Episode Transcript
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Speaker 1 (00:00):
Great to be here this morning on Saturday, December seventh,
a day that will live in infamy for reasons going
back to nineteen forty one and maybe for reasons coming
forward as we go through today's topic. But I just
want to wish everyone a happy holiday season. I was
great to hear Steve Bouchet back on the radio this morning,
(00:20):
who precedes our show. We're sandwiched in between two very
very highly skilled financial planners, Steve Bouchet and his group
and then Dave Kopek and his group, and we're the
legal side of this, and we're going to bring some
legal action to you today. The holidays are a time
to think about gathering at home, staying at home, being
(00:43):
at home. Our law firm works with families on a
whole variety of different types of planning, a state planning, trusts, wills,
powers of attorney, healthcare proxies, and we also do a
significant amount of work with our clients as their health
begins to fade and as they have conditions that require
(01:06):
significant services. The question becomes if you want to stay
home for the holidays for your lifetime, you know, and
be part of the family and be in your home
where the Christmas tree is and the comfy chair and
all the things that you have in your home. How
do you coordinate and bring care into the home when
(01:28):
care is needed? And that's really today's topic, what is
the future of home healthcare in New York State. And
we've had some very excellent guests on from Al Cardillo,
who's the head of the Home Care Association of New
York State, to Greg Olsen, who's the head of the
State Office for Aging, Rebecca Prevy, the head of the
(01:50):
Area Agencies on Aging. And today's topic is something that
you know, we're lawyers and we're used to litigation, but
in this field that is not the norm. But here
we are today and we're going to be talking about
litigation as it pertains to home healthcare. And it's a
serious topic because statewide, and nationally and internationally, there is
(02:15):
not enough staff to care for the people who need
to get care. And we're going to focus on home
healthcare because that's where ninety nine point nine percent of
our clients want to be. But these problems are not
unique to home healthcare. The same kinds of staffing issues
exist in nursing homes and hospitals. Where do we find
(02:36):
the people to provide the care. In New York State,
there is an innovative program. Several states have this. I
believe many states have this, and we're focused in New
York and there's a program in New York that became
extremely popular and in our estimation, we're going to talk
about that in just a moment because of the need
(02:57):
for families to be able to find the care care
when they needed and we're going to go through this
in some detail. But the program that New York State
began to utilize and our clients began to utilize is
something called the consumer directed Personal Assistance Program. This program
(03:18):
really grew up in the disability community. People who could
self direct people who were otherwise very highly competent and
skilled in their ability to manage their own care, but
who had physical disabilities and they needed care. So we
had a number of people, a number of clients with
(03:38):
disabilities who were able to hire people and manage that
staff because of their very unique needs. Well as time
went on, the need for home health care and the
ability to find agencies that could staff your case was
the struggle and was the challenge for many people. And
the consumer directed pro is just that the consumer finds
(04:03):
the care, finds the aids and is able to have
them go on to a state program, the Consumer Directed
Personal Assistance Program and become part of the state payroll
for home healthcare. And that program has become extremely popular.
(04:23):
And we're going to introduce our next guest who's going
to help explain why it's popular, how it grew, and
where we are today, and that's Chris Graeber. Excuse me,
he did not come. I apologize to that. Brian O'Malley,
who is with the Consumer Directed Personal Assistance Association of
New York State. Brian represents many of the agencies that
(04:48):
administer the consumer directed program and at least today, but
there are major changes coming and Brian, I want you
to introduce yourself to our audience and talk a little
bit about the Consumer Directed Personal Assistants Association and the program.
Speaker 2 (05:04):
Thanks Lou Yeah, as you said, I am an executive
director at Consumer Directed Personal Assistance Association of New York
as well as our advocacy arm, the Consumer Directed Action
of New York, and we work to build and strengthen
the state's Consumer Directed Personal Assistance program or as many
(05:25):
of you may have seen on commercials or elsewhere CDPAP
we as we move forward, we represent about fifty of
the fiscal intermediaries or the agencies that help administer the
program on behalf of the people that use it throughout
(05:46):
the state, Chris Graber and cd Choices being one right
here in the Capital region. We also represent the consumers
that utilize the program, and we really work at the
intersection of both of there of what works for both
of them. If it is good for the consumer and
good for the agency, it is good for the program
(06:07):
and it will we will help lift that up and
work to benefit that. Unfortunately, the program has been under
attack for many years at this point because of its
rising popularity. The independence that it grants people really is
something that they like. You know, you can have people
(06:28):
you don't know being sent to your house, or you
can hire your own staff in some instances your family
and people like being in control of who comes into
their house. These are intimate services we are often talking about.
We're talking about showering, we're talking about going to the bathroom,
and people like the control of who is doing that
(06:50):
with me and for me. That has led to a
tremendous growth in the overall success of the program, and
combine that with the shortage of workers. As you were
talking about the rest throughout the rest of this healthcare
sector overall, it's home care agencies, it's nursing homes, it's hospitals.
(07:12):
Everyone has a shortage of workers. And really, this is
not only popular because it gives independence and control. It's
popular because it is, in many cases the only option
that people have.
Speaker 1 (07:24):
So I want to get this down to the conversation
around the kitchen table when the family is sitting there
and mom's in the hospital, and they're talking to the
discharge planner, and the discharge planner says, well, you need
a safe discharge plan and mom needs care at home.
Speaker 3 (07:44):
Where are you going to find it?
Speaker 1 (07:45):
And our clients are then looking and struggling because they
have to get mom out of the hospital. They don't
want to put Mom in the nursing home. And the
family is sitting and saying, how do we navigate this system?
How do we bring people in to provide the service.
Sometimes it's children, Sometimes it's grandchildren, nieces, nephews, neighbors, church
members that are available immediately to provide the care. We
(08:10):
work up to the Canadian border. I was in Plattsburgh
yesterday meeting with a client in Plattsburgh. And the wife
has Alzheimer's that is progressing. The husband has his own
health issues. And what did they do. They hired somebody
that they heard about from a neighbor who came in
and is providing care fifteen hours a week under the table.
(08:34):
And probably more than half seventy five percent of the
case is that we start with they've already found somebody
to bring in and they're paying them, violating several laws
and putting them on a payroll in the home and.
Speaker 3 (08:49):
Doing it just because of necessity.
Speaker 1 (08:52):
And that necessity is like a burning fire, and unless
you put that fire out, it's going to just burn
the building down. So how does Consumer Directed fit into
that family's discussion and how do they make use of
the program.
Speaker 2 (09:09):
So Consumer Director really can serve as that immediate help
in so many instances. It used to be that you
would call a home care agency and the home care
agency could have somebody to your house tomorrow, and that
was the immediate way to get services. It might take
longer to hire a staff person on your own, and
(09:32):
you might want to go that way, but the homecare
agency could fill that need tomorrow. Well, the home care
agencies can't very often fill that need anymore. They don't
have the staff to deal with the clients that they
currently have. And so when you're sitting around that table
trying to figure out how to get mom out of
the hospital, it does come down to who's going to
(09:57):
provide that care, and oftentimes it is somebody in the family.
It is more often than not the daughter, or you know,
a granddaughter or a grandson. I merely speak to demographics
when I say more often than not the daughter, But
that has its own consequences. People have mortgages, people have
(10:21):
rents they need to pay. You still need to put
food on the table. It's cold in upstate New York.
You have to pay the heat. So Consumer Directed can
step in and help fill that need. You're probably not
going to be making what you would have been making
in a full time career, but you can supplement household
(10:45):
income through wages from the state, through wages from the
Medicaid program and help fill that need so that mom
can be out of the hospital. You can be confident
in the level of services that she is getting because
you're providing them, or someone else in the family or
someone else, you know, from outside the family is providing
(11:07):
them and you can still make sure that you can
pay the mortgage at the end of the month. You
can still make sure that you can put food on
the table for your family.
Speaker 1 (11:17):
Yeah, the staffing shortage is what is driving this, folks.
It's really the lack of people available to those home
health agencies who they could hire. The pay scale is
relatively low. The people that are working in those agencies
don't make a significant amount of money. The turnover rate
is over eighty percent in home health care. So if
(11:37):
you think about you're hiring an agency, well who are
you hiring? They're gonna put somebody in your home that
could be gone the next week, and now you've got
a new person coming in. So you don't have control
over who the staff is in the home. The agency
controls that and as they have lost their staff. We
have a wonderful organization here in the Capitol region, the EDDIE,
(11:58):
and the EDDIE has the VNA, and the VNA had
what's called a licensed home Healthcare Agency or ALIXA in
the parlance of home health care. And at one point,
and this is coming from the CEO of the EDDIE,
they had four hundred home health aids employed through the
eddy VNA staffing cases all across the Capital region. They
(12:20):
were down to forty and they shut the home healthcare
agency down. They shut their licensed home healthcare agency down.
So what do you call most counties? There's one or
two or three agencies in Upstate New York. Now, this
is a very different program in New York City because
there are people. The ability to find home health aids
(12:41):
for an agency in Manhattan is very different than an
agency in Plattsburgh, New York.
Speaker 3 (12:46):
So just talk a little bit about this to.
Speaker 1 (12:47):
Divide between New York City and upstate and the differences.
Speaker 2 (12:53):
You know, in some ways there are tremendous differences. You know,
the sheer quantity of people as you mentioned that, the
staffing shortages, and the ability to get services. You know,
it's one thing if you are in Albany or rensel
Air in Skohary, where you might be the only person
(13:17):
that that agency would be sending someone to, and they're
going to send you out for one or two hours,
it's not worth it. The agency is going to lose
tremendous amounts of money if they send someone out you.
They just will not even consider that case. You know,
my own father went through this as just outside of Poughkeepsie.
(13:40):
Here's twenty minutes outside of Poughkeepsie, and the agency said, well,
if we find four more people in your area, then
we'll consider sending someone out. Okay, but I need services.
Speaker 1 (13:51):
Right, and there's there's the bottom line, right, you need
it when you need it right, And so many people
haven't planned for this, haven't really thought about this. We're
gonna take a short break. And the popularity of this
program because we pushed our clients to it because we
were in a position where we're calling home health agencies
(14:13):
no staff, no staff, no staff, We're doing Medicaid applications
and we can't get them any service even though we
file the application, which puts us in a bad position
because we just got our job done. We got them
on Medicaid, but there's nobody to provide the service. So
Consumer Directed Folks has grown to the point where the
(14:35):
state has now made a major shift because of the
success of the program. And I've been doing this forty years,
and I've been in state policy forty years and was
on the Governor's task force. And they used to call
it the woodworking effect. If you build a program that's
too good, people will come out of the woodwork to
(14:55):
use it. That's the thing consumer directed is suffering from.
Going to come back after a short break with Brian
O'Malley and talk about the consumer directed program in New
York where it is today, and folks, it's in court,
it's in litigation, and the litigation will talk about how
it got there, why it got there, what the potential
outcome is, and how it impacts you and your family
(15:17):
this holiday season as you want to build that plan
that keeps your whole family home for the holidays. We'll
be right back after the short break. I'm Loupiro, your
host for this morning. I am here live in studio
and we're very happy to have Brian O'Malley, who is
(15:37):
the head of the Consumer Directed Personal Assistance Association of
New York State, and we're talking about home healthcare and
a program that has become extremely popular called the Consumer
Directed Personal Assistance Program. And that program has grown over
the last several years because of need, Folks, and this
is just demographics.
Speaker 3 (16:00):
Members.
Speaker 1 (16:00):
The number of seniors who are coming into the system
and looking for home healthcare continues to grow. The fastest
segment of the population. Fastest growing segment in New York
State is eighty five plus. The number of workers eligible
workers to provide services in healthcare, in particular home healthcare
is going the other way. The curve is going down.
(16:23):
So when you have demand going up and supply going down,
what happens usually costs go up. But this is the
state and the state is regulating the reimbursements to the
home health aids. So with the numbers going up and
people finding this outlet and they opened the door to
(16:43):
allow people to find care. Oh my goodness, we could
actually find a caregiver to use our medicaid that we
just got approved for. And the only way we could
do it was to hire our own help. We couldn't
get an agency to staff the case. There's the problem.
They had to use the program because there was no alternative.
And Brian O'Malley that has led to New York State
(17:06):
and the numbers are staggering, folks. Medicaid budget in New
York was ninety six billion dollars last year. It's a
big number. The total state budget I think was somewhere
in the two thirties. Ninety six billion of that was Medicaid,
and Brian this program was one of the fastest growing
components of medicaid. So the states saw that and said, oh,
let's put the brakes on.
Speaker 3 (17:26):
And what happened.
Speaker 2 (17:29):
You know, the state wanted to put the brakes on,
but if I could just take one second to back up. Sure,
demand was growing because of need, but that growth was
also very intentional. That was intentional from the state's purpose.
Back in twenty thirteen, the state put out their Olmsted Plan,
(17:51):
which was required on how are we going to keep
people in there?
Speaker 1 (17:55):
Just for our listeners, we've talked about Homestead a lot
because it was a great It's the US Supreme Court
case that said every state has a mandate to provide
services to people in the most independent setting possible, and
that's the Olmstead mandate. And then there was the Almost
That Act signed by President Bush George W. Which brought
(18:19):
that case into legislation. And you have the Almost Act,
which now every state, I think we're thirty two state
agencies that had to comply with this order to rejigger
their programs to provide services in the most independent setting possible.
So you have this constant shift going from institutions to
the home. You had the demand growing for a variety
(18:42):
of reasons, including, as you said, the legal reason.
Speaker 2 (18:46):
But on addition, the state said, you know, we're going
to have to provide these services. Consumer directed is the
least expensive way to do that, right, and it comes
out with better quality, better outcomes. We're going to judge
which managed care plans based on how many people they
can get into consumer directed. They drove this by telling
(19:07):
the managed care plans, we want you to enroll people
in consumer directed. The managed care plans did it, and
the state said, wait, there's too many people in consumer directed.
And so really that was what drove us and got
us to the situation today. And now the state is
trying to figure out, Okay, we have an aging population
where record numbers of eighty five plus, record numbers of
(19:29):
sixty five plus who are living in poverty and have
come out of institutional poverty and have chronic conditions that
lead to the need for home care services, and the
state says, we don't want to do that, we don't
want to provide these services. We had built a great system.
I'll constantly refer back to the Seinfeld rental car episode
where you know, anyone can take the reservation. The taking
(19:51):
as of their renovation is easy. It's the holding of
the reservation that's important. Well, in home care, anyone can
offer home care benefits, you can get all the hours
and in the world, that's easy. If you can't fill
those hours, it's meaningless. And the state really had built
themselves a system where they can offer all this great
home care but didn't have to actually staff it. And
(20:13):
now Consumer Directed broke that and they actually had to
staff it. And so they said, well, we're going to
try this thing of bringing in one company from Georgia
who will be able to fill this need for everyone.
And we're going to put out a business the Consumer
Directed Choices and all of these other companies from around
(20:35):
the state who have been working in New York with
people locally for decades in some instances, and shift to
this one company from george.
Speaker 1 (20:46):
So we're going to try not to get political with this,
but we're going to try to talk reality. And the
reality is that you have a system that is different
New York City, from Buffalo to Plattsburgh to Albany, and
every community, every geographic area had providers that we're familiar
with that area, and we're familiar with the population. How
(21:08):
many agencies evolved and grew to service the consumer directed program.
Speaker 2 (21:15):
You know, the state will say there are six hundred
agencies around the state. We are aware of about three
hundred and fifty that have filed the state required cost
reports if you are operating it, so not entirely sure
where the state gets their number from, but we know
of about three hundred and fifty that have cost reports.
But as you said, a number of those are operating
(21:39):
in niche areas. There are some that serve a portion
of a neighborhood in New York City. Now, a portion
of a neighborhood in New York City might be larger
than the city of Albany, but you know that that
portion of a neighborhood is a discrete group of immigrants
who are very tightly knit and very and have a
(22:00):
language and a culture that you know, and the organization
coming in just wouldn't be able to understand or work within.
And this agency could do that. And you know that
exists upstate in many places as well. It's to a
smaller scale, but the folks upstate, you know, nobody in Albany,
(22:22):
nobody in Plattsburgh. Nobody in Potepsie wants this agency from
the city coming in and telling them what to do.
Speaker 1 (22:29):
Well, they say that all politics are local and all
care is local. And we have clients that could get
agency care because they're on.
Speaker 3 (22:39):
A bus line.
Speaker 1 (22:41):
If you go five blocks from the bus line, they
couldn't staff the case because their aids couldn't get to
the home. So it is broken down household by household,
blocked by block as to what services are available. And
what the state has done is taken that fabric of
all these three hundred and fifty community based organizations that
(23:05):
administer consumer directed and replace them with a single agency.
And it's something that when you're looking at a single agency,
the state wide Fiscal Intermediary is what it's being called.
The state put out a bid for contracts for this
statewide fiscal intermediary and that the requirements were somewhat narrow.
(23:31):
Let's say that many agencies couldn't meet the requirements. They
took our controller out of the process so they couldn't
The controller couldn't review the contract. And now we have
a statewide fiscal intermediary who is starting talk about the
start and what we're anticipating. We got Actually we're going
(23:51):
to take a break in about thirty seconds. So this
is where the state of the Consumer directed program is, folks,
and for many people in upstate New York, this is
home healthcare under Medicaid. Because agencies cannot staff your case.
Twenty four to seven is very difficult to do. We
have done it with Consumer Directed and you get to
know the people. They're consistent, they're your staff. This is
(24:14):
the program that has worked maybe too well. When we
come back, we're going to break it down a little further,
talk about the future of home healthcare and consumer directed,
and talk about how you can plan and prepare your
family for this eventuality. We'll be back right after the news.
We're talking about home care, keeping your loved ones at home,
(24:34):
keeping yourself at home. And I want to just give
you a heads up. On Monday, December ninth, to two
days from now, we will be doing our last Medicaid
Monday of the year. Brian O'Malley was a guest on
our Medicaid Monday and you can see his show. It's
on our website at purolaw dot com. All of our
past Medicaid Monday shows are there. You can also find
(24:57):
all of our past radio shows and podcas casts. But
this Monday, December ninth, the three partners in Albany of
Pure O'Connor and Strauss, Aaron Connor, Frank Heming and myself,
we're going to be talking about what to expect in
twenty twenty five appropoted today's discussion. If you are planning
and looking at your future, what is available to you
(25:17):
today to help to prepare for tomorrow? So you don't
want to be doing this when you get into the hospital,
go through the emergency room, get to the discharge planner,
and you have no plan.
Speaker 3 (25:30):
You don't want to be in that situation.
Speaker 1 (25:32):
So we're going to talk about how to prepare, how
to plan, how to get yourself ready for whatever happens.
In folks, life happens. That's the name of the show,
and this is why we named it. It's something that
we want you to think about. But you don't have
to get negative about it. You have to prepare, plan
and be ready. That's the best you can do. So
we're going to help you do that. Monday at twelve noon, Aaron, Frank, myself.
(25:56):
You can register at purolaw dot com go to the website,
go to the events tab and register for this Monday's
Medicaid Monday twelve to twelve thirty. It's a thirty minute
tour de force of what to look for for next
year in healthcare, home health care, and Medicaid Again this Monday,
December ninth, twelve to twelve thirty Medicaid Monday.
Speaker 3 (26:17):
Don't miss it.
Speaker 1 (26:18):
Frank Aaron myself will be on and we're going to
talk about all the things, including a little bit about
this consumer directed program that we're tackling today here on
Life Happens. And my guest today is Brian O'Malley, who
is with the Consumer Directed Personal Assistance Association. So the
association represents a number of providers that administered this home
(26:41):
healthcare program called consumer directed. So if you need care
and you've called every agency in your county and none
of them can staff your case, and you need to
go out and pull in a caregiver, you don't want
to do it and pay them under the table, because
that's illegal.
Speaker 3 (26:56):
Folks.
Speaker 1 (26:57):
You're not paying taxes doing withholdings, you're not paying workers compensation.
If that aid is being paid under the table and
falls down your stairs and breaks their neck guess what,
they can sue you and they'll own your home and
they can take everything that you have. So you need
to do this legally. What better way, Brian, to do
this legally then to bring that aid into the consumer
(27:21):
directed program. And let's flip the coin and say what
does an aid get for working through consumer directed Because
that twenty dollars an hour under the table doesn't have
vacation time, doesn't have benefits. Talk about what it means
to work through the consumer directed program.
Speaker 2 (27:37):
So working through the consumer directed program gives you the
safety of having that job that's not in the gray market.
It gives you the safety of having workers compensation if
you fall down the stairs or more common if you
just are transferring somebody and week you're back. I can
(28:02):
speak personally through the horrors of that. So it gives
you number of those protections. It is about, you know,
the wages you had mentioned before. It's not glamorous. It's
you know, in Upstate, generally on January first, it will
go to about eighteen fifty five an hour. I think
(28:23):
there are some agencies who pay more. That's one thing
we are worried about in this transition is everyone is
going to fall to the lowest possible wage. The benefits
vary by agency, and that's often something that consumers, those
who are using the program will shop for when they
are picking an agency. Hey, what can I offer my workers?
(28:44):
Some want more pay, some want higher benefits. But there
is paid time off. You get holidays. Some agencies are
giving you extra time and a half for working on
a holiday. So if you have to come in on
Christmas because people still need services on Christmas, you can
get time in a half. With some agencies, you can
get sick time, you get maternity weave. You know, you
(29:07):
get all of those extra benefits, and you get workplace
protections because this is intimate work in people's homes, and
so you get those protections to make sure that you
know that employee, you are being treated properly as an employee.
Speaker 1 (29:23):
So we have worked with this program for many, many
many years and going through it, and we've we've worked
very closely with the Consumer Directed Choices program. And I
think back to the founder of Choices, Constance Lehman, who
became a close friend of mine. We actually had her
on this radio show and Constance was a force to
be reckoned with. She's a young woman who at the
(29:45):
age of eighteen, and she told her whole story on
this show before she passed. Unfortunately she's no longer with us.
But Constance, at age eighteen, was having a little outing
with her friends and fell off a cliff and became
pair and she was relying on a home health agency
to staff her case because she now needed help in
(30:07):
the home. She's wheelchair bound and she needed help in
the home, and the aids wouldn't show up. There was
a different aid every day that didn't know what her
needs were, and she had very specific needs in terms
of how her care had to be administered. And oh,
by the way, consumer directed aids can do a lot
of things that agency aids cannot do. If you have
a case where you have someone that's tube fed, you
(30:30):
can't use an agency, but you can use consumer directive.
Speaker 3 (30:33):
It's kind of an ironic twist.
Speaker 1 (30:36):
That consumer directed aids can do a whole host of
things that agency aids cannot. But Constance had this program
and she started to use it to the point where
she opened her own agency. And initially she was on Medicaid,
and she actually went off Medicaid because her agency became successful.
So she became a full private pay patient and had
(30:56):
a very successful business. So Constance Layman is one of
the pion years of consumer directed personal assistance, and I
wish she were still here to advocate against these changes.
And that's who this benefits. It's the people who want
to have some say over their care. It's aids who
can get the benefits and the security that you just mentioned.
(31:16):
And it's a program that worked. So why can't it
continue in the form that has been so successful?
Speaker 3 (31:23):
Right? And what changes have been made?
Speaker 2 (31:27):
Honestly, we don't know. We are trying to figure out
why it can't continue in the way it's been so successful.
You know, the state wanted savings. Well, the state put
in five hundred million dollars worth of savings this year.
We currently have five hundred million dollars in savings going
in effect, all of which is actually going to go
(31:48):
away once they bring in that new single five who
they're hoping will bring in a different five hundred million
in savings. That is the definition of the bird in
the hand, you know, So don't we don't understand fully
why they are so insistent on moving to this new.
Speaker 3 (32:08):
Single fiscal intermediary.
Speaker 2 (32:11):
Yes, so all the program right off the time.
Speaker 3 (32:13):
How many people.
Speaker 1 (32:15):
Are served by the Consumer Directed program in New York
State currently.
Speaker 2 (32:19):
There are about two hundred and eighty thousand people using
the program today according to the Department of Health, and
by our estimates, that means there's about four hundred or
four hundred and twenty five thousand people who are providing
those services to those two hundred and eighty thousand people
around the state. So you know, we're really at the
(32:41):
end of the day looking at close to three quarters
of a million people who are directly in this program.
Speaker 3 (32:48):
Impacted by it.
Speaker 1 (32:50):
And what will it mean and what are the time
what's the timing of this When when do these changes
go into effect? And what will it mean to people
who using Consumer direct and people who want to use
Consumer direct?
Speaker 2 (33:04):
The timing is astronomically fast, especially by government standards. I mean,
you know, government is famous for making sloths look like
you said, bolt, but the state wants to do this.
They are going to begin on January sixth, and they
(33:25):
will begin in of this upcoming year in less than
a month as of today, and they will begin in
a number of the more rural counties upstates. So I
think you know, Clinton County, Plattsburgh, Allegheny County, Broome County,
or Binghamton, and they're going to begin there. And folks
(33:47):
in those rural counties primarily will begin getting letters from
the Department of Health or their managed care plan or
in many instances public Partnerships LLC or PPL saying you
need to switch your services now. Importantly, you don't need
to switch your services that day, right, you can wait.
(34:10):
You can stick with your single FI, you can singlify there,
you can stick with your current FI. You're with consumer
directed choices, you can stay with them for the time being.
I want to say that there are efforts underway to
try to undo this, so you know we will get
more to that, but efforts, legal efforts, yes, and you
(34:32):
know those are ongoing. But on January sixth, people in
about twenty counties will start getting notices. On January twentieth,
folks in kind of that Rower, Hudson Valley Area, Duchess, Orange, Putnam, Rockland, Sullivan,
Ulster will start getting notices. Those will go out on
January twentieth. The kind of upstate urban counties will begin
(34:59):
getting shifted on February third, And so you know, as
of February third. If you live in Aubany County, Rensselaer County,
Monroe County, Onondaga, you can expect to start getting these
notices at some point, probably within that week. And then, interestingly,
(35:21):
the two hundred to two hundred and ten thousand people
in New York City, Nassau County, Suffolk County, and Westchester
will begin getting moved on February tenth. Now, how long
is this transition going to be? Well, if you are
not fully moved by March twenty eighth, you lose your services,
(35:45):
you are out of the program.
Speaker 1 (35:47):
Yeah, and having done this for forty years, folks, these
timeframes are incredibly fast. This announcement was made by the state.
Speaker 3 (35:55):
On October first.
Speaker 1 (35:58):
And the state made the decision on the October first,
citing and I'm reading now from a Channel six news
bulletin advocates worry about accessibility in New York's consumer directed overhaul.
The state made this decision on October first, citing Controller
and other reports that some of the programs in CDPAP
were found to be abusing the system, including one recently
(36:20):
being indicted by the US Attorney's Office for fraud. So
when the government wants to cut a program, they find
abuses and they allege fraud. Anecdotally, I've been working with
the Consumer directed program for fifteen twenty years. I have
not witnessed that my clients are hiring, they're paying, they're working,
(36:44):
they're caring for people. Where is the evidence of fraud?
And what are these agencies? And remember, folks, this statewide
change is taking three hundred and fifty or so agencies
that are administering program for two hundred and eighty thousand people,
transitioning them to a single company coming from Georgia to
(37:07):
take all two hundred and eighty thousand people by March
twenty eighth and transitioned. And anybody that works in government
knows that is a challenge and a challenge that is
going to just be pushed back. There's no my estimation,
this is just my guess. There's no way they're going
to meet that deadline to get all two hundred and
eighty thousand people converted within that timeframe.
Speaker 3 (37:31):
Where is the fraud?
Speaker 1 (37:32):
And have there been cases where prosecutions have happened, where
there are things going on in the industry that people
are scamming the system?
Speaker 3 (37:44):
You know, we.
Speaker 2 (37:47):
Have been looking for the fraud for the better part
of the year. Do you find cases? Sure? The governor
likes to point to one case in twenty twenty where
the government around did agency owner on a cruise when
she was supposed to be working. I guess this was
(38:07):
the one person who got a cruise in twenty twenty.
But ye, January, you're a very very short window. But
there are anecdotes, and in a program with two hundred
and eighty thousand people four hundred thousand workers, you will
find anecdotes. I think if you go to the Office
of the Medicaid Inspector General, this is an agency that
(38:30):
is tasked with finding fraud in Medicaid, what you will
see is universally consumer directed Personal Assistance or CDPAP. That's
the least fraud of any system in our healthcare system.
And that's really because you know, we're talking about family
members who are providing care for family and if you're
saying that someone is committing fraud, you are saying, I'm
(38:52):
going to deny my mom's services, and ask yourself the question,
would you deny your mom's service is for eighteen fifty
five an hour, like that's a fairly awful human being.
Do they exist one hundred percent? They are not the norm.
I think more often what we hear when we actually
(39:12):
go rooting for these frauds is the ever popular. While
my brothers sisters shrep boyfriend's neighbor told me that a
friend of theirs neighbor is using the program and their
worker gets paid and never comes in, is always at
the movies. And that's that's not evidence, that's not even
(39:34):
an anecdote.
Speaker 3 (39:35):
That's triple hearsaying.
Speaker 2 (39:37):
At the least. Yeah, And so we can't find widespread,
massive fraud we want. Look, we've been asking for more
regulation in this program since twenty twelve because we want
to make sure every dollar is going through services that
can But said, while we can always tighten things up,
(40:02):
while we can always get closer to zero, we're as
close to zero as any healthcare program in the Medicaid
has gotten.
Speaker 1 (40:12):
So it's a targeted change. And are we throwing the
baby out with the bath water here? And we're going
to come back and finish up talking about what you
can do now to start preparing. If you need care
now and you need to transition, be prepared. There are
(40:32):
resources We're going to identify those resources for you. If
you're not yet needing care, but someday you want to
make sure that you're prepared. We're going to talk about
that when we come back after this break. You're listening
to Life Happens Radio every Saturday morning right here on
Talk Radio WGY.
Speaker 3 (40:48):
We'll be right back.
Speaker 1 (40:52):
Around the hearth, around the fire, round the tree, singing
like bing hopefully or some version of that, and we
all try. But today we're talking about being at home
when you need care. How do you be at home,
stay at home, get the care you need, and successfully
navigate a system that just gets more and more complicated
(41:17):
by the day. I'm Lupiro, your host for this morning
live and in studio with Brian O'Malley, and we're talking
about consumer directed Personal assistance, the program where you get
to pick and hire your own aids. You have to
manage those aids, supervise them, make sure that the payroll
is in, make sure all the things are complied with.
And I've done this for relatives. I'll talk about that
(41:38):
in a moment, but right now we're facing a major change.
Speaker 3 (41:42):
We're going from three.
Speaker 1 (41:43):
Hundred and fifty agencies serving two hundred and eighty thousand
people to one, and that one is the statewide fiscal
intermediary that's going to take over all of this. So, Brian,
we've been talking about the fraud, the abuse again personal
I haven't seen it. If it's there, it should be prosecuted.
It should there should be additional regulations you would think
(42:06):
over time. And as you said, you've been trying to
get tighter regulations on some of these issues for the
last twelve years. And the change is going to be
that this one fiscal intermediary is going to come in
and where is the accountability in the system. Who is
going to be held accountable? When eighty thousand of those
two hundred and eighty thousand loose service because of glitches
(42:30):
in the system, and now you're putting people with severe
disabilities living at home at risk, where are they going
to go?
Speaker 2 (42:39):
You know what, that's a huge question we have is
who's going to be held accountable? You know, when Spectrum
doesn't provide your cable correctly, or you know, you have
your your internet goes out, where's your accountability? What where
can you go to handle Spectrum? Where can you go
(43:00):
whenever you are dealing with monopoly to hold that monopoly accountable.
You know, once this change happens, there won't be other agencies.
If the state doesn't like what PPL is doing, there's
no place else. This is the option. If they kick
(43:21):
PPL out, well, you're going to have at least a
three to six month window. You know, they're going to
have to go hire someone else. They're going enough to
transition everyone to that new entity. There is no option,
There is no accountability. And let's face facts, DALH does
not have the staff to actually hold this entity accountable
if they want to. So we are extremely worried about
(43:47):
where the accountability is because it's not an abstract thought.
When we look around the country. PPL has not done well,
and they have needed those parties to hold them accountable.
They have lost contracts in Pennsylvania, they have lost contracts
in Massachusetts, they have lost contracts in New Jersey, Tennessee, Colorado,
(44:10):
Washington State.
Speaker 1 (44:11):
Yeah, and this is the provider that New York State
has chosen to take on these two hundred and eighty
thousand consumers by March twenty eighth. And I've read a
lot of the reports from those other states and just
talked very briefly about the latest litigation because there was
a competing bidder that could have been awarded this contract
(44:32):
that didn't get it, and they have now sued New
York State.
Speaker 2 (44:36):
There is so there is a bitter Freedom Care. Many
of you may have known them. They actually are in
New York because the contract said you have to have
you have to have a statewide contract with a state
not named New York because that somehow made sense. But
Freedom Care could meet that quality. They are statewide in
New York, but they also do operate in other states.
(44:58):
They have thirty thousand people according to their court records
in the state of New York. They are a lower
price than PPL coming in they had because they have infrastructure,
They had no transition costs, whereas PPL is at I
think forty eight dollars per person for a transition. That
(45:23):
the bid had higher quality, more established nature of providing
services allegedly in the state of New Yorleans. I think
it's factual that Freedom Care is providing services in New
York and PPL is not, and they somehow did not
(45:45):
make the bid. They were cheaper, have a history of
providing services here, but did not win the bid.
Speaker 3 (45:51):
And that's the graviment of their loss.
Speaker 2 (45:53):
That is the gravimen of their lawsuit. And interestingly, there
is an affidavit in that lawsuit that says and in
the VIDU was in a meeting with the Governor's office
in early April before the budget even passed. The budget
was where this was. This change was initially made and
individuals in the Governor's office told this person, PPL will
(46:17):
be the single FI. There wasn't a budget, there hadn't
been an RFP process or a bid process, but the
governor's office already knew that PPL would be the single FI.
Speaker 1 (46:29):
So public contracts are supposed to go through a process.
They're supposed to be a bidding process.
Speaker 3 (46:34):
We're taxpayers.
Speaker 1 (46:36):
We want to know that the money is being spent
properly by qualified providers. And there is one person that
I think does a really good job in New York
and that's a controller, mister Danapoli, Thomas Napoli, who is
your controller, folks.
Speaker 3 (46:48):
He does a great job as a watchdog. He's out
of the process.
Speaker 2 (46:52):
He is out of the process. He you know his job.
He has very discreet jobs. One of them is review
every kind tract, make sure the rules were followed. It's
not make sure this makes sense politically, it's not any
it's make sure the rules of contracting were followed. They
exempted him. They said, you're not allowed to look at
(47:14):
this contract. That's weird that if you go to the
controller's website, it on average takes a week for him
to look at a contract and say this is that
we approve this. We don't the new contracts. It might
be like eight point three days. They exempted him. They
exempted him on one of, if not the largest contract.
(47:39):
This is a forty five billion dollar, five year contract.
Speaker 1 (47:43):
Think about that, folks. This contract was awarded before the
budget passed, awarded to a provider without competition, and forty
five billion dollars over five years with a b with
a bee. That's enormous. We're going to keep following it.
But Brian, we have so a few minutes left. What
can people do now to prepare for the transition, and
(48:05):
how should they be reaching out and finding those resources
that can be available.
Speaker 2 (48:09):
So I think it's important get informed. There is a
lot of competing information out there. There's stuff that PPL
is trying to tell you to make sure that you
move in the direction They want as fast as possible
to make this a fait accompany that it will happen,
because it has happened. The plans are telling things, the
agencies are telling things. We have a resource that's just
(48:31):
an FAQ. It is all factually based on our website
cdp A A nys dot org. One more time, c
dp A A nys dot org, cdpenies dot org. There's
a link to an FAQ right there on the front
(48:52):
page at the top. If you see questions you don't
that aren't there, please let us know if you have
the question. Do we want to be the resource for folks.
We want folks to know because at the end of
the day, two hundred and eighty thousand people rely on
this program to live independently in the community, and the
consequences of this going badly are devastating for hundreds of
(49:17):
thousands of people and families across the state.
Speaker 1 (49:20):
We're anticipating phone calls at our law firm, folks, so
please feel free to call us number one if you
want to start looking at how you plan for this
and what are the best ways to access care at
home stay at home. That's a big part of Pierre
O'Connor and Strauss's practice. We work very closely with other agencies, organizations,
offices for the aging, and a group that we work
(49:41):
with very closely, ever, home care advisors. They are personal advocates, nurses,
social workers, therapists who can help you through the system.
Speaker 3 (49:50):
Reach out to us.
Speaker 1 (49:51):
We're happy to channel your questions, your information and tune
in Monday at noon for Midicaid Monday thirty minutes. We're
going to talk more about the planning aspects of this,
how to look at medicaid as a resource, and how
to get yourself ready to age properly, living well in
the comfort of your own home. Bran O'Malley, thank you
(50:12):
so much, thanks for being here today. It's been a
great conversation.
Speaker 3 (50:16):
Folks.
Speaker 1 (50:16):
These are your tax dollars. Watch them carefully. We'll be
following it. Stay with us, you're listening to Life Happens
every Saturday morning. Be back next week.
Great to be here this morning on Saturday, December seventh,
a day that will live in infamy for reasons going
back to nineteen forty one and maybe for reasons coming
forward as we go through today's topic. But I just
want to wish everyone a happy holiday season. I was
great to hear Steve Bouchet back on the radio this morning,
(00:20):
who precedes our show. We're sandwiched in between two very
very highly skilled financial planners, Steve Bouchet and his group
and then Dave Kopek and his group, and we're the
legal side of this, and we're going to bring some
legal action to you today. The holidays are a time
to think about gathering at home, staying at home, being
(00:43):
at home. Our law firm works with families on a
whole variety of different types of planning, a state planning, trusts, wills,
powers of attorney, healthcare proxies, and we also do a
significant amount of work with our clients as their health
begins to fade and as they have conditions that require
(01:06):
significant services. The question becomes if you want to stay
home for the holidays for your lifetime, you know, and
be part of the family and be in your home
where the Christmas tree is and the comfy chair and
all the things that you have in your home. How
do you coordinate and bring care into the home when
(01:28):
care is needed? And that's really today's topic, what is
the future of home healthcare in New York State. And
we've had some very excellent guests on from Al Cardillo,
who's the head of the Home Care Association of New
York State, to Greg Olsen, who's the head of the
State Office for Aging, Rebecca Prevy, the head of the
(01:50):
Area Agencies on Aging. And today's topic is something that
you know, we're lawyers and we're used to litigation, but
in this field that is not the norm. But here
we are today and we're going to be talking about
litigation as it pertains to home healthcare. And it's a
serious topic because statewide, and nationally and internationally, there is
(02:15):
not enough staff to care for the people who need
to get care. And we're going to focus on home
healthcare because that's where ninety nine point nine percent of
our clients want to be. But these problems are not
unique to home healthcare. The same kinds of staffing issues
exist in nursing homes and hospitals. Where do we find
(02:36):
the people to provide the care. In New York State,
there is an innovative program. Several states have this. I
believe many states have this, and we're focused in New
York and there's a program in New York that became
extremely popular and in our estimation, we're going to talk
about that in just a moment because of the need
(02:57):
for families to be able to find the care care
when they needed and we're going to go through this
in some detail. But the program that New York State
began to utilize and our clients began to utilize is
something called the consumer directed Personal Assistance Program. This program
(03:18):
really grew up in the disability community. People who could
self direct people who were otherwise very highly competent and
skilled in their ability to manage their own care, but
who had physical disabilities and they needed care. So we
had a number of people, a number of clients with
(03:38):
disabilities who were able to hire people and manage that
staff because of their very unique needs. Well as time
went on, the need for home health care and the
ability to find agencies that could staff your case was
the struggle and was the challenge for many people. And
the consumer directed pro is just that the consumer finds
(04:03):
the care, finds the aids and is able to have
them go on to a state program, the Consumer Directed
Personal Assistance Program and become part of the state payroll
for home healthcare. And that program has become extremely popular.
(04:23):
And we're going to introduce our next guest who's going
to help explain why it's popular, how it grew, and
where we are today, and that's Chris Graeber. Excuse me,
he did not come. I apologize to that. Brian O'Malley,
who is with the Consumer Directed Personal Assistance Association of
New York State. Brian represents many of the agencies that
(04:48):
administer the consumer directed program and at least today, but
there are major changes coming and Brian, I want you
to introduce yourself to our audience and talk a little
bit about the Consumer Directed Personal Assistants Association and the program.
Speaker 2 (05:04):
Thanks Lou Yeah, as you said, I am an executive
director at Consumer Directed Personal Assistance Association of New York
as well as our advocacy arm, the Consumer Directed Action
of New York, and we work to build and strengthen
the state's Consumer Directed Personal Assistance program or as many
(05:25):
of you may have seen on commercials or elsewhere CDPAP
we as we move forward, we represent about fifty of
the fiscal intermediaries or the agencies that help administer the
program on behalf of the people that use it throughout
(05:46):
the state, Chris Graber and cd Choices being one right
here in the Capital region. We also represent the consumers
that utilize the program, and we really work at the
intersection of both of there of what works for both
of them. If it is good for the consumer and
good for the agency, it is good for the program
(06:07):
and it will we will help lift that up and
work to benefit that. Unfortunately, the program has been under
attack for many years at this point because of its
rising popularity. The independence that it grants people really is
something that they like. You know, you can have people
(06:28):
you don't know being sent to your house, or you
can hire your own staff in some instances your family
and people like being in control of who comes into
their house. These are intimate services we are often talking about.
We're talking about showering, we're talking about going to the bathroom,
and people like the control of who is doing that
(06:50):
with me and for me. That has led to a
tremendous growth in the overall success of the program, and
combine that with the shortage of workers. As you were
talking about the rest throughout the rest of this healthcare
sector overall, it's home care agencies, it's nursing homes, it's hospitals.
(07:12):
Everyone has a shortage of workers. And really, this is
not only popular because it gives independence and control. It's
popular because it is, in many cases the only option
that people have.
Speaker 1 (07:24):
So I want to get this down to the conversation
around the kitchen table when the family is sitting there
and mom's in the hospital, and they're talking to the
discharge planner, and the discharge planner says, well, you need
a safe discharge plan and mom needs care at home.
Speaker 3 (07:44):
Where are you going to find it?
Speaker 1 (07:45):
And our clients are then looking and struggling because they
have to get mom out of the hospital. They don't
want to put Mom in the nursing home. And the
family is sitting and saying, how do we navigate this system?
How do we bring people in to provide the service.
Sometimes it's children, Sometimes it's grandchildren, nieces, nephews, neighbors, church
members that are available immediately to provide the care. We
(08:10):
work up to the Canadian border. I was in Plattsburgh
yesterday meeting with a client in Plattsburgh. And the wife
has Alzheimer's that is progressing. The husband has his own
health issues. And what did they do. They hired somebody
that they heard about from a neighbor who came in
and is providing care fifteen hours a week under the table.
(08:34):
And probably more than half seventy five percent of the
case is that we start with they've already found somebody
to bring in and they're paying them, violating several laws
and putting them on a payroll in the home and.
Speaker 3 (08:49):
Doing it just because of necessity.
Speaker 1 (08:52):
And that necessity is like a burning fire, and unless
you put that fire out, it's going to just burn
the building down. So how does Consumer Directed fit into
that family's discussion and how do they make use of
the program.
Speaker 2 (09:09):
So Consumer Director really can serve as that immediate help
in so many instances. It used to be that you
would call a home care agency and the home care
agency could have somebody to your house tomorrow, and that
was the immediate way to get services. It might take
longer to hire a staff person on your own, and
(09:32):
you might want to go that way, but the homecare
agency could fill that need tomorrow. Well, the home care
agencies can't very often fill that need anymore. They don't
have the staff to deal with the clients that they
currently have. And so when you're sitting around that table
trying to figure out how to get mom out of
the hospital, it does come down to who's going to
(09:57):
provide that care, and oftentimes it is somebody in the family.
It is more often than not the daughter, or you know,
a granddaughter or a grandson. I merely speak to demographics
when I say more often than not the daughter, But
that has its own consequences. People have mortgages, people have
(10:21):
rents they need to pay. You still need to put
food on the table. It's cold in upstate New York.
You have to pay the heat. So Consumer Directed can
step in and help fill that need. You're probably not
going to be making what you would have been making
in a full time career, but you can supplement household
(10:45):
income through wages from the state, through wages from the
Medicaid program and help fill that need so that mom
can be out of the hospital. You can be confident
in the level of services that she is getting because
you're providing them, or someone else in the family or
someone else, you know, from outside the family is providing
(11:07):
them and you can still make sure that you can
pay the mortgage at the end of the month. You
can still make sure that you can put food on
the table for your family.
Speaker 1 (11:17):
Yeah, the staffing shortage is what is driving this, folks.
It's really the lack of people available to those home
health agencies who they could hire. The pay scale is
relatively low. The people that are working in those agencies
don't make a significant amount of money. The turnover rate
is over eighty percent in home health care. So if
(11:37):
you think about you're hiring an agency, well who are
you hiring? They're gonna put somebody in your home that
could be gone the next week, and now you've got
a new person coming in. So you don't have control
over who the staff is in the home. The agency
controls that and as they have lost their staff. We
have a wonderful organization here in the Capitol region, the EDDIE,
(11:58):
and the EDDIE has the VNA, and the VNA had
what's called a licensed home Healthcare Agency or ALIXA in
the parlance of home health care. And at one point,
and this is coming from the CEO of the EDDIE,
they had four hundred home health aids employed through the
eddy VNA staffing cases all across the Capital region. They
(12:20):
were down to forty and they shut the home healthcare
agency down. They shut their licensed home healthcare agency down.
So what do you call most counties? There's one or
two or three agencies in Upstate New York. Now, this
is a very different program in New York City because
there are people. The ability to find home health aids
(12:41):
for an agency in Manhattan is very different than an
agency in Plattsburgh, New York.
Speaker 3 (12:46):
So just talk a little bit about this to.
Speaker 1 (12:47):
Divide between New York City and upstate and the differences.
Speaker 2 (12:53):
You know, in some ways there are tremendous differences. You know,
the sheer quantity of people as you mentioned that, the
staffing shortages, and the ability to get services. You know,
it's one thing if you are in Albany or rensel
Air in Skohary, where you might be the only person
(13:17):
that that agency would be sending someone to, and they're
going to send you out for one or two hours,
it's not worth it. The agency is going to lose
tremendous amounts of money if they send someone out you.
They just will not even consider that case. You know,
my own father went through this as just outside of Poughkeepsie.
(13:40):
Here's twenty minutes outside of Poughkeepsie, and the agency said, well,
if we find four more people in your area, then
we'll consider sending someone out. Okay, but I need services.
Speaker 1 (13:51):
Right, and there's there's the bottom line, right, you need
it when you need it right, And so many people
haven't planned for this, haven't really thought about this. We're
gonna take a short break. And the popularity of this
program because we pushed our clients to it because we
were in a position where we're calling home health agencies
(14:13):
no staff, no staff, no staff, We're doing Medicaid applications
and we can't get them any service even though we
file the application, which puts us in a bad position
because we just got our job done. We got them
on Medicaid, but there's nobody to provide the service. So
Consumer Directed Folks has grown to the point where the
(14:35):
state has now made a major shift because of the
success of the program. And I've been doing this forty years,
and I've been in state policy forty years and was
on the Governor's task force. And they used to call
it the woodworking effect. If you build a program that's
too good, people will come out of the woodwork to
(14:55):
use it. That's the thing consumer directed is suffering from.
Going to come back after a short break with Brian
O'Malley and talk about the consumer directed program in New
York where it is today, and folks, it's in court,
it's in litigation, and the litigation will talk about how
it got there, why it got there, what the potential
outcome is, and how it impacts you and your family
(15:17):
this holiday season as you want to build that plan
that keeps your whole family home for the holidays. We'll
be right back after the short break. I'm Loupiro, your
host for this morning. I am here live in studio
and we're very happy to have Brian O'Malley, who is
(15:37):
the head of the Consumer Directed Personal Assistance Association of
New York State, and we're talking about home healthcare and
a program that has become extremely popular called the Consumer
Directed Personal Assistance Program. And that program has grown over
the last several years because of need, Folks, and this
is just demographics.
Speaker 3 (16:00):
Members.
Speaker 1 (16:00):
The number of seniors who are coming into the system
and looking for home healthcare continues to grow. The fastest
segment of the population. Fastest growing segment in New York
State is eighty five plus. The number of workers eligible
workers to provide services in healthcare, in particular home healthcare
is going the other way. The curve is going down.
(16:23):
So when you have demand going up and supply going down,
what happens usually costs go up. But this is the
state and the state is regulating the reimbursements to the
home health aids. So with the numbers going up and
people finding this outlet and they opened the door to
(16:43):
allow people to find care. Oh my goodness, we could
actually find a caregiver to use our medicaid that we
just got approved for. And the only way we could
do it was to hire our own help. We couldn't
get an agency to staff the case. There's the problem.
They had to use the program because there was no alternative.
And Brian O'Malley that has led to New York State
(17:06):
and the numbers are staggering, folks. Medicaid budget in New
York was ninety six billion dollars last year. It's a
big number. The total state budget I think was somewhere
in the two thirties. Ninety six billion of that was Medicaid,
and Brian this program was one of the fastest growing
components of medicaid. So the states saw that and said, oh,
let's put the brakes on.
Speaker 3 (17:26):
And what happened.
Speaker 2 (17:29):
You know, the state wanted to put the brakes on,
but if I could just take one second to back up. Sure,
demand was growing because of need, but that growth was
also very intentional. That was intentional from the state's purpose.
Back in twenty thirteen, the state put out their Olmsted Plan,
(17:51):
which was required on how are we going to keep
people in there?
Speaker 1 (17:55):
Just for our listeners, we've talked about Homestead a lot
because it was a great It's the US Supreme Court
case that said every state has a mandate to provide
services to people in the most independent setting possible, and
that's the Olmstead mandate. And then there was the Almost
That Act signed by President Bush George W. Which brought
(18:19):
that case into legislation. And you have the Almost Act,
which now every state, I think we're thirty two state
agencies that had to comply with this order to rejigger
their programs to provide services in the most independent setting possible.
So you have this constant shift going from institutions to
the home. You had the demand growing for a variety
(18:42):
of reasons, including, as you said, the legal reason.
Speaker 2 (18:46):
But on addition, the state said, you know, we're going
to have to provide these services. Consumer directed is the
least expensive way to do that, right, and it comes
out with better quality, better outcomes. We're going to judge
which managed care plans based on how many people they
can get into consumer directed. They drove this by telling
(19:07):
the managed care plans, we want you to enroll people
in consumer directed. The managed care plans did it, and
the state said, wait, there's too many people in consumer directed.
And so really that was what drove us and got
us to the situation today. And now the state is
trying to figure out, Okay, we have an aging population
where record numbers of eighty five plus, record numbers of
(19:29):
sixty five plus who are living in poverty and have
come out of institutional poverty and have chronic conditions that
lead to the need for home care services, and the
state says, we don't want to do that, we don't
want to provide these services. We had built a great system.
I'll constantly refer back to the Seinfeld rental car episode
where you know, anyone can take the reservation. The taking
(19:51):
as of their renovation is easy. It's the holding of
the reservation that's important. Well, in home care, anyone can
offer home care benefits, you can get all the hours
and in the world, that's easy. If you can't fill
those hours, it's meaningless. And the state really had built
themselves a system where they can offer all this great
home care but didn't have to actually staff it. And
(20:13):
now Consumer Directed broke that and they actually had to
staff it. And so they said, well, we're going to
try this thing of bringing in one company from Georgia
who will be able to fill this need for everyone.
And we're going to put out a business the Consumer
Directed Choices and all of these other companies from around
(20:35):
the state who have been working in New York with
people locally for decades in some instances, and shift to
this one company from george.
Speaker 1 (20:46):
So we're going to try not to get political with this,
but we're going to try to talk reality. And the
reality is that you have a system that is different
New York City, from Buffalo to Plattsburgh to Albany, and
every community, every geographic area had providers that we're familiar
with that area, and we're familiar with the population. How
(21:08):
many agencies evolved and grew to service the consumer directed program.
Speaker 2 (21:15):
You know, the state will say there are six hundred
agencies around the state. We are aware of about three
hundred and fifty that have filed the state required cost
reports if you are operating it, so not entirely sure
where the state gets their number from, but we know
of about three hundred and fifty that have cost reports.
But as you said, a number of those are operating
(21:39):
in niche areas. There are some that serve a portion
of a neighborhood in New York City. Now, a portion
of a neighborhood in New York City might be larger
than the city of Albany, but you know that that
portion of a neighborhood is a discrete group of immigrants
who are very tightly knit and very and have a
(22:00):
language and a culture that you know, and the organization
coming in just wouldn't be able to understand or work within.
And this agency could do that. And you know that
exists upstate in many places as well. It's to a
smaller scale, but the folks upstate, you know, nobody in Albany,
(22:22):
nobody in Plattsburgh. Nobody in Potepsie wants this agency from
the city coming in and telling them what to do.
Speaker 1 (22:29):
Well, they say that all politics are local and all
care is local. And we have clients that could get
agency care because they're on.
Speaker 3 (22:39):
A bus line.
Speaker 1 (22:41):
If you go five blocks from the bus line, they
couldn't staff the case because their aids couldn't get to
the home. So it is broken down household by household,
blocked by block as to what services are available. And
what the state has done is taken that fabric of
all these three hundred and fifty community based organizations that
(23:05):
administer consumer directed and replace them with a single agency.
And it's something that when you're looking at a single agency,
the state wide Fiscal Intermediary is what it's being called.
The state put out a bid for contracts for this
statewide fiscal intermediary and that the requirements were somewhat narrow.
(23:31):
Let's say that many agencies couldn't meet the requirements. They
took our controller out of the process so they couldn't
The controller couldn't review the contract. And now we have
a statewide fiscal intermediary who is starting talk about the
start and what we're anticipating. We got Actually we're going
(23:51):
to take a break in about thirty seconds. So this
is where the state of the Consumer directed program is, folks,
and for many people in upstate New York, this is
home healthcare under Medicaid. Because agencies cannot staff your case.
Twenty four to seven is very difficult to do. We
have done it with Consumer Directed and you get to
know the people. They're consistent, they're your staff. This is
(24:14):
the program that has worked maybe too well. When we
come back, we're going to break it down a little further,
talk about the future of home healthcare and consumer directed,
and talk about how you can plan and prepare your
family for this eventuality. We'll be back right after the news.
We're talking about home care, keeping your loved ones at home,
(24:34):
keeping yourself at home. And I want to just give
you a heads up. On Monday, December ninth, to two
days from now, we will be doing our last Medicaid
Monday of the year. Brian O'Malley was a guest on
our Medicaid Monday and you can see his show. It's
on our website at purolaw dot com. All of our
past Medicaid Monday shows are there. You can also find
(24:57):
all of our past radio shows and podcas casts. But
this Monday, December ninth, the three partners in Albany of
Pure O'Connor and Strauss, Aaron Connor, Frank Heming and myself,
we're going to be talking about what to expect in
twenty twenty five appropoted today's discussion. If you are planning
and looking at your future, what is available to you
(25:17):
today to help to prepare for tomorrow? So you don't
want to be doing this when you get into the hospital,
go through the emergency room, get to the discharge planner,
and you have no plan.
Speaker 3 (25:30):
You don't want to be in that situation.
Speaker 1 (25:32):
So we're going to talk about how to prepare, how
to plan, how to get yourself ready for whatever happens.
In folks, life happens. That's the name of the show,
and this is why we named it. It's something that
we want you to think about. But you don't have
to get negative about it. You have to prepare, plan
and be ready. That's the best you can do. So
we're going to help you do that. Monday at twelve noon, Aaron, Frank, myself.
(25:56):
You can register at purolaw dot com go to the website,
go to the events tab and register for this Monday's
Medicaid Monday twelve to twelve thirty. It's a thirty minute
tour de force of what to look for for next
year in healthcare, home health care, and Medicaid Again this Monday,
December ninth, twelve to twelve thirty Medicaid Monday.
Speaker 3 (26:17):
Don't miss it.
Speaker 1 (26:18):
Frank Aaron myself will be on and we're going to
talk about all the things, including a little bit about
this consumer directed program that we're tackling today here on
Life Happens. And my guest today is Brian O'Malley, who
is with the Consumer Directed Personal Assistance Association. So the
association represents a number of providers that administered this home
(26:41):
healthcare program called consumer directed. So if you need care
and you've called every agency in your county and none
of them can staff your case, and you need to
go out and pull in a caregiver, you don't want
to do it and pay them under the table, because
that's illegal.
Speaker 3 (26:56):
Folks.
Speaker 1 (26:57):
You're not paying taxes doing withholdings, you're not paying workers compensation.
If that aid is being paid under the table and
falls down your stairs and breaks their neck guess what,
they can sue you and they'll own your home and
they can take everything that you have. So you need
to do this legally. What better way, Brian, to do
this legally then to bring that aid into the consumer
(27:21):
directed program. And let's flip the coin and say what
does an aid get for working through consumer directed Because
that twenty dollars an hour under the table doesn't have
vacation time, doesn't have benefits. Talk about what it means
to work through the consumer directed program.
Speaker 2 (27:37):
So working through the consumer directed program gives you the
safety of having that job that's not in the gray market.
It gives you the safety of having workers compensation if
you fall down the stairs or more common if you
just are transferring somebody and week you're back. I can
(28:02):
speak personally through the horrors of that. So it gives
you number of those protections. It is about, you know,
the wages you had mentioned before. It's not glamorous. It's
you know, in Upstate, generally on January first, it will
go to about eighteen fifty five an hour. I think
(28:23):
there are some agencies who pay more. That's one thing
we are worried about in this transition is everyone is
going to fall to the lowest possible wage. The benefits
vary by agency, and that's often something that consumers, those
who are using the program will shop for when they
are picking an agency. Hey, what can I offer my workers?
(28:44):
Some want more pay, some want higher benefits. But there
is paid time off. You get holidays. Some agencies are
giving you extra time and a half for working on
a holiday. So if you have to come in on
Christmas because people still need services on Christmas, you can
get time in a half. With some agencies, you can
get sick time, you get maternity weave. You know, you
(29:07):
get all of those extra benefits, and you get workplace
protections because this is intimate work in people's homes, and
so you get those protections to make sure that you
know that employee, you are being treated properly as an employee.
Speaker 1 (29:23):
So we have worked with this program for many, many
many years and going through it, and we've we've worked
very closely with the Consumer Directed Choices program. And I
think back to the founder of Choices, Constance Lehman, who
became a close friend of mine. We actually had her
on this radio show and Constance was a force to
be reckoned with. She's a young woman who at the
(29:45):
age of eighteen, and she told her whole story on
this show before she passed. Unfortunately she's no longer with us.
But Constance, at age eighteen, was having a little outing
with her friends and fell off a cliff and became
pair and she was relying on a home health agency
to staff her case because she now needed help in
(30:07):
the home. She's wheelchair bound and she needed help in
the home, and the aids wouldn't show up. There was
a different aid every day that didn't know what her
needs were, and she had very specific needs in terms
of how her care had to be administered. And oh,
by the way, consumer directed aids can do a lot
of things that agency aids cannot do. If you have
a case where you have someone that's tube fed, you
(30:30):
can't use an agency, but you can use consumer directive.
Speaker 3 (30:33):
It's kind of an ironic twist.
Speaker 1 (30:36):
That consumer directed aids can do a whole host of
things that agency aids cannot. But Constance had this program
and she started to use it to the point where
she opened her own agency. And initially she was on Medicaid,
and she actually went off Medicaid because her agency became successful.
So she became a full private pay patient and had
(30:56):
a very successful business. So Constance Layman is one of
the pion years of consumer directed personal assistance, and I
wish she were still here to advocate against these changes.
And that's who this benefits. It's the people who want
to have some say over their care. It's aids who
can get the benefits and the security that you just mentioned.
(31:16):
And it's a program that worked. So why can't it
continue in the form that has been so successful?
Speaker 3 (31:23):
Right? And what changes have been made?
Speaker 2 (31:27):
Honestly, we don't know. We are trying to figure out
why it can't continue in the way it's been so successful.
You know, the state wanted savings. Well, the state put
in five hundred million dollars worth of savings this year.
We currently have five hundred million dollars in savings going
in effect, all of which is actually going to go
(31:48):
away once they bring in that new single five who
they're hoping will bring in a different five hundred million
in savings. That is the definition of the bird in
the hand, you know, So don't we don't understand fully
why they are so insistent on moving to this new.
Speaker 3 (32:08):
Single fiscal intermediary.
Speaker 2 (32:11):
Yes, so all the program right off the time.
Speaker 3 (32:13):
How many people.
Speaker 1 (32:15):
Are served by the Consumer Directed program in New York
State currently.
Speaker 2 (32:19):
There are about two hundred and eighty thousand people using
the program today according to the Department of Health, and
by our estimates, that means there's about four hundred or
four hundred and twenty five thousand people who are providing
those services to those two hundred and eighty thousand people
around the state. So you know, we're really at the
(32:41):
end of the day looking at close to three quarters
of a million people who are directly in this program.
Speaker 3 (32:48):
Impacted by it.
Speaker 1 (32:50):
And what will it mean and what are the time
what's the timing of this When when do these changes
go into effect? And what will it mean to people
who using Consumer direct and people who want to use
Consumer direct?
Speaker 2 (33:04):
The timing is astronomically fast, especially by government standards. I mean,
you know, government is famous for making sloths look like
you said, bolt, but the state wants to do this.
They are going to begin on January sixth, and they
(33:25):
will begin in of this upcoming year in less than
a month as of today, and they will begin in
a number of the more rural counties upstates. So I
think you know, Clinton County, Plattsburgh, Allegheny County, Broome County,
or Binghamton, and they're going to begin there. And folks
(33:47):
in those rural counties primarily will begin getting letters from
the Department of Health or their managed care plan or
in many instances public Partnerships LLC or PPL saying you
need to switch your services now. Importantly, you don't need
to switch your services that day, right, you can wait.
(34:10):
You can stick with your single FI, you can singlify there,
you can stick with your current FI. You're with consumer
directed choices, you can stay with them for the time being.
I want to say that there are efforts underway to
try to undo this, so you know we will get
more to that, but efforts, legal efforts, yes, and you
(34:32):
know those are ongoing. But on January sixth, people in
about twenty counties will start getting notices. On January twentieth,
folks in kind of that Rower, Hudson Valley Area, Duchess, Orange, Putnam, Rockland, Sullivan,
Ulster will start getting notices. Those will go out on
January twentieth. The kind of upstate urban counties will begin
(34:59):
getting shifted on February third, And so you know, as
of February third. If you live in Aubany County, Rensselaer County,
Monroe County, Onondaga, you can expect to start getting these
notices at some point, probably within that week. And then, interestingly,
(35:21):
the two hundred to two hundred and ten thousand people
in New York City, Nassau County, Suffolk County, and Westchester
will begin getting moved on February tenth. Now, how long
is this transition going to be? Well, if you are
not fully moved by March twenty eighth, you lose your services,
(35:45):
you are out of the program.
Speaker 1 (35:47):
Yeah, and having done this for forty years, folks, these
timeframes are incredibly fast. This announcement was made by the state.
Speaker 3 (35:55):
On October first.
Speaker 1 (35:58):
And the state made the decision on the October first,
citing and I'm reading now from a Channel six news
bulletin advocates worry about accessibility in New York's consumer directed overhaul.
The state made this decision on October first, citing Controller
and other reports that some of the programs in CDPAP
were found to be abusing the system, including one recently
(36:20):
being indicted by the US Attorney's Office for fraud. So
when the government wants to cut a program, they find
abuses and they allege fraud. Anecdotally, I've been working with
the Consumer directed program for fifteen twenty years. I have
not witnessed that my clients are hiring, they're paying, they're working,
(36:44):
they're caring for people. Where is the evidence of fraud?
And what are these agencies? And remember, folks, this statewide
change is taking three hundred and fifty or so agencies
that are administering program for two hundred and eighty thousand people,
transitioning them to a single company coming from Georgia to
(37:07):
take all two hundred and eighty thousand people by March
twenty eighth and transitioned. And anybody that works in government
knows that is a challenge and a challenge that is
going to just be pushed back. There's no my estimation,
this is just my guess. There's no way they're going
to meet that deadline to get all two hundred and
eighty thousand people converted within that timeframe.
Speaker 3 (37:31):
Where is the fraud?
Speaker 1 (37:32):
And have there been cases where prosecutions have happened, where
there are things going on in the industry that people
are scamming the system?
Speaker 3 (37:44):
You know, we.
Speaker 2 (37:47):
Have been looking for the fraud for the better part
of the year. Do you find cases? Sure? The governor
likes to point to one case in twenty twenty where
the government around did agency owner on a cruise when
she was supposed to be working. I guess this was
(38:07):
the one person who got a cruise in twenty twenty.
But ye, January, you're a very very short window. But
there are anecdotes, and in a program with two hundred
and eighty thousand people four hundred thousand workers, you will
find anecdotes. I think if you go to the Office
of the Medicaid Inspector General, this is an agency that
(38:30):
is tasked with finding fraud in Medicaid, what you will
see is universally consumer directed Personal Assistance or CDPAP. That's
the least fraud of any system in our healthcare system.
And that's really because you know, we're talking about family
members who are providing care for family and if you're
saying that someone is committing fraud, you are saying, I'm
(38:52):
going to deny my mom's services, and ask yourself the question,
would you deny your mom's service is for eighteen fifty
five an hour, like that's a fairly awful human being.
Do they exist one hundred percent? They are not the norm.
I think more often what we hear when we actually
(39:12):
go rooting for these frauds is the ever popular. While
my brothers sisters shrep boyfriend's neighbor told me that a
friend of theirs neighbor is using the program and their
worker gets paid and never comes in, is always at
the movies. And that's that's not evidence, that's not even
(39:34):
an anecdote.
Speaker 3 (39:35):
That's triple hearsaying.
Speaker 2 (39:37):
At the least. Yeah, And so we can't find widespread,
massive fraud we want. Look, we've been asking for more
regulation in this program since twenty twelve because we want
to make sure every dollar is going through services that
can But said, while we can always tighten things up,
(40:02):
while we can always get closer to zero, we're as
close to zero as any healthcare program in the Medicaid
has gotten.
Speaker 1 (40:12):
So it's a targeted change. And are we throwing the
baby out with the bath water here? And we're going
to come back and finish up talking about what you
can do now to start preparing. If you need care
now and you need to transition, be prepared. There are
(40:32):
resources We're going to identify those resources for you. If
you're not yet needing care, but someday you want to
make sure that you're prepared. We're going to talk about
that when we come back after this break. You're listening
to Life Happens Radio every Saturday morning right here on
Talk Radio WGY.
Speaker 3 (40:48):
We'll be right back.
Speaker 1 (40:52):
Around the hearth, around the fire, round the tree, singing
like bing hopefully or some version of that, and we
all try. But today we're talking about being at home
when you need care. How do you be at home,
stay at home, get the care you need, and successfully
navigate a system that just gets more and more complicated
(41:17):
by the day. I'm Lupiro, your host for this morning
live and in studio with Brian O'Malley, and we're talking
about consumer directed Personal assistance, the program where you get
to pick and hire your own aids. You have to
manage those aids, supervise them, make sure that the payroll
is in, make sure all the things are complied with.
And I've done this for relatives. I'll talk about that
(41:38):
in a moment, but right now we're facing a major change.
Speaker 3 (41:42):
We're going from three.
Speaker 1 (41:43):
Hundred and fifty agencies serving two hundred and eighty thousand
people to one, and that one is the statewide fiscal
intermediary that's going to take over all of this. So, Brian,
we've been talking about the fraud, the abuse again personal
I haven't seen it. If it's there, it should be prosecuted.
It should there should be additional regulations you would think
(42:06):
over time. And as you said, you've been trying to
get tighter regulations on some of these issues for the
last twelve years. And the change is going to be
that this one fiscal intermediary is going to come in
and where is the accountability in the system. Who is
going to be held accountable? When eighty thousand of those
two hundred and eighty thousand loose service because of glitches
(42:30):
in the system, and now you're putting people with severe
disabilities living at home at risk, where are they going
to go?
Speaker 2 (42:39):
You know what, that's a huge question we have is
who's going to be held accountable? You know, when Spectrum
doesn't provide your cable correctly, or you know, you have
your your internet goes out, where's your accountability? What where
can you go to handle Spectrum? Where can you go
(43:00):
whenever you are dealing with monopoly to hold that monopoly accountable.
You know, once this change happens, there won't be other agencies.
If the state doesn't like what PPL is doing, there's
no place else. This is the option. If they kick
(43:21):
PPL out, well, you're going to have at least a
three to six month window. You know, they're going to
have to go hire someone else. They're going enough to
transition everyone to that new entity. There is no option,
There is no accountability. And let's face facts, DALH does
not have the staff to actually hold this entity accountable
if they want to. So we are extremely worried about
(43:47):
where the accountability is because it's not an abstract thought.
When we look around the country. PPL has not done well,
and they have needed those parties to hold them accountable.
They have lost contracts in Pennsylvania, they have lost contracts
in Massachusetts, they have lost contracts in New Jersey, Tennessee, Colorado,
(44:10):
Washington State.
Speaker 1 (44:11):
Yeah, and this is the provider that New York State
has chosen to take on these two hundred and eighty
thousand consumers by March twenty eighth. And I've read a
lot of the reports from those other states and just
talked very briefly about the latest litigation because there was
a competing bidder that could have been awarded this contract
(44:32):
that didn't get it, and they have now sued New
York State.
Speaker 2 (44:36):
There is so there is a bitter Freedom Care. Many
of you may have known them. They actually are in
New York because the contract said you have to have
you have to have a statewide contract with a state
not named New York because that somehow made sense. But
Freedom Care could meet that quality. They are statewide in
New York, but they also do operate in other states.
(44:58):
They have thirty thousand people according to their court records
in the state of New York. They are a lower
price than PPL coming in they had because they have infrastructure,
They had no transition costs, whereas PPL is at I
think forty eight dollars per person for a transition. That
(45:23):
the bid had higher quality, more established nature of providing
services allegedly in the state of New Yorleans. I think
it's factual that Freedom Care is providing services in New
York and PPL is not, and they somehow did not
(45:45):
make the bid. They were cheaper, have a history of
providing services here, but did not win the bid.
Speaker 3 (45:51):
And that's the graviment of their loss.
Speaker 2 (45:53):
That is the gravimen of their lawsuit. And interestingly, there
is an affidavit in that lawsuit that says and in
the VIDU was in a meeting with the Governor's office
in early April before the budget even passed. The budget
was where this was. This change was initially made and
individuals in the Governor's office told this person, PPL will
(46:17):
be the single FI. There wasn't a budget, there hadn't
been an RFP process or a bid process, but the
governor's office already knew that PPL would be the single FI.
Speaker 1 (46:29):
So public contracts are supposed to go through a process.
They're supposed to be a bidding process.
Speaker 3 (46:34):
We're taxpayers.
Speaker 1 (46:36):
We want to know that the money is being spent
properly by qualified providers. And there is one person that
I think does a really good job in New York
and that's a controller, mister Danapoli, Thomas Napoli, who is
your controller, folks.
Speaker 3 (46:48):
He does a great job as a watchdog. He's out
of the process.
Speaker 2 (46:52):
He is out of the process. He you know his job.
He has very discreet jobs. One of them is review
every kind tract, make sure the rules were followed. It's
not make sure this makes sense politically, it's not any
it's make sure the rules of contracting were followed. They
exempted him. They said, you're not allowed to look at
(47:14):
this contract. That's weird that if you go to the
controller's website, it on average takes a week for him
to look at a contract and say this is that
we approve this. We don't the new contracts. It might
be like eight point three days. They exempted him. They
exempted him on one of, if not the largest contract.
(47:39):
This is a forty five billion dollar, five year contract.
Speaker 1 (47:43):
Think about that, folks. This contract was awarded before the
budget passed, awarded to a provider without competition, and forty
five billion dollars over five years with a b with
a bee. That's enormous. We're going to keep following it.
But Brian, we have so a few minutes left. What
can people do now to prepare for the transition, and
(48:05):
how should they be reaching out and finding those resources
that can be available.
Speaker 2 (48:09):
So I think it's important get informed. There is a
lot of competing information out there. There's stuff that PPL
is trying to tell you to make sure that you
move in the direction They want as fast as possible
to make this a fait accompany that it will happen,
because it has happened. The plans are telling things, the
agencies are telling things. We have a resource that's just
(48:31):
an FAQ. It is all factually based on our website
cdp A A nys dot org. One more time, c
dp A A nys dot org, cdpenies dot org. There's
a link to an FAQ right there on the front
(48:52):
page at the top. If you see questions you don't
that aren't there, please let us know if you have
the question. Do we want to be the resource for folks.
We want folks to know because at the end of
the day, two hundred and eighty thousand people rely on
this program to live independently in the community, and the
consequences of this going badly are devastating for hundreds of
(49:17):
thousands of people and families across the state.
Speaker 1 (49:20):
We're anticipating phone calls at our law firm, folks, so
please feel free to call us number one if you
want to start looking at how you plan for this
and what are the best ways to access care at
home stay at home. That's a big part of Pierre
O'Connor and Strauss's practice. We work very closely with other agencies, organizations,
offices for the aging, and a group that we work
(49:41):
with very closely, ever, home care advisors. They are personal advocates, nurses,
social workers, therapists who can help you through the system.
Speaker 3 (49:50):
Reach out to us.
Speaker 1 (49:51):
We're happy to channel your questions, your information and tune
in Monday at noon for Midicaid Monday thirty minutes. We're
going to talk more about the planning aspects of this,
how to look at medicaid as a resource, and how
to get yourself ready to age properly, living well in
the comfort of your own home. Bran O'Malley, thank you
(50:12):
so much, thanks for being here today. It's been a
great conversation.
Speaker 3 (50:16):
Folks.
Speaker 1 (50:16):
These are your tax dollars. Watch them carefully. We'll be
following it. Stay with us, you're listening to Life Happens
every Saturday morning. Be back next week.
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