Filling The CDPAP Gap: How Home Care Providers Are Rebuilding After Tumultuous Transition

Multiple lawsuits, seniors losing access to care, inadequate caregiver compensation — these are just some of the consequences of New York’s rocky consolidation of its self-directed Medicaid home care program.

But that’s not all.

The Consumer Directed Personal Assistance Program’s (CDPAP) transition from having multiple fiscal intermediaries to just one administrator also meant the loss of business for New York home-based care companies that served in these roles.

For some home-based care providers, losing their role as a fiscal intermediary meant the loss of up to 50% of their business, according to Bryan O’Malley, executive director of the Consumer Directed Personal Assistance Association of New York State (CDPAANYS).

“There’s been layoffs, … in some cases, there were closures,” he told Home Health Care News. “It was a significant loss of revenue.”

CDPAANYS is an organization focused on supporting consumer-directed personal assistance providers and recipients in New York State.

Addus HomeCare Corporation (Nasdaq: ADUS) was public about its decision to leave the New York market entirely, following the loss of its fiscal intermediary business.

“It wasn’t a stable environment … we felt we could take our capital and move it to other states that were more appropriate for our programs,” Addus CEO Dirk Allison said at the Jefferies Global Healthcare Conference last year. “When we were approached to look at selling it, we decided to make that move. While we hate to leave New York, from a standpoint of financial implication, and the time we’ve had to put in, it’s a good move for us.”

In 2024, the company sold its New York personal care business to home-based care provider HCS-Girling.

HouseWorks CEO Mike Trigilio also cited the CDPAP transition as one of the company’s biggest pain points, though they’ve since recovered.

“We were one of those providers that had a program one day and didn’t the next, but we didn’t sit around and talk about it for a year,” he previously told HHCN. “We actually pivoted the business about seven to nine months prior to the April 1 deadline, and we discontinued CDPAP services, literally on April 2. That was one of the largest financial shifts in this organization, hopefully, ever, and we’ve since outrun that.”

Laura J. Ehrich, vice president of public policy at home care trade association New York State Association of Health Care Providers, explained that company size wasn’t always a predictor of which companies would be hit the hardest by losing the CDPAP business.

“I think rather than agency size, it was really the percentage of overall business that determines the level of disruption,” she said.

Home-based care providers make up the loss

Though companies like Addus and HouseWorks have been able to either sell off portions of their business or pivot, other home-based care providers find themselves trying to make up for the hole CDPAP has created in their business.

Samantha DiCicco, CEO of the Albany Med Health System Visiting Nurses, explained that the CDPAP transition was a disruption in clients’ care.

“The state decided to sort of pluck that CDPAP piece out that destroyed that continuum for patients, for clients,” she told HHCN. “It was really devastating, and it was integral. It was a really good value[-add] that supported all of those services, and now they have to go to someone totally different. We still have clients that call.”

Albany Med Health System Visiting Nurses is part of the Albany Med Health System. This nursing organization includes the VNA of Albany, Visiting Nurses Home Care, the Visiting Nurse Foundation, and the Albany Med Health System Staffing Alliance.

Albany Med Health System Visiting Nurses lost 61% of its revenue as a result of the CDPAP transition.

“It’s very difficult to make up that type of money, so we know that we will be at a loss for many years to come,” DiCicco said. “We know that it’s our mission to care for our community, and so we will persevere and continue to push forward.”

To that end, Albany Med Health System Visiting Nurses has begun repurposing its staff. The organization has also set its sights on increasing its licensed home-based care business.

“We’ve done everything we can to increase that business — keeping us as whole as possible,” DiCicco said. “We really sat down with staff and had an open, transparent conversation about what the future looks like today, what it might look like tomorrow and next year. They’re really dedicated to taking care of people.”

At St. Nicks Alliance, it has been important to let CDPAP consumers know about the company’s licensed home care services.

“We pride ourselves on the ability to support our consumers, as well as the [personal assistants],” Simone Mayhew, director of elder care at St. Nicks Alliance, told HHCN. “We did speak to consumers. We let them know they had a choice to [receive] traditional coverage or they could continue with CDPAP.”

St. Nicks Alliance is a non-profit community development organization that serves low-to moderate-income Brooklyn residents. The company’s home care division has been around for over 45 years, and serves Brooklyn, Queens, Manhattan and the Bronx.

St. Nicks Alliance served as a CDPAP fiscal intermediary since 2017, until the program’s transition to a single fiscal intermediary. CDPAP accounted for 15-20% of the organization’s business.

“Losing 15 to 20% of our caseload was a blow to us,” Mayhew said. “We started to out-market more for the private-pay aspect of our business, and we’re doing that more aggressively with our marketing.”

St. Nicks Alliance has also leaned into specialized training and programs, according to Mayhew.

“We are also training for specialized populations, individuals with developmental disabilities, which is an untapped market,” she said. “We’re training with our aides to give more to individuals who may have cognitive impairments like dementia or Alzheimer’s. We know that this is a population that needs a lot of care, and having the specialized training will help us to be in a position to provide that care.”

The organization also operates two older adult care centers, an assisted living program and a social adult day program.

“That will go hand-in-hand with those clients who have Alzheimer’s or dementia, so that’s how we are looking to make up for the CDPAP shortfall,” Mayhew said.

Looking ahead, O’Malley hopes to see major changes applied to CDPAP.

“I’m hoping at some point, officials with the capacity to undo this contract and move forward and make sense for the state of New York — do that,” he said. “This has been extremely disruptive to home care in New York … the transition has not had hiccups, it’s been a disaster.”