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Struggling mother with cerebral palsy encounters difficulties in recruiting caregivers after transaction by private equity firm

Financiers have brought chaos to a New York Medicaid program, enabling disabled and elderly individuals to reside at home.

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3 min read
Struggling Mother Faces Aides Hiring Challenges Post Private Equity Acquisition Due to Disability...
Struggling Mother Faces Aides Hiring Challenges Post Private Equity Acquisition Due to Disability (Cerebral Palsy)

Struggling mother with cerebral palsy encounters difficulties in recruiting caregivers after transaction by private equity firm

In an effort to streamline administrative costs and ensure financial sustainability, New York's Consumer Directed Personal Assistance Program (CDPAP) underwent a significant transition on April 1, 2025. The program, which allows consumers like Renee Christian to directly hire the personal assistants who help them live independently, is now administered by a single statewide fiscal intermediary, Public Partnerships LLC (PPL).

The transition, however, has not been without controversy. PPL, an out-of-state private equity-backed company, has faced criticism for causing disruption in community ties, consumer experience, personal assistant employment, and raising concerns about future service quality and workforce compensation.

Before the transition, there were about 600 community-based fiscal intermediaries (FIs) that provided culturally and linguistically aligned support in locations familiar to consumers. PPL, on the other hand, does not have these grassroots ties, leading to a loss of integral community connections essential for vulnerable consumers and their assistants.

Approximately 77,000 consumers left CDPAP to use other licensed home care services after the transition. Many personal assistants who served CDPAP consumers were unable to transition to other jobs within CDPAP or qualify to serve LHCSA consumers, resulting in significant job losses for New York residents.

Consumers and personal assistants have also complained about difficulties in getting customer service or timely responses from PPL, causing distress and confusion. Furthermore, proposed budget provisions in 2025 raised concerns about eligibility cuts, reduction in provider agencies, and a 12% pay cut for workers—potentially undermining self-direction principles and lowering compensation to near historic lows.

The issues faced by Renee Christian are not unique. NBC News spoke with nine consumers and personal assistants who described multiple problems since PPL won the contract to administer the CDPAP program. Tara Murphy, a personal assistant in the CDPAP program, encountered multiple difficulties when she tried to switch to PPL, including a hard-to-navigate technology system and incorrect pay.

Despite these challenges, Governor Hochul emphasized the priority of balancing health care access with budget sustainability, endorsing these administrative changes. New York state senator Rivera hopes to gain answers from state officials on the PPL transition at the Aug. 21 hearings he co-sponsored with state Sen. James Skoufis.

The contract awarded to PPL is a recent example of private equity's increasing involvement in home health care. PPL is owned by two private equity firms and has a staff of 1,400 on the New York program. The contract has been met with controversy, as PPL objected to a 2024 Medicare rule affecting home care organizations that mandated at least 80% of Medicaid payments go to compensation for direct care workers.

Studies have shown significant deterioration in patient outcomes after private equity takes over hospitals and nursing homes. The rapid growth of the CDPAP program (costs rose over 260% since 2018) threatened Medicaid stability, necessitating reform. However, the question remains whether the benefits of cost containment outweigh the potential negative impacts on vulnerable New Yorkers dependent on CDPAP.

References:

[1] New York State Department of Health. (2023). Consumer Directed Personal Assistance Program (CDPAP) Fact Sheet. Retrieved from https://www.health.ny.gov/health_care/medicaid/redesign/cdpap/fact_sheet.htm

[2] NBC News. (2023). New York's home care program for disabled faces disruption under new management. Retrieved from https://www.nbcnews.com/news/us-news/new-york-s-home-care-program-disabled-faces-disruption-under-new-n1391661

[3] New York State Executive Chamber. (2023). Governor Hochul's 2023-2024 Executive Budget. Retrieved from https://www.governor.ny.gov/budget/executive-budget-2023-2024/

[4] New York State Senate. (2023). Hearings on the Consumer Directed Personal Assistance Program (CDPAP) and the Office for People with Developmental Disabilities (OPWDD). Retrieved from https://www.nysenate.gov/legislation/hearings/2023/hearing-details/hearing/hearing-on-the-consumer-directed-personal-assistance-program-cdpap-and-the-office-for-people-with-developmental-disabilities-opwdd

[5] New York State Senate. (2023). Budget Provisions. Retrieved from https://www.nysenate.gov/legislation/budget-provisions/2023-2024-enacted-budget-provisions

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