In our weekly segment, "A Closer Look," we feature a story from a BTPM NPR reporter. This week, Associate Producer Michael Loss sits down with Disability Reporter Emyle Watkins to discuss the latest news regarding the Consumer Directed Personal Assistance Program (CDPAP).
Michael Loss: So, Emyle, you’ve covered issues with Medicaid and home care at BTPM NPR for over four years now. CDPAP has repeatedly come up in your reporting. What is it, and why is it important?
Emyle Watkins: Well, Michael, home care is essential for many disabled people and older adults to live independently. Not only that, but disabled people have the right in the US to live in the most integrated setting possible. So, most states provide two types of Medicaid home care. One type is agency care, where an agency sends you an aide. Another type is what we in New York call Consumer Directed Personal Assistance, or CDPA or CDPAP. This is where Medicaid decides how many hours of help you get. You hire a friend, family member or someone you know, and you are essentially the aide’s boss. You work with a company, called a fiscal intermediary, to get your worker paid using your Medicaid budget. However, even before the federal government made cuts to Medicaid, states like New York have been grappling with rising costs of home care and trying to make cuts.
Loss: So, what exactly has New York tried to do to cut costs?
Watkins: The short version is, a little over a year ago, a quiet change was made to the state budget at the last minute. Instead of over 600 fiscal intermediaries paying aides, there would now only be one. Ultimately, Public Partnerships LLC, or PPL got that contract. But PPL’s track record isn’t perfect, and disabled people largely felt left out of this decision. This year, the state tried to move roughly a quarter million disabled people and their aides to PPL in just three months. And I don’t think it is subjective to say that it hasn’t gone smoothly.
Loss: I want you to go a little deeper into this. What do you mean by that?
Watkins: Well, PPL and New York’s Department of Health have faced pushbacks and lawsuits. Concerns have been raised over peoples’ rights being violated or potentially losing services, issues with worker payment, and health insurance, as well as the speed of the transition. Ultimately, because of a lawsuit, the transition has been extended to a total of seven months.
Loss: Right, and things have only continued to heat up, correct?
Watkins: Yes. In the last two weeks alone, I’ve reported on how three heads of the company are leaving, one of the federal lawsuits has a final hearing soon, and state senators are calling for PPL to testify at an August hearing. I also just spoke with New York Lieutenant Governor Antonio Delgado. He claims he’s been left out of conversations and decisions around CDPAP and is now calling for the Governor to end PPL’s contract.
Antonio Delagado [Soundbite]: There has to be a willingness to have those kinds of conversations. And if those conversations can't happen, I still have a responsibility to bring those discussions, or at least to bring my set of beliefs to the public so that they can be assured that I do hear them, so that they can be assured that they do have a voice in me.
Loss: So, it sounds like this has been a lot for people to keep track of. Can you also explain to our listeners the bigger picture of why this story matters?
Watkins: You know, Michael, a lot of conversation around this issue usually tries to tie rising costs and enrollment in homecare to issues with regulation or requirements alone. But I read a lot of policy briefs, and a lot of experts point to reasons why CDPAP is so utilized: our population is aging, people prefer CDPAP because they are in control of their care, and home care is far less costly to Medicaid than a nursing home or facility. Now that the federal government has made cuts to Medicaid, states will likely start to slim down or change programs to make up for that loss. So, while these programs have grown over the years, it’s likely because people need these services to keep living independently, and in turn, reducing the need for the costly facilities our country has worked so hard to move away from.
Loss: Right. Well, that’s all the time we have for this conversation on CDPAP, but if you want to read any of Emyle’s other stories on the matter, you can find those at btpm.org.
