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CDPA is under attack in the budget (Plain English version)

The proposed state budget includes changes that will harm the consumer directed personal assistance (CDPA) program. These include limiting the number of fiscal intermediary agencies; eliminating thousands of consumers who need help directing their own care; cutting workers’ pay by over $2.50 per hour; and restricting consumers’ right to self-direction. These cuts will not only hurt CDPA, they will be bad for the entire health care system. These cuts to the CDPA program must be rejected. 

CDPA Related Budget Proposals Must Be Rejected

    1. Carving CDPA out of wage parity (Part G)The Governor wants to cut pay and benefits for downstate CDPA workers. The cuts amount to over 12%, or $2.54/hour in New York City and $1.66/hour in Long Island and Westchester. These pay cuts will total $800 million. If this change is made, personal assistants (PAs) in New York City will see the lowest pay since 2018, undoing years’ worth of fighting for Fair Pay for Home Care. Many PAs will be forced to quit their jobs. This change will only affect CDPA, not agency home care. It will make it harder for consumers to hire PAs. It also tells PAs, who are mostly Black, Latina, and immigrant women, that the Governor sees them as less valuable than other home care workers.


    2. Removing designated representatives (DRs) from CDPA (Part HH, Sec. 14-17) – The Governor wants to eliminate designated representatives in CDPA. Designated representatives have been an important part of the program for many years. Approximately 40%, or 100,000, of CDPA consumers use a DR and would lose their CDPA on October 1, 2024. These include disabled children; about 6,000 people who use both CDPA and services through the Office of People With Developmental Disabilities; older adults with Alzheimer’s and dementia; people with traumatic brain injuries; and those who are nonverbal or face other language barriers. Getting rid of DRs would mean that on October 1, all of the people who use CDPA with the help of a DR will need to find other types of health care. This will be very difficult for the healthcare system we have now.


    3. Undoing the state contracting process and limiting the number of FIs (Part HH, Sec. 1-7) – The Governor wants to get rid of the state contracting process that they started in 2019 and to change the rules. This change would require all fiscal intermediaries to apply for “authorization” in a new process. It would also allow the Department of Health to decide how many fiscal intermediaries can operate in a county, which could force hundreds to close their businesses.

    4. State-mandated training and daily and weekly hour limits for PAs (Part HH, Sec. 7) – In CDPA, consumers train and schedule their own PAs. The Governor’s budget wants to require PAs to receive state training and will limit how many hours PAs can work. Training requirements are both expensive and dangerous to consumers, because it will cause confusion to the PA whether to do what the consumer – their boss – has trained them to do vs. what they were taught in state training. The disability community fought hard to train their own workers in a self-directed program. Data shows that self-direction has excellent outcomes for consumers, who are healthier and safer directing their own care. Requiring state training could create new problems.

      Limiting the hours PAs can work is also dangerous for consumers. There are not enough PAs statewide. Limiting weekly hours will result in consumers going without care they need. For the consumers who need the most care, daily hour limits create a dangerous problem. These consumers are most at risk during shift changes, when the next PA might arrive late or not at all. For this reason – for their own safety – many of these consumers will schedule shifts in blocks of 12 hours or more, up to the 16 currently allowed by law.

    5. Disallowing licensed home care service agencies (LHCSAs) from providing FI services (Part HH, Sec. 8) – Since the beginning of CDPA, some agencies serving as FIs have also been LHCSAs. This has been good for consumers who may choose to use both CDPA and agency-based home care services because they need help directing specific tasks, have short-term needs better met by an agency, or prefer LHCSA care but have to use CDPA because there are not enough home care workers. This change would prevent consumer choice. It could also harm CDPA in New York City, where every FI that works with the Human Resources Administration would be affected. It is difficult to understand what problem the budget seeks to solve.

    6. Cuts to Fiscal Intermediary Per Member/Per Month payments (Admin) – In 2021, the Department of Health changed the ways FIs are paid by Medicaid. The new and current system is a three-tiered per member/per month (PMPM) payment system, which pays FIs a certain amount based on how much care a consumer needs. Since 2021, we have experienced record inflation as the cost of living increases. Instead of adjusting the PMPM rates to account for inflation, the Governor wants to cut rates for the two lowest tiers of services, while raising the highest, and smallest, tier. This means that the State will reduce payments to FIs for anyone who receives less than 16 hours of CDPA a day. This action will harm FIs in county Medicaid, known as fee-for-service. Managed care and MLTC plans do not use the PMPM system. Instead of cutting rates, the PMPM should be regulated and based on regional rates. The regional rates should also be adjusted annually for inflation.    


Enact The Home Care Savings and Reinvestment Act – Managed long-term care (MLTC) has not been successful. These plans promised many services and using care managed to coordinate with Medicare and make consumers healthier. Instead, MLTC plans gradually reduced the services they offer to consumers. Social adult day care was removed unless other benefits were also used. Then nursing homes. On March 1, transportation services were removed. Service assessments for personal care and CDPA have been moved to the New York Independent Assessor (NYIA). 

Now, over 80% of the benefits paid for by MLTCs are related to personal care. Plans selectively “cherry pick” consumers who don’t need many hours because they make more money from them than from consumers who need more care. They are not managing care. Consumers have a hard time reaching their care managers. Often, care managers will give wrong information about their services. Some plans require consumers trying to reach their care managers to leave voicemails and wait days or weeks to hear back. All of this means that MLTCs receive between $4,500 – $5,000 per person per month to manage, essentially, one service. 

A recent report by New York’s former Budget Director found that getting rid of MLTC would save New York State at least $900 million. A new system would return personal care and CDPA to state payments through fee-for-service. Instead of going to insurance plan profits, this money could be used to increase funding for CDPA. The NYIA will continue with assessments. To replace care managers, organizations experienced in working with older and disabled people will coordinate care. This new system will improve health and safety for consumers while increasing transparency and accountability for all.

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