By Ronald Fatoullah and Stacey Meshnick
Most dual eligible (Medicare and Medicaid) individuals aged 65 or older are required to receive home care through Managed Long-Term Care (MLTC) plans. MLTCs are insurance plans that pay the same monthly rate per person, whether care is provided 4 hours per day or 24 hours per day. MLTCs took over the role that local Medicaid offices used to play, i.e., deciding whether an individual is eligible to receive home care and how many hours they are entitled to. Care is directly provided by a Personal Care Aide from a home care agency contracted with the MLTC.
Some individuals are enrolled in another program authorized by Medicaid – the Consumer Directed Personal Assistance Program (CDPAP). Individuals in need of care join CDPAP for several reasons. One reason is that a Personal Care Aide is not permitted to assist with skilled needs such as administration of medication and suctioning. Only informal support (family members or friends) or a care provider through CDPAP, known as a Personal Assistant, is permitted to perform skilled tasks. Hence, individuals with need for such skilled tasks will not be able to receive the care they need through MLTC plans.
When an individual is receiving care through CDPAP, an agency called a Fiscal Intermediary manages payroll and benefits for the Personal Assistant. The Fiscal Intermediary pays the Personal Assistant, monitors hours, administers benefits, processes tax information, checks immigration status, etc. In the CDPAP program, the Personal Assistant works for the individual rather than an agency. However, it is the Fiscal Intermediary that contracts with and is paid by the MLTC Plan.
Effective April 1, 2025, CDPAP is changing from working with over 600 Fiscal Intermediaries to a single Fiscal Intermediary called Public Partnerships LLC. The purported intention of the change is to protect home care recipients and caregivers from fraud and abuse.
All individuals currently enrolled with another Fiscal Intermediary are required to sign up with Public Partnerships LLC by phone, online, in-person, or with a facilitator by March 28, 2025. There are 31 facilitators who are currently available to assist in New York State.
All Fiscal Intermediaries other than Public Partnerships LLC must stop operating by April 1, 2025. Anyone not registered with Public Partnerships LLC will have their services stopped. Advocates have expressed concern that there is not enough time to transition all CDPAP individuals, and that they are not going to receive any notice of discontinuance prior to April 1, 2025.
Several organizations have filed lawsuits, none of which will protect individuals from having their care discontinued. The major concern is that workers will not be paid and individuals will therefore cease to receive care.
Another change coming in late 2025 is that, in order to qualify for CDPAP, applicants will require the need for physical assistance with three activities of daily living (ADLs) or supervisory assistance with two ADLs if the person has dementia or Alzheimer’s disease.