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How NY’s $6 billion CDPAP Medicaid program has been abused, overused for years

how-ny’s-$6-billion-cdpap-medicaid-program-has-been-abused,-overused-for-years
How NY’s $6 billion CDPAP Medicaid program has been abused, overused for years

New Yorkers with zero healthcare experience are allowed to care for their elderly or disabled relatives and friends — potentially earning more than $43,000 a year — under a $6 billion Medicaid program that’s been rife for fraud, abuse and overuse for years, insiders say.

The Consumer Directed Personal Assistance Program, known as CDPAP, exploded several years back when state lawmakers loosened rules to make more people eligible for the government cash.

Critics argue that CDPAP, which has received huge funding injections from the state government, has been allowed to expand rapidly with little oversight — despite rampant signs of dysfunction and being a waste of taxpayer money.

“The program is growing many times faster than the size of the elderly population and shows no sign of slowing down,” Bill Hammond, a senior fellow for health policy at the Empire Center, an Albany-based government watchdog group, told The Post.

“It’s long past time for state officials to bring the program under control — while taking care to protect services for those who need them most.”

There are currently 250,000 New Yorkers enrolled in CDPAP across the state, the latest Medicaid enrollment report data show — up considerably from 140,000 in 2015.

A CDPAP-funded home care worker in New York City can rake in as much as $21.09 an hour caring for their relatives or friends — or $43,867.20 a year based on a 40-hour work week. On Long Island, the CDPAP caregiver rate is $20.22 per hour, while in the rest of the state it’s $17.55 per hour.

The decades-old program was relatively small until legislative changes expanded eligibility by allowing family members or friends of Medicaid recipients to become CDPAP aides.

State lawmakers passed the bill, spearheaded by then-Assemblyman Joe Morelle — now a Democratic congressman for New York’s upstate 25th congressional district — in 2015 before it was implemented the following year by then-Gov. Andrew Cuomo.

Daughter assisting senior father on stairs, rear view.

New Yorkers with zero healthcare experience are allowed to care for their elderly or disabled relatives and friends potentially earning more than $43,000 a year under a $6 billion Medicaid program. Andrey Popov – stock.adobe.com

Easy ways to qualify for CDPAP

  • Prove you have an ongoing medical condition
  • Demonstrate a need for long term care
  • Show you need help in ONE of these categories: bathing or showering, dressing, getting in and out of bed/chair, walking, using the toilet or eating
  • No need to provide a 5-year “look back” on finances to prove Medicaid eligibility as one would in nursing homes or assisted living facilities.

Morelle said at the time that the changes, which now allowed parents of adult disabled children to be hired as their carers, would save those families from fearing for their financial security.

But experts warn that the vague rules for eligibility are prime for exploitation — and that the program’s flaws run deep.

“Consumer-directed personal assistance is an important and life-changing benefit when used appropriately, but it’s also highly vulnerable to overuse and fraud — and in New York’s program, all the warning lights are flashing bright red,” Hammond said.

Under CDPAP, people can choose their own, unlicensed caregivers to help assist them at home in a bid to avoid more costly nursing homes or assisted-living facilities.

But while there’s been an increase in people signing up for the program, there hasn’t been much of a change in the nursing-home resident population.

A woman in a wheelchair holding a sign during a picket line outside Governor Andrew Cuomo's office in New York.

The Consumer Directed Personal Assistance Program, known as CDPAP, exploded several years back when state lawmakers loosened rules to make more people eligible for the government cash. LightRocket via Getty Images

Meanwhile, the criteria to qualify for CDPAP are somewhat hazy.

For instance, those seeking Medicaid coverage who live in a nursing home are required to have their past five years of financial records reviewed.

The list includes “bathing or showering, dressing, getting in and out of bed or a chair, walking, using the toilet, and eating,” according to the US Centers for Medicare & Medicaid Services.

In comparison, those applying for home-based care don’t have any look-back period, which means they can potentially transfer cash, or sell off assets, to relatives so they can then qualify for Medicaid.

Currently, an applicant has to undergo an assessment of eligibility, which includes, in part, having an ongoing medical condition, a need for medical assistance and a need for long-term care.

A medical insurance card seen up close.

Critics argue that CDPAP, which has received huge funding injections from the state government, has been allowed to expand rapidly with little oversight — despite rampant signs of dysfunction and being a waste of taxpayer money. Kameleon007

One of the prerequisites, though, requires the person to prove they need help with just one category included on an “Activity of Daily Living” list — essentially setting the barrier to ­entry extremely low.

The list includes “bathing or showering, dressing, getting in and out of bed or a chair, walking, using the toilet and eating,” according to the US Centers for Medicare & Medicaid Services.

Businesses and nonprofits — known as fiscal intermediaries — can serve as the middleman by collecting money from Medicaid that is then doled out to CDPAP aides in the form of paychecks.

These intermediaries take a cut of funding, but aren’t responsible for training or supervising aides.

The legislative changes prompt­ed fiscal intermediaries to start trying to enroll as many people as possible — including those with less severe and costly illnesses, according to the 1199 Service Employees International health care union, which represents home health aides.

The number of fiscal intermediaries surged from just seven to 700 in the wake of the changes, the union added.

In 2020, the FBI busted a Brooklyn-based million-dollar fraud ring that found CDPAP home health aides were working in conjunction with fiscal intermediaries to illegally bill hours to the state they supposedly worked when they were actually vacationing or socializing.

One of the carers was allegedly on a Caribbean cruise when she was supposed to be caring for a Brooklyn patient, while another was drinking at a New Jersey vineyard, federal prosecutors said.

“The people overseeing the program is like the fox in the henhouse,” Helen Schaub, the health care union’s political director, told The Post.

“It’s not a good use of taxpayer dollars and the state ought to
stop it.”

federal audit in 2018 estimated the Empire State had illegally billed Medicaid almost $75 million in fraudulent CDPAP claims between 2012 and 2016 – even before the program was expanded to allow relatives to act as caregivers.

Gov. Kathy Hochul, on her part, is slated to announce long-awaited proposed reforms to the CDPAP program Thursday — including ways to rein in the unnecessary and unsustainable spending, The Post has learned.

Details on how the state plans to better manage the program weren’t immediately clear.

“With health-care costs continuing to escalate, Governor Hochul is committed to protecting taxpayer dollars any way we can. That includes common sense fixes to CDPAP — a program that provides essential home care to many New Yorkers, but has grown by over 1,200 percent in just 8 years with minimal oversight. Our goal is to ensure quality health services are going to the New Yorkers that truly need them most while protecting against waste and abuse,” Hochul’s budget director Blake Washington said in a statement Wednesday.

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