In April of 2025, private equity-backed firm Public Partnerships, LLC (PPL) became the sole Statewide Fiscal Intermediary for New York State’s Medicaid-funded home health program known as the Consumer Directed Personal Assistance Program (CDPAP). Between April and December of 2025, Caring Majority Rising conducted nine surveys and published nine fact sheets capturing how the transition affected many CDPAP Personal Assistants (PAs), consumers, and designated representatives. Each survey received between 200 and 500 responses. 

Hundreds of respondents self-report negative experiences with pay, job security, health insurance, care, and accessibility, according to survey data. This brief describes these findings as reported on the fact sheets and draws from a body of public health research to explain why each issue surfaced in the survey data is a matter of public health concern.

Key Findings

Hundreds of PAs and consumers report concerns about PPL takeover. Based on our research, these concerns have public health and health equity impacts.

The main concerns respondents raised in the surveys are as follows:

• Throughout the survey period, hundreds of survey respondents reported that they or their staff had not been paid adequately or consistently.
• Survey results also point to concerns around job security for many PAs.
• PPL’s health insurance options for PAs lack comprehensive coverage and, depending on the plan, have high costs.
• When PAs lose their pay, leave their jobs, or lose their certification, it can affect consumer care — and family caregiver income.
• Overall survey findings raise concerns about health equity.

Why these findings matter for health:

• Low income and financial stress are associated with myriad negative physical and mental health outcomes.
• Employment gaps have financial and health impacts. Perceived job insecurity is a predictor of adverse health outcomes.
• Health insurance is essential for health, and keeping health expenses low is important for overall financial security.
• Compared to CDPAP, alternative care choices may be costly, reduce consumer autonomy and dignity, and prevent family members from being paid for their care work.
• Health inequities are not natural or inevitable: they are the result of systems and structures. When groups of people experience inaccessibility, it deepens health inequities. 

Publicly accessible programs like CDPAP are essential for health equity. To fulfill the program’s potential, lawmakers must ensure that public dollars are invested in public health.

Policy Recommendations

1. We urge New York legislators to include the Home Care Data Transparency Act (S9142/A10537) in this year’s state budget. This would require the Statewide Fiscal Intermediary (SFI) to provide quarterly and annual public reports to the Commissioner of the State Department of Health on utilization, finances, customer service, workforce data, sub-contractors and fraud. This will protect Medicaid integrity, our services and public dollars, and ensure solvency of the SFI.  
2. Support the Home Care Savings & Reinvestment Act (S2332/A2018) to eliminate private insurance middlemen and reinvest savings directly into home care wages and care.
3. Support Fair Pay for Home Care (S8955/A1991) so that workers can earn a dignified living, alleviating New York’s home care shortage so people can receive the home care they deserve.
4. End the PPL monopoly and restore choice to CDPAP by reinstating trusted, vetted, community-based fiscal intermediaries.

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