Mother with cerebral palsy struggles to hire aides after private equity takeover
In April, however, Christian's life was upended when the state forced her and her assistants to work with a new company administering the nation's largest consumer-directed personal assistance program, called CDPAP. One by one, she lost nearly half her assistants because they said they did not receive the proper pay for their work, Christian said. She now fears for her future living at home where she needs help getting dressed, doing laundry and cooking meals.
'I'm trying to hire new staff, and I am very good at navigating technology,' Christian, 37, said. 'But it's hard when you have to tell your new hires, 'I can't guarantee you're going to get paid on time or get the appropriate amount of hours.''
Christian is not the only one affected by the state program's recent takeover.
NBC News spoke with nineconsumers and personal assistants who described multiple problems since Public Partnerships LLC (PPL) won the $1 billion, five-year contract in 2024, replacing roughly 600 entities that had been administering the program. The issues range from assistants receiving checks for zero dollars to problems arranging for direct deposit, onboarding new workers and clocking hours worked.
PPL, which has a staff of 1,400 on the New York program, is owned by two private equity firms. Its takeover as the program's sole administrator triggered an avalanche of complaints from consumers unable to reach anyone to answer questions and assistants unpaid for hours they worked and unhappy with reduced health insurance benefits, according to lawmakers, consumer advocates and the consumers and assistants interviewed by NBC News.
Before the transition to PPL, roughly 280,000 consumers were participating in the CDPAP program, according to the New York Department of Health. Since PPL took over, some 80,000 have left the program, the department said.
'A lot of these folks need the services being provided by the program,' Gustavo Rivera, a New York state senator who represents constituents in the Bronx, told NBC News. 'It's likely they dropped out because of difficulties making the program work or they switched to programs that are more expensive.'
Rivera has scheduled hearings in August about what he calls the botched transition to PPL.
At a cost of $9 billion a year, New York's CDPAP is the largest personal assistance program in the nation. It allows consumers like Christian to directly hire the folks who help them pursue their lives rather than rely on a staffing agency. At-home programs like New York's are less costly than providing institutional care, research shows. In 2024, according to one analysis, a semi-private room in a nursing home cost an average $9,277 a month nationwide. That's 43% more than a home health aide costing on average $6,483 each month.
Amanda Lothrop, chief operating officer for New York State's Medicaid program, told NBC News that the transition to PPL aimed to eliminate the former program's administrative inefficiencies while protecting taxpayers. She said fraud and abuse had marred the previous program, but the state has identified very few cases. A 2022 audit by the Office of Medicaid Inspector General in New York, for example, uncovered only $46,000 in overpayments in the program, a 99% accuracy rate.
In response to questions from NBC News, PPL and the New York state health department said together they had identified 30 instances of home care workers under the previous system billing consumers who were hospitalized or dead, five cases of workers billing for work with consumers who were out of the country, one worker claiming to work for two people at the same time and another who claimed to be in two places simultaneously. More than 200,000 workers are in the CDPAP program.
'In partnership with PPL,' the department of health said in a statement, it 'is using enhanced data and monitoring tools to protect program integrity, support consumers, and take timely action when issues arise.'
Meg Fitzgerald, a PPL spokeswoman, said in a statement that the company's 'systems and centralized control processes would have been able to identify and prevent these violations.'
The contract New York State awarded to PPL is a recent example of private equity's increasing involvement in home health care, said Aditi Sen, managing director of research and campaigns at Americans for Financial Reform, a nonprofit nonpartisan organization that advocates for fairness in the U.S. financial system. Last month, Sen published a report detailing the industry's forays into home health care entitled, 'Wall Street on Your Doorstep: Protecting Home Care from Private Equity Abuses.'
'The private equity industry is looking for any streams of steady public funding,' Sen said in an interview. 'As advocates have secured more funding for home and community-based services, that has resulted in the private equity encroachment.' She said the next step for researchers is to analyze the quality of home care after private equity gets involved.
Founded in 1999, PPL calls itself an industry leader 'in financial management services for consumer direction, serving consumers throughout the U.S.'
As for the difficulties in the New York program, the PPL spokeswoman said in a statement: 'The transition to a single fiscal intermediary required a significant element of education and, in some cases, a change in practices for submitting and approving time. We have been committed to providing various methods of extensive education and resources to all stakeholders. Ultimately, we strive to provide the accountability this program deserves.'
Three CEOs in five years
Private equity firms have taken over wide swaths of the health care industry in recent years and ill effects on care have been well-documented in independent academic research. The firms typically acquire companies or doctors' practices using debt and hope to sell them within five to seven years at a profit. This requires the firms to improve the financial results of the companies they buy, often firing employees or cutting services to slash costs. The private equity firms bought PPL three years ago.
Studies on hospitals and nursing homes have found significant deterioration in patient outcomes after private equity takes them over. Other research has found that prices rise significantly after private equity acquires a practice or operation.
According to Sen, private equity firms have rolled up hundreds of small home health and home care chains into large companies like Comfort Keepers, Help at Home and Accentcare. Combined, private equity-owned companies offering home and community-based care services are second only in size to chains owned by insurers Humana and UnitedHealthcare, Sen found.
Many acquisitions by private equity-owned chains have been in companies offering home and community-based services for people with physical, intellectual and developmental disabilities, Sen determined. Pediatric home care for children with disabilities is another area of interest as is the consumer self-directed care industry, PPL's focus.
Private equity acquisitions are not always easy to track. PPL's website does not identify its owners, but a recent court ruling disclosed the two private equity firms that control it — DW Healthcare Partners of Toronto and Park City, UT, and Linden Capital Partners of Chicago. Although both the firms' websites list other companies they have invested in, neither lists PPL as an investment.
After winning the New York State contract, PPL tried to keep its ownership secret.
In a lawsuit filed last year against New York's Department of Health by a home care company over the transition to PPL, the company's private equity owners were identified in a document that PPL requested the judge keep under seal. If the information were made public, the company argued, it 'may put individuals in danger and/or allow them to become targets of violence.' Public disclosure would also increase the risk of 'unwanted attention and harassment,' PPL said. The company lost that battle and the document became public.
Fitzgerald, PPL's spokeswoman, declined to elaborate on the company's desire for secrecy in its ownership. Neither DW Healthcare nor Linden Capital Partners responded to emails seeking comment for this story.
PPL also objected to a 2024 Medicare rule affecting home care organizations. The rule mandated that at least 80% of Medicaid payments go to compensation for direct care workers, such as personal assistants, not a company's 'administrative overhead or profit.'
Fitzgerald said the company's objections were not about worker compensation. Rather, she said, the company believed the rule would 'make it more difficult for states to initiate new self-directed programs and to maintain small self-directed programs.'
Participants in the CDPAP program aren't the only ones experiencing upheaval in the transition to PPL. Recently, Vince Coppola, PPL's former chief executive, and Maria Perrin, its former president, departed unexpectedly. PPL has had three CEOs over the past five years, Fitzgerald said.
Filling out forms for hours
Tara Murphy said she enjoyed working as a personal assistant in the CDPAP program for 25 years. But when she tried to switch to PPL, she encountered multiple difficulties, she said.
'Their technology is so hard to navigate, it took me four and a half hours to fill out their forms,' she recalled. 'I uploaded them nine times before they were finally accepted in their system.'
Murphy's hourly pay with PPL was 2% less than she had previously earned, she said, and she never received the correct pay under the new program.
'I ended up having to quit my job and leave my consumer,' she said.
Rivera, the New York state senator, said he hopes to gain some answers from state officials on the PPL transition at the Aug. 21 hearings in New York City he co-sponsored with state Sen. James Skoufis.
'Last year, when it was pushed upon us in the budget process I said back then that I thought it was a bad idea,' Rivera said of the switch to PPL. 'Unfortunately, what I heard from my constituents is the transition was indeed bungled.'
Meanwhile, Christian, the Buffalo mom who has lost five personal assistants since PPL took over, is especially worried about how it might impact her daughter.
'My daughter is 12 years old, she needs me here for her,' Christian told NBC News. 'If I have to go into a facility because I can't get care in my home, where is she going to go?'
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