New York’s tumultuous ongoing transition to a single fiscal intermediary for the state’s self-directed home care program, the Consumer Directed Personal Assistance Program (CDPAP), has caught the attention of the U.S. Centers for Medicare & Medicaid Services (CMS).

CDPAP is a New York Medicaid home care program that allows eligible individuals to hire the caregiver of their choosing. The program gained popularity over the years due to the autonomy it provided home care consumers.

“Generally speaking, CMS will be reviewing the change for compliance with all Federal statutory and regulatory requirements,” Damon Terzaghi, senior director of Medicaid and home and community-based services at the National Alliance for Care at Home, told Home Health Care News in an email.

As part of an overhaul of the program, consumers and personal assistants were required to register with fiscal intermediary Public Partnerships LLC (PPL) by April 1. However, the New York Department of Health extended this April 1 registration deadline amid calls from lawmakers and advocacy organizations pushing for a delay.

Plus, last week, a federal judge ordered a temporary restraining order (TRO) and a preliminary injunction to stop the New York State Department of Health from enforcing its CDPAP overhaul.

All of the recent attention the CDPAP transition has received makes this review stand out, according to Terzaghi.

“Usually, a technical review would not be controversial; however, the politics surrounding this issue have really brought it to the forefront,” he said. “From my perspective, the move to a single statewide fiscal intermediary is allowable under Medicaid, so if there is an impact, it means that the review expanded beyond the narrow scope of this amendment.”

Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. recently posted about CDPAP on X.

“Costs in the NY State Medicaid CDPAP program rose from $2.5B in 2019 to a projected $12B in 2025, with future projections on a steep upward trajectory,” he wrote. “New York has filed a state plan amendment related to substantial changes to this program, and we are taking a 90-day review period to assess the updates for consistency with federal law. This review allows the federal government to evaluate how the changes affect access to care and evaluate the appropriate use of federal dollars.”

While Terzaghi noted that Kennedy’s posting about the program, and concerns about its growth, raises the stakes of the CMS review, he doesn’t believe that the move to a single fiscal intermediary is controversial.

“It’s the politics and processes preceding the SPA that created these issues,” Terzaghi said. “I think that bigger questions to me are around whether HHS directs OIG to investigate either the procurement process and/or the underlying CDPAP program for irregularities.”

Ultimately, Terzaghi thinks the greater question around the future of the CDPAP overhaul is whether the courts will continue to intervene beyond the initial injunction issued late last month.

“I do not think that [New York] will completely scrap the overhaul, but if any of the allegations about an improper procurement process are proven to be true, then there could be further delays and potentially a re-procurement,” he said. “That would require some type of legislative or judiciary intervention.”