ROCHESTER, N.Y. – Those who care for loved ones on Medicaid were promised health insurance but getting that coverage has been an uphill battle.
Lisa Robinson is a full-time caregiver for her adult daughter Hannah. She gets paid hourly through the Consumer Direct Personal Assistance Program, commonly known as CDPAP. In March, New York State overhauled the program in an effort to cut down on fraud and abuse but as News10NBC has reported, the rollout of the new system has been anything but smooth.
New York now uses a single statewide facilitator, Public Partnerships LLC, to manage eligibility, hours and payment for caregivers. In the past, there were more than 600 intermediaries.
One of the promises PPL made to caregivers when it took over was to offer health insurance plans to full-time caregivers. It was one of the only things appealing to the Robinson family about the transition since Lisa’s husband Scott had just been laid-off. “We were promised May 1st, it was actually June 1st so, we signed up on June 1st, we get no cards, we get no information, it’s the middle of the month, doctors are asking us what’s your insurance because we cancelled COBRA so, finally I called and they said just pop on the Anthem site and download your cards,” Lisa explains.
The family did that and gave the information to their providers. It wasn’t long before those providers started calling to cancel appointments. “They couldn’t get an authorization because they couldn’t reach anybody or when they called the numbers they were supposed to call, basically they were told we didn’t have insurance,” Scott says.
The Robinsons tried calling themselves. “Then we started trying to get pre-authorizations and all these numbers, they are baloney,” Lisa says. “I get cards from Leading Edge, I get cards with Omni on them but yet you call them and they say, we’re not the administrator.”
In her desperation, Lisa called the state Department of Health’s help line set up specifically to deal with PPL issues. “When I’m on with the Department of Health, I’m literally sobbing, I’m like I can’t take it anymore, I can’t. Between having a child with a complex medical condition through no fault of her own and then all of this” Lisa says through tears.
“All of these startup issues, if they’ve already done all of this in other states why is this so bad?” Scott questioned.
That’s the exact question News10NBC Investigative Reporter Jennifer Lewke asked Governor Kathy Hochul back in April:
Jennifer Lewke, News10NBC: “It seems like PPL had some issues like this in other states during the rollout, why did you choose them and were you aware of those issues and are you worried that history might be repeating itself?”
Governor Kathy Hochul: “I was not involved in the selection process. I want be very clear on that. That’s not something I thought was appropriate so it was done independently evaluating other applicants and their records and other states and we feel very confident.”
The Robinsons don’t share that confidence.
In a statement, a spokeswoman for PPL says, “Under the previous CDPAP system, thousands of full-time personal assistants across New York State were left without health insurance because their fiscal intermediaries didn’t offer it. Now, as the sole fiscal intermediary for CDPAP, PPL is working with our benefits broker and Third-Party Administrator to ensure every full-time CDPAP worker and their dependents have access to health insurance. These partners have been selected due to their experience working with NY healthcare workers including CDPAP personal assistants. PAs were issued communications regarding the benefits available to them, and PPL has a benefits team that answers general questions about benefits and enrolling in these programs. Our Third-Party Administrator also has a customer service center to answer questions about the health plan. For any concerns regarding specific insurance issues, we engage directly with the PA and health plan to address these issues. Overall, we continually look to enhance health benefits as we gain a better understanding of the health care needs of the CDPAP population, as well as changes within the healthcare industry overall.”
There is also some concern about the quality of the plans that are being offered. The non-profit publication New York Focus which News10NBC occasionally partners with, has done a deep dive into the policies.
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News10NBC Investigates: Caregivers face uphill battle getting health insurance through state’s new PPL program WHEC.com.
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