Hochul bows to health-worker unions $12B senior-care power play that could bust NYs budget

Gov.Hochul’s overhaul of the Consumer Directed Personal Assistance Program reached a milestone last week when she named a Georgia-based company as the winning bidder to be the program’s statewide “fiscal intermediary” — and to replace hundreds of smaller companies that currently handle those duties.The announcement drew a chorus of criticism from consumers, providers and disability rights advocates who contend the shift will jeopardize vital services for clients of CDPAP.Yet Hochul’s press release featured a laudatory quote from George Gresham, president of the health-care union 1199 SEIU — a reminder that one of Albany’s most powerful interest groups is squarely behind the governor’s controversial plan.The union’s motive is no mystery: Putting a single company in charge of the $12 billion program would pave the way for 1199 to unionize hundreds of thousands of CDPAP caregivers, vastly expanding both its membership and its dues revenue.Hochul’s thinking is harder to parse.On one hand, she and her budget advisors have raised an alarm about the CDPAP’s explosive growth — and framed downsizing the bureaucracy as a strategy for restraining costs.On the other hand, she is inviting a unionization drive that would create pressure for higher spending.If Hochul continues on this contradictory course, CDPAP could end up as bloated and dysfunctional as ever.CDPAP is an alternative to traditional home care for the elderly and disabled: Instead of relying on workers employed by home-care agencies, CDPAP recipients hire, train and manage caregivers of their own choosing — who can be family members or friends — with Medicaid paying their wages.The previously little-known program has mushroomed over the past decade, with enrollment spiking from 12,000 to more than 250,000 from 2015 to 2023, and Medicaid outlays soaring above $12 billion per year.CDPAP is one of the primary reasons that New York has higher rates of spending on Medicaid personal ...