One of four regional subcontractors helping to administer changes to a Medicaid home care program in the coming months said Thursday that New York lawmakers need to delay the April 1 deadline when they return to Albany next year.

The state is forging ahead to change the $9 billion Consumer Directed Personal Assistance Program under Medicaid, which more than 250,000 New Yorkers rely on for home care, in under six months. Pushback is growing for that timeline to be extended to change the program — including from companies partnering with the state to manage it.

"The timeline needs to be realistic," said Anthony Caputo, CEO of the nonprofit Concepts of Independence. "...Seeing and learning from what has happened in other states that have much smaller programs, it's going to be difficult."

The state Health Department is negotiating with Public Partnerships LLC to finalize a five-year, multi-billion-dollar contract for the company to take over CDPAP by mid-2025 — down from over 600 – to cut back on widespread fraud and abuse. 

Concepts of Independence, which serves home care recipients in the Hudson Valley, is one of four core regional home care suppliers partnering with the state to assist PPL in the transition.

Current state law mandates the other FIs must shutter by April 1.

"I've spoken to state senators about this, and to make this happen, they're going to have to extend the time," Caputo said. "The Senate, the Assembly and the governor are going to have to agree to extend that period of time so there is a smooth transition. ...I hope they open the window for another year."

Last week, eight people involved in the state's CDPAP were federally indicted, accused of defrauding $68 million through the program. Gov. Kathy Hochul has touted the indictment as proof that consolidating the program is the right move and will reduce program abuse and make it more financially viable. 

"This was a process that was managed by our Department of Health, and for those trying to undermine the decision-making process of these professionals, these public servants, I resent that," Hochul told reporters in Albany on Thursday. "One only needs to look at the genesis of why we took on this issue. States like California, with double our population, have one fiscal intermediary to manage this program."

Caputo, who penned an op-ed Thursday supporting the program changes, said Concepts of Independence started CDPAP in the state in 1980 to serve about 100 disabled New Yorkers. The state program has skyrocketed to the nation's largest — growing from $2.5 billion annually in 2015 up to the current $9 billion price.

"The contract will be finalized very soon," representatives with PPL said in a statement Thursday. "We are prepared to execute the transition by April 1. If the Department of Health changes the timeline, we will accommodate their decision."

The powerful health workers union 1199 SEIU has an agreement with PPL that the company will not interfere with workers as they make a decision to unionize under the new agreement.

"We're looking forward to working with them, to both implement the single FI and help the workers make the decision if they want to be represented by the union, but we didn't have a dog in the race about who will get the contract," 1199SEIU Interim Political Director Helen Schaub said.

Union leaders with Home Health Care Workers of America, representing the largest number of health care workers in the state, continue to be skeptical the changes will reduce fraud. Advocates have criticized PPL's history of mismanagement and losing contracts in other states.

Connor Shaw, the union's political director, is pushing for the state to transition CDPAP recipients to be reliant on traditional home care, which has more safeguards built in.

"This is not new or shocking that this program was being exploited," Shaw said. "For years, you couldn't ride the subway without seeing advertisements that said 'Get paid to take care of your mom.' 

"There's more sensible ways to address the aging care population. Bad actors have entered the industry because there's not regulation," he added. "The solution to this is not allowing one FI that has had issues in other states, it's to have more regulation and guardrails, and that's what exists in traditional home care."

Representatives with Hochul's administration said too many FIs do not comply with federal electronic filing and verification requirements, and PPL's billing system uses the federal system created under the 21st Century Cures Act. 

“Anyone concerned about this should be pleased with our plan to strengthen CDPAP, since the state can now use its contractual oversight to ensure the program operates in compliance with Electronic Visit Verification," a spokesperson with Hochul's office said Thursday.

Caputo said New York transitioning to a single FI is the correct move, but only with the proper communication with all CDPAP workers and recipients.

"It is going to work," Caputo said. "But information must go out sooner than later."

Every worker must have documented medical exams and other paperwork digitized in the transition, but Caputo said some workers do not have an email address, and must be tracked down in person.

Officials with the state Health Department met this week with concerned independent living centers, which will also serve as program subcontractors. 

"They weren't even getting information," he said. "We all need to sit down at the table. There needs to be stakeholder meetings with consumers and stakeholders, potential FIs and local (Department of Social Security) so we can all answer each other's questions. It is going to be a large task, and it's going to take more time to do it properly."

Several lawmakers have expressed concerns about the quick change, even though they voted for the budget that established it in state law. Lawmakers this winter plan to probe the effectiveness of the transition during legislative budget hearings to determine how the timeline should be altered.

The change in the last budget was negotiated last-minute behind closed doors, and without typical oversight by the state comptroller.

State Health Commissioner Dr. James McDonald has said the timeline could be flexible, but New York's competitive bidding process was done correctly.