, has directly impacted our client’s health and housing stability.

This is one example of the many calls we have received during the transition to PPL as the single FI. The ability of older adults to thrive in the community remains at risk. Absent a full repeal of the single FI mandate, NYS must take action:

• NYS Office of the Comptroller Must Have Oversight of the PPL Contract and Investigate PPL’s Operations

Private Equity (PE) has no business in health care. Yet, NYS allows for it and PE finances many health care-related entities. The harms and adverse impact on patient care and increased costs has been widely reported,1 yet, NYS allowed for PPL, while not itself a PE firm, is owned by PE firms DW Healthcare Partners and Linden Capital Partners, to take over as the sole FI.2 As we have seen in nursing homes, PE firms have a history of prioritizing profits over patient/resident care. The NYS Office of the Comptroller must have oversight of the contract with PPL and be empowered to conduct a full investigation.

• Implement Transparency Measures to Ensure Accountability

NYS proceeded with the move to a single FI under the guise it was needed to address fraud and waste. Yet, transparency and accountability is lacking. To ensure issues with enrollment, pay, and other challenges are addressed, there must be public information. This means implementing measures that can track access to home care services, call wait times, complaint information, and others. CELJ supports the recommendations detailed in the New York Legal Assistance Group (NYLAG) testimony.

• Create a Stakeholder Group

CDPAP was created by persons with disabilities and is essential to their well-being. Yet, during the transition to the single FI, their concerns were minimized and appeared to be brushed off. This is not acceptable. The people who utilize the CDPAP must have a seat at the table and their concerns must be heard. NYS must create a Stakeholder Group, were consumers lead the discussion and not PPL or the NYS DOH.

• Enable Consumer Choice by Reinstating Independent Living Centers as FIs

Independent Living Centers, acting as facilitators actively worked with consumers and PAs navigate the PPL transition and onboarding. Consumers have a legal right to choice. CELJ supports S7954(Rivera)/A8355(Paulin) that would restore Independent Living Centers as Fiscal Intermediaries. Consumers have a legal right to choice.

Resources

1 See https://kffhealthnews.org/private-equity/

2 As reported in various media outlets: Mother with cerebral palsy struggles to hire aides after private equity takeover and https://homehealthcarenews.com/2022/08/two-private-equity-firms-reportedly-back-self-directed-at-home-care-enabler-public-partnerships/

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