New York Gov. Kathy Hochul last week told reporters that the state’s self-directed home care program has become a “racket.” While New York’s program – dubbed the Consumer Directed Personal Assistance Program (CDPAP) – is unique, self- and consumer-directed home care has become a much more popular model over the last few years across the country.
Hochul expressed her displeasure with the program during a conversation with Bloomberg News.
“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 said.
She went on to call the program “one of the most abused programs in the history of New York,” adding that “something has to give.”
CDPAP has increasingly become a point of discussion and contention during the state’s budget-setting season, as costs tied to the program have ballooned.
Broadly, CDPAP and other self-directed home care programs allow potential home care consumers to choose their own caregiver. A fiscal intermediary – such as a traditional home care agency, the state or another vendor – is generally involved in the process.
The idea behind these programs is to pay family caregivers who have been conducting unpaid labor, while also keeping seniors home and out of brick-and-mortar facilities that would cost the state more money. They are generally operated through state Medicaid programs.
Because of the nationwide caregiver shortage, some policymakers found this to be a sensible way to fill gaps in care. The hope was also that, eventually, these family caregivers would convert to full-time caregivers in certain instances.
Home care agencies, particularly in New York, often provide home care services while also acting as intermediaries for self-directed care.
But traditional home care agency leaders have been skeptical since the model began gaining more traction over the last few years. They see self-directed care as an area that can be exploited by fraudulent actors, as Hochul does. They also believe that the quality of care is likely to be lesser within these programs, as they spend time, money and resources to train their own caregivers.
Those leaders are also perturbed by OIG findings that come out highlighting fraud in “personal care.” That lumps all home care together, when much of that is coming from the area of self-directed care.
Besides the aforementioned reasons for self-directed care’s rise, the Biden administration has also pushed it.
Self-directed care remains an opportunity for the health care system to fill care gaps and reduce costs. But this mode of care’s rise could be – particularly in New York – a case of “too much, too soon.”
On her end, Hochul hopes to make changes to New York’s CDPAP program next year.
