New York’s 2025 Budget Makes Big Changes To The State’s Consumer-Directed Program

Last month, the New York state budget for 2025 passed. It will bring on sweeping changes for home care stakeholders and recipients in the state.

The budget makes major changes to New York’s Consumer Directed Personal Assistance Program (CDPAP).

Under New York’s CDPAP, individuals seeking care are allowed to hire a caregiver of their own choosing. This often means informal caregivers. These caregivers are paid for their services through the program.


The most notable change the budget makes to CDPAP is that it will designate one statewide fiscal intermediary to oversee the program.

Some of New York’s home-based care providers — AccentCare is one example — serve as fiscal intermediaries (FI).

“Our providers really feel like the state is trying to dig a hole with a grenade,” Kevin Wade, a vice president at Sandata, told Home Health Care News. “The state takes the perspective that there’s significant fraud, waste and abuse within CDPAP. They feel that by moving to one, singular FI, they can reach $200 million worth of savings. A change like this adds an additional layer of complexity to an already complex system.”


Sandata is a technology company and an electronic visit verification provider. It works with states, home-based care providers and MCOs.

Wade noted that there were likely other steps the state could’ve taken to help reduce fraud, waste and abuse that would not have upended the current system.

“There are ways to monitor and oversee programs without necessarily altering or transforming the way that care is delivered,” he said.

There are also many questions about how having one statewide FI would work in practice, according to Wade.

“There’s a lot that’s still to be figured out with one singular FI, in terms of how many subcontractors will be allowed within a given area,” he said. “We know that there’s going to be at least one subcontracted FI per rate setting region, so there’s four within New York State. But past that, it’s not known. We don’t know who this fiscal intermediary would be.”

Wade also pointed out that moving from hundreds of FIs to one could impact care, as many of the providers that serve in this role are entrenched in the communities they operate in.

Aside from changes to CDPAP, the budget included a minimum wage increase for home care workers, and Medicaid rate increases for hospitals, nursing homes and assisted living communities.

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