Frequently Asked Questions on the Single Fiscal Intermediary

As part of the state’s budget this past year, Gov. Hochul and the Legislature determined that all of CDPAP will be administered by one fiscal intermediary (FI). Governor Hochul and her Department of Health chose Public Partnerships, LLC, or PPL, as the sole FI for the state. This means that, if this measure takes effect, consumers and their personal assistants will have to switch from their current FI to enroll with PPL in order to continue to use CDPA. CDPAANYS will keep you up to date with information about when you have to make this change.

Right now, fiscal intermediaries (FIs) are continuing to operate as normal. However, unless the law is changed, your fiscal intermediary will be required to close by April 1, 2025. If you want to continue to use your FI until that date, you do not need to do anything unless and until you are told by the Department of Health, your managed care company or county, or see it through CDPAANYS.

Your current fiscal intermediary will not be allowed to provide you services as of April 1, 2025. As of 3/19/2025, the current plan is to move forward without any form of a delay.

If you and your PAs are not registered with PPL by 3/28/2025, you will be unable to continue your services.

If you were waiting to act hoping for a delay, we cannot assume that one is forthcoming. Because of this, and because it is our obligation to advise you of the facts and the consequences of any actions or inactions on your part, we do advise you to contact PPL or one of their facilitators if you wish to continue to receive CDPA services.

If you your designated representative, and/or your personal assistants are trying to enroll and experiencing issues, or if any of you experience issues as you try to enroll with PPL and/or the facilitator, please contact the Department of Health or your local Senator and Assemblymember for further assistance.

Questions to the Department of Health regarding the Consumer Directed Personal Assistance Program may be directed to StatewideFI@health.ny.gov.

Governor Hochul and her Department of Health chose Public Partnerships, LLC, or PPL, as the state’s single fiscal intermediary. The Georgia-based company has a history of having worked in NJ, WA, PA, CO, and a number of other states, although many of those contracts no longer are in place.

The law passed by Governor Hochul and the Legislature required that the company chosen to be the single statewide FI must have experience running an FI  statewide in any other state besides New York. This meant that most FIs in New York were not qualified to apply. The few agencies who were qualified were unsuccessful, although because the law eliminated many standard contracting rules, we do not know why.

At CDPAANYS, we are unclear as to how Governor Hochul arrived at $500 million in estimated savings from this policy change. The Division of the Budget, in charge of the state’s finances, did not make their estimates public. Through Medicaid rate reductions to managed care plans, DOH has already enacted $700 in cuts to CDPA this year. Those savings will disappear when the switch to PPL is made, as the agency’s reimbursement was determined by their contract. This means that to achieve the $500 million in additional savings, the state will in fact need to save $1.2 billion overall. DOH also plans to reduce CDPAP eligibility in the coming months based on disability, claiming too many consumers are enrolled.

Before Pennsylvania transitioned to one FI, its self-directed program had 36 FIs and 20,000 consumers. Today advocates in Pennsylvania tell us there are 8,000. PPLs electronic visit verification (EVV) system did not recognize several consumers, which prevented them from accessing their services. EVV problems also kept workers from receiving paychecks for up to 6 – 8 weeks. A class action lawsuit is still pending due to a failure to pay overtime hours While PPL still has a contract in Pennsylvania, it is only for a fraction of the state’s participants in fee-for-service Medicaid. The strong majority of consumers who self-direct through managed long term care do so with Tempus, a different company.

When Governor Hochul and the Legislature changed the law to create a single statewide fiscal intermediary (FI), they also created “subcontractors” which are now referred to as “facilitators.”  Facilitators are current FIs who, while they will no longer be a FI, have a contract with PPL to help consumers in the transition process and continue with support of the consumer in some manner after the transition is completed. The full list of facilitators can be found here.

Facilitators are not FIs and are legally prevented from performing key FI functions such as setting wages or benefits; processing payroll; contracting with managed care plans or counties; or determining the electronic visit verification (EVV) system that will be used. These duties will all be performed by PPL.

Yes. Because the law passed by Governor Hochul and the Legislature only allows the single statewide fiscal intermediary (FI), or PPL, to perform core functions of a FI, every consumer will have to transition themselves and their personal assistants to PPL, even if your current fiscal intermediary is a facilitator.

No. Independent living centers are facilitators under contract with PPL. Like all other facilitators, ILCs cannot legally perform critical FI functions such as setting a wage, running payroll, contracting with or billing insurance companies, or establishing benefits. You may still interact with your ILC FI in some way but it will be different from your current relationship. Please consult with your ILC to determine exactly what support functions they will perform under PPL.

Though you will not have to go through the eligibility and enrollment process again, you will still need to switch to a new fiscal intermediary (FI). Whenever a consumer changes their FI, the consumer and their personal assistant (PA) must go through the onboarding process, which includes health assessments and other steps for PAs before they can begin work. Nearly half a million PAs will be transferring by April 1, 2025, which will lead to annual health assessments being due at nearly the same time for all PAs, rather than spread throughout the year as they currently are. To date, this has created significant delays in both initial onboarding and annual assessments, causing service disruptions for consumers.

No requirement was added to the law that would mandate, or permit, a criminal background check for personal assistants (PAs) unless it is requested by the consumer. The program’s rules, including those in the request for proposals that Public Partnerships, LLC, or PPL, submitted to become the state’s single fiscal intermediary (FI), is clear that the consumer and/or the consumer’s designated representative have sole authority over who is hired. An explicit statement authorizing PPL, or any FI, to exclude a PA based on a criminal background check, would therefore be needed to allow such exclusions. CDPAANYS will work to educate decision-makers about the harm any proposal that seeks to limit who can be a PA based on criminal background checks or other measures not currently in law would cause and its impact on the “Dignity of Risk” model that serves as the foundation of CDPA.

No.  While switching from CDPA to “traditional” personal care services may be better for some, there are four critical differences that you should know. First, while personal assistants (PAs) in CDPAP can do personal care, home health care, and nursing services, personal care attendants (PCAs) in “traditional” personal care can only do personal care tasks. This means no medication administration, wound care, suctioning, or other more intensive tasks. Second, your PA will now only work for the agency. That means the agency can schedule them to work for other people, and potentially not for you at all, and you will not control the schedule. Third, PCAs in “traditional” personal care may not be family members, so if your family is your PA, they will not be permitted to do so in a “traditional” agency setting. Fourth, while PAs do not need formal training or credentialing, staff in “traditional” agencies do. If you are considering changing, talk to the FI/LHCSA about all of these factors before deciding which is best for you.

 All three of these jobs are broadly referred to as “home care workers” but there are important differences between them that shape the way consumers receive services:

• CDPAP is self-directing and allows the consumer or their designated representative (DR) to hire a person of their choosing to serve as their personal assistant, or PA. The consumer or DR is responsible for hiring, training, and if necessary firing a PA. The only people who cannot work as a PA are the consumer’s DR, legal spouse, or parents of a consumer under 21 years of age. The PA may reside with the consumer and do personal care (housekeeping, dressing, bathing), home health care (wound care), and nursing (suctioning, medication administration) tasks. 
  
  
• A personal care aide, or PCA is an individual who has taken a training course, is licensed through the state, and works for a licensed home care agency. They are limited in some tasks they can perform (housekeeping, meal preparation, dressing, bathing, transferring) and are assigned by their employer agency to patients on a schedule set by the agency. A PCA cannot be a spouse, parent, son, son-in-law, daughter or daughter-in-law, or any family member who resides in the same household.
  
  
• A home health aide, or HHA, can do more than a PCA but less than a nurse. A HHA will often do more complex tasks such as wound care or meal preparation for diabetics or others with restricted diets. Like a PCA, a HHA is assigned by their employer agency, in this case a Certified Home Health Agency or CHHA, to patients on a schedule set by the agency. A HHA cannot be a spouse, parent, son, son-in-law, daughter or daughter-in-law, or any family member who resides in the same household.

Wages and benefits will be set by PPL. According to their website, PPL is offering:

• The minimum base wage rate for PAs serving consumers living in Bronx, New York, Kings, Queens, and Richmond counties is $20.10.
• The minimum base wage rate for PAs serving consumers living in Nassau, Suffolk, and Westchester counties is $19.50.
• The minimum base wage rate for PAs serving consumers living in any other county (not listed above) is $18.10.

There is also health insurance and other benefits being offered to some PAs employed by PPL, although some reports from the independent Fiscal Policy Institute have questioned the value of those plans and reported that they may actually be worse than nothing. 

According to PPL if a consumer is not registered by March 28th, 2025, they risk losing their services. While your eligibility assessment should not be affected by missing this deadline, failure to register by this date could lead to gaps in services and PAs not being paid. While we do not believe this move to a single FI will in any way benefit the consumers who use the program, nor do we believe that PPL can register all 280,000 consumers and their 450,000 PA’s in time to meet their own deadline, we do urge everyone who does use the program to not put their care and safety, or the livelihoods of their PAs at risk unnecessarily. Given that the state seems unconcerned about the thousands who are likely to lose their care and or their jobs because of PPL’s inability to register everyone on time, we urge every consumer and PA to make every effort to get registered by the 28th. 

Per a press conference held by the Commissioner of Health and PPL on March 24, a grace period will exist for consumers and PAs through April. In this grace period, PAs can continue to work for consumers. Consumers should manually (on paper) keep track of the hours worked by their PAs. As long as the consumer and the PAs are onboarded with PPL during the month of April, wages will be paid retroactively. We currently do not have any other details on this proposal, such as how it impacts worker’s compensation, unemployment, onboarding new PAs, or other details. 

According to PPL you can either register by email here or by mobile here they also say that they have multiple language supports available at: 1-833-247-5346 and dedicated lines for some languages at the following numbers:

English: 1-833-247-5346
Arabic: 1-833-278-4829
Bangla: 1-833-278-5781
French: 1-833-279-3511
Haitian Creole: 1-833-279-3513
Italian: 1-833-279-3514
Mandarin: 1-833-279-3467
Spanish: 1-833-281-0927
Urdu: 1-833-281-3277
TTY: 1-833-204-9042 (we have seen nothing to indicate they support ASL or can accommodate VRS)

You can also reach out to a PPL facilitator to assist you they can be found here.

We understand that health insurance is a critical factor for many PAs. Some have health insurance through the Exchange, Medicaid, or a spouse and do not wish for their own coverage that could mess that up. Others rely on the coverage provided by the consumer’s FI. 

With PPL, we know that every For many PAs the move to PPL will mean switching your health insurance to the one they provide. Depending on the coverage you currently have and PPL’s rules for taking up their coverage there may be gaps between coverage that result from the switch. (for a more detailed analysis look here) Our best advice is to consult with PPL about their coverage offerings.