State Sen. George Borrello, R-Sunset Bay, debates a change to the state’s Medicaid-funded Consumer Directed Personal Assistance Program recently on the state Senate floor.

A state Medicaid program used by people who need care in their home is going to change – and state Sen. George Borrello isn’t sure the change is for the better.

To be fair, Borrello is far from alone in questioning the move from some 700 financial intermediaries with thousands of employees who provide local contacts in the Consumer Directed Personal Assistance Program, or CDPAP, to one intermediary broker. The aim of the program is to provide Medicaid funding to allow family members to provide critical care to disabled New Yorkers, which keeps them at home versus in a private institution.

The changes were driven by Gov. Kathy Hochul and questioned by both Republicans and Democrats in the state Legislature. Borrello was among those questioning the change, debating with state Sen. Gustavo Rivera, D-New York City and chair of the Senate Health Committee. Borrello first questioned how the change to one broker to manage the CDPAP system was any different than the state’s 2018 change from locally managed non-emergency medical transport to one managed by a single, state-chosen broker. That system, Borrello said, has been shown to be full of fraud and waste, including from an audit by the state Comptroller’s Office.

“This is the moment where, if I was in court, I’d say I’d like that read back into the record,” Rivera said. “Because I would answer basically the same way as I did in the prior one. I started with the fact that it wasn’t my idea and that I don’t think it’s a good idea, but it’s the best that we could actually get.”

Borrello also raised several questions about changes to the law that exempt the CDPAP changes from oversight by the state Comptroller’s Office until after a contractor is chosen and money has actually been spent. Other such contracts are typically subject to review by the comptroller under the state’s procurement guidelines.

Hochul has said the move to a single broker is necessary because there have been substantial fraud found in the program. The Empire Center released a 2022 audit that showed New York’s CDPAP program is the costliest of the 34 states that have opted into the program, costing about $12 billion a year. That amount has almost doubled since 2016. At the same time the state’s workforce of home health aides has increased from 250,000 to almost 480,000 over the past decade, accounting for two-thirds of the state’s net job growth during that period.

“We’re claiming, and there has been evidence of fraud in this current program,” Borrello said. “Likely it’s not the entire program but certain elements of it. So what we’re going to do now is we’re going to basically just wipe away this entire program and pick one vendor. OK, you could perhaps make an argument for that although I have made the argument that that was a complete, utter disaster under Andrew Cuomo’s pay-to-play NEMT program. So what are we going to do preventing that same fraudulent disaster from happening again? We should have some guardrails in place, first and foremost, a review by our comptroller of the process of picking a vendor. Secondly, just like every local government, just like every agency, just like everyone else who buys a box of pens, follow the state procurement process. But, for a multibillion dollar contract, we’re going to say no, we don’t have to follow that process.”

Rivera often agreed with criticisms of the change, saying only that there will be some oversight from the Comptroller’s Office once money is spent on the program. But, even that limited debate showed his displeasure with the governor’s office.

“I am in agreement with you,” Rivera said. “We should have, everywhere state dollars are being used, we should be able to have oversight; and particularly if we’re talking about in the case of the comptroller, whose level of expertise is to make sure money is being spent wisely that having them there the entire process (is good). And, lastly, I would say having them in a process that could potentially mean billions of dollars of Medicaid, both state and federal, dollars flowing to a particular entity, having the comptroller involved at that point, I’m fully in agreement with you. I would say that was not my idea.”