On Monday, July 22nd, New York Governor Kathy Hochul called the state’s Consumer Directed Personal Assistance Program (CDPAP) a “racket,” citing its rampant abuse and skyrocketing costs. The CDPAP, designed to allow Medicaid recipients to hire friends, family members, or others as caregivers, has grown substantially, both in enrollment and financial burden on the state.
Hochul’s remarks came during an interview with Bloomberg News, where she emphasized the program’s misuse. “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,” she said.
Since the state relaxed eligibility rules in 2015, the number of people receiving care through CDPAP surged from just under 20,000 in 2016 to almost 248,000 last year. The program’s cost to New York’s Medicaid system more than tripled over five years, reaching about $9.1 billion.
The CDPAP has been a significant driver of job growth in New York City. Budget documents released in April showed that nearly all job gains in the city over the past year were in the home health industry, largely due to CDPAP. Without these gains, the city’s total private-sector jobs would have contracted.
Hochul described the program as “wildly expensive” and one of the most abused in the state’s history. She has convened a commission to recommend changes to the state’s healthcare system by the end of the year, with hopes to implement reforms in the CDPAP program next year. “Something has to give here,” she stated.
The program, aimed at keeping seniors out of costlier brick-and-mortar facilities, allows potential home care consumers to choose their caregivers, with a fiscal intermediary managing the process. Despite the benefits, the lack of oversight has led to concerns about fraud and quality of care. Traditional home care agencies have expressed skepticism, arguing that self-directed care is prone to exploitation and might deliver inferior care compared to trained caregivers.
The rise of self-directed care programs like CDPAP reflects a broader national trend driven by the caregiver shortage and policy initiatives, including support from the Biden administration. These programs aim to fill care gaps and reduce costs by compensating family caregivers who have been performing unpaid labor.
However, the rapid expansion of such programs has raised alarms about sustainability and effectiveness. Hochul’s push for CDPAP reform is part of a broader effort to enhance the efficiency and accountability of state-funded health programs, ensuring that they fulfill their intended purpose without being exploited.
The CDPAP has been a crucial support system for many New Yorkers, particularly the elderly and disabled, allowing them to receive personalized care in their homes. However, the program’s exploitation underscores the need for comprehensive reforms to preserve its benefits while curbing abuse and ensuring financial sustainability.
