NY pols probe controversial $9B taxpayer-funded program for home-health-care aides: 'Significant concerns'
State lawmakers are launching a public hearing to probe New York's controversial $9 billion taxpayer-funded program that connects residents with home-health-care aides.
State Senate Health Committee Chair Gustavo Rivera (D-Bronx) and state Sen. James Skoufis (D-Hudson Valley) said they will be calling on people to testify about the troubled Consumer Directed Personal Assistance Program, or CDPAP.
4 State Senator James Skoufis announces that the Department of Motor Vehicles will remain in West Haverstraw.
Tania Savayan/The Journal News via Imagn Content Services, LLC
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4 New York State Senator Gustavo Rivera speaking at a podium.
Kevin C Downs forThe New York Post
The program initially came fire for its alleged rampant abuse and waste involving the under-regulated middlemen companies that were connecting residents with aides as part of the state-funded Medicare initiative.
Gov. Kathy Hochul's administration then did away with the private go-betweens — but its awarding of the massive job to one firm in a no-bid contract only created more questions and outcry.
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'We are going to lay out in clear terms how the transition worked, what didn't work, how it happened and what are the things to learn to make sure that individuals being served by the program continue to be served,' Rivera said.
4 Gov. Kathy Hochul's administration then did away with the private go-betweens
Luiz C. Ribeiro for New York Post
Rivera said 'fallout is still being felt' from the governor's consolidation move – noting that some workers have not been paid or have left the program, while patients have not been getting the care they need and others have ended back in nursing homes 'or worse.'
The program has already come under scrutiny from the feds, who The Post reported earlier this month are probing the governor's selection of Public Partnerships, LLC, as the sole 'fiscal intermediary' for CDPAP.
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Skoufis said how that contact was awarded will be part of the state hearing's scope.
'We do have questions. We do have concerns,' he said. 'I have significant concerns about just how this company was awarded the contract and were they awarded the contract fairly.'
4 Rivera said 'fallout is still being felt' from the governor's consolidation move – noting that some workers have not been paid or have left the program.
zinkevych – stock.adobe.com
Hochul administration rep Sam Spokony said in a statement, 'New York State protected home care and prevented a fiscal crisis by putting an end to the waste, fraud and abuse of an old system.
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'The vast majority of consumers and workers have reported a positive experience with the new statewide fiscal intermediary.'
The state lawmakers' hearing on the issue will be held July 9.
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Miami Herald
2 hours ago
- Miami Herald
Have job-based health coverage at 65? You may still want to sign up for Medicare
When Alyne Diamond fell off a horse in August 2023 and broke her back, her employer-based health plan through UnitedHealthcare covered her emergency care in Aspen, Colorado. It also covered related pain management and physical therapy after she returned home to New York City. The bills totaled more than $100,000. The real estate lawyer, now 67, was eligible for Medicare at the time but hadn't enrolled. Since she was still working, she thought her employer health insurance plan would cover her. That misunderstanding has had financial repercussions that she continues to deal with today. More than a year after her riding accident, Diamond was back at the emergency room after she tripped on a step while entering a New York restaurant. Her face covered in blood, Diamond was examined by staff, who did multiple CT scans. The bill for that care: $12,000. This time, though, the insurance coverage wasn't routine. Nearly all her claims were denied. Diamond was caught in a fairly common coverage snag: People who have group health insurance when they become eligible for Medicare sometimes find themselves on the hook for their medical bills because their group plan stops paying. Diamond contacted several people at UnitedHealthcare before she found out why the insurer refused to pay her claims. When Diamond turned 65 in 2022, Medicare — unbeknownst to her — became the 'primary payer' for her claims, meaning the federal health program for older or disabled people was supposed to take the lead in covering her medical bills, before other insurers paid anything. (As secondary payer, Diamond's employer policy picked up 20% of what Medicare would have paid.) Had she signed up for the government insurance plan when she turned 65, Diamond could have avoided a financially perilous situation that left her unexpectedly responsible for the medical costs she incurred during that time. She began to understand what had happened as she made inquiries about the denied claims. Diamond said she was told that UnitedHealthcare audited her claims last year and determined it had been improperly paying for her care, perhaps because her pricey medical claims after her fall from the horse raised a red flag. The insurer not only stopped paying current claims but also moved to claw back tens of thousands of dollars it had paid to providers in the two years since she turned 65. Some of those providers are now seeking payment from her. 'It's horrifying,' she said. 'For about two months I was devastated. I thought, 'Where am I going to get the money to pay all these people? There goes my retirement.'' The mistake has already cost her $25,000 and may cost her much more if providers continue to bill her for amounts that UnitedHealthcare has clawed back for care she received before signing up for Medicare in February. A UnitedHealthcare spokesperson declined to provide an on-the-record statement, citing safety concerns. Patient advocates say they frequently hear from people who, like Diamond, thought they didn't need to sign up for Medicare upon turning 65 because they had group health coverage. That assumption is generally correct if they or their spouse is working at a company with at least 20 employees. In that case, employer coverage is considered primary and they can delay signing up for Medicare as long as they or their spouse continues to be employed there. But if someone has employer coverage through a company with fewer than 20 workers, Medicare generally becomes the primary payer when they turn 65. The real estate law firm at which Diamond is a partner has a handful of employees. Similarly, if someone is older than 65 and has retiree health coverage or has left their job and opted to continue their employer coverage under the Consolidated Omnibus Budget Reconciliation Act, also known as COBRA, Medicare pays first. The issue can also arise for people who are younger than 65 if they are eligible for Medicare because of a disability. In those instances, Medicare pays first if they or their family member works at a company with fewer than 100 employees. If people in these groups don't sign up for Medicare when they become eligible, they can find themselves responsible for all their medical bills for years. (They may also owe a penalty for late enrollment in the Medicare program.) 'It's very alarming and there's no current fix to the situation,' said Fred Riccardi, president of the New York-based Medicare Rights Center, a national patient advocacy organization. The Centers for Medicare & Medicaid Services did not respond to a request for comment. Mark Scherzer, a lawyer in Germantown, New York, who helps people with insurance problems, and who advised Diamond, said he gets calls a couple of times a month from people who face this issue. 'What I see constantly now is that insurers go back and they claw back the money from the doctor and the doctor then claws the money back from the patient,' he said. Costly claims may trigger an insurer to examine someone's coverage. Those big claims 'seem to get on the insurer's radar,' said Casey Schwarz, senior counsel for education and federal policy at the Medicare Rights Center. UnitedHealthcare has recouped over $50,000 in medical bills from some of the providers who treated Diamond in New York after her riding accident. She's paid them about $25,000 so far. Some have agreed to let her pay the amount Medicare would have paid. But there may be more bills to come. Under New York law, health plans have two years after claims are paid to claw back payments from providers, and providers have three years to sue patients for medical debt. So, while there is still time for Diamond to be billed, the clock will eventually run out. Diamond plans to sue the broker who manages her company's health plan and other benefits for negligence. 'The Medicare secondary payment rules basically say that if you didn't sign up because you didn't know Medicare was supposed to be primary, that's on you,' said Melanie Lambert, senior Medicare advocate at the Center for Medicare Advocacy in Connecticut. Lambert said she has seen the issue 'many, many times.' In some instances, if a beneficiary can demonstrate they were misled by an employer or a federal employee, they may qualify for relief or a special enrollment period, she said. In a 2023 letter to the acting secretary of the Department of Labor, the National Association of Insurance Commissioners advocated applying a 'commonsense rule to COBRA plans, individual health insurance, and other coverage sources: those entitled to Medicare Part B but not enrolled in it should not lose benefits they pay for from a non-Medicare coverage source.' The Department of Labor didn't respond to a request for comment. In earlier times, people started collecting Social Security benefits then automatically got Medicare when they turned 65. Now, enrolling in Medicare is more complicated for many people, said Tricia Neuman, a senior vice president and the executive director of the Program on Medicare Policy at KFF, a health information nonprofit that includes KFF Health News. 'As more people are delaying going on Social Security and delaying going on Medicare, there's more opportunities for people to make mistakes, and those mistakes are costly,' Neuman said. Coverage experts say there are no clear requirements for insurers, employers, or the federal government to notify people about how the payment rules governing coordination of benefits between health plans may change when they become eligible for Medicare. The information appears in a chart in the government's 'Medicare & You' handbook, if someone knows to look for it. But it is not easy to find. A straightforward fix could solve many of the problems people face in this area, Scherzer said. Since every health plan knows its enrollees' ages, why not require them to notify people approaching 65 of possible benefit coordination issues with Medicare? 'It's so simple and such a no-brainer.' KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Los Angeles Times
2 hours ago
- Los Angeles Times
Social Security is still in good shape but faces challenges — from Trump
The annual reports of the Social Security and Medicare trustees provide yearly opportunities for misunderstandings by politicians, the media, and the general public about the health of these programs. This year is no exception. A case in point is the response by House Budget Committee Chairman Jodey Arrington (R-Tex.) to the Social Security and Medicare trustees' projections about the depletion of the programs' reserves: 'Doing nothing to address the solvency of these programs will result in an immediate, automatic, and catastrophic cut to benefits for the nearly 70 million seniors who rely on them.' The reports say nothing about an 'immediate' cut to benefits. They talk about cuts that might happen in 2034 and 2033, when there still would be enough money coming in to pay 89% of scheduled Medicare benefits and 81% of scheduled Social Security benefits. House Ways and Means Committee chairman Jason Smith (R-Mo.) used the release of the reports to plump for the budget resolution that the House narrowly passed on orders from President Trump and that is currently being masticated by several Senate committees. The reports, Smith said, make clear 'how much we need pro-growth tax and economic policies that unleash our nation's growth, increase wages, and create new jobs.' The budget bill 'would do just that,' he said. Neither Arrington nor Smith mentioned the leading threats to the programs coming from the White House. In Social Security's case, that's Trump's immigration, taxation and tariff policies, which work directly against the program's solvency. For Medicare, the major threat is a rise in healthcare costs. But those have flattened out as a percentage of gross domestic product since 2010, when the enactment of the Affordable Care Act brought better access to medical care to millions of Americans. That trend is jeopardized by Republican healthcare proposals, which encompass throwing millions of Americans off Medicaid. Policy proposals by Health and Human Services Secretary Robert F. Kennedy Jr. such as discouraging vaccinations can only drive healthcare costs higher. Let's take a closer look. (The Social Security trustees are Kennedy, Treasury Secretary Scott Bessent, Labor Secretary Lori Chavez-DeRemer and newly confirmed Social Security Commissioner Frank Bisignano, all of whom serve ex officio; two seats for public trustees are vacant. The Medicare trustees are the same, plus Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services.) The trust funds are built up from payroll taxes paid by workers and employers, along with interest paid on the treasury bonds the programs hold. At the end of this year, the Medicare trust fund will hold about $245 billion, and the Social Security fund — actually two funds, consisting of reserves for the old-age and disability programs, but typically considered as one — more than $2.3 trillion. Trump has consistently promised that he won't touch Social Security and Medicare, but actions speak louder than words. 'Trump's tariffs and mass deportation program will accelerate the depletion of the trust fund,' Kathleen Romig of the Center on Budget and Policy priorities observed after the release of the trustees' reports this week. 'The Trump administration's actions are weakening the country's economic outlook and Social Security's financial footing.' Immigration benefits the program in several ways. Because 'benefits paid out today are funded from payroll taxes collected from today's workers,' notes CBPP's Kiran Rachamallu, 'more workers paying into the system benefits the program's finances.' In the U.S., he writes, 'immigrants are more likely to be of working age and have higher rates of labor force participation, compared to U.S.-born individuals.' The Social Security trustees' fiscal projections are based on average net immigration of about 1.2 million people per year. Higher immigration will help build the trust fund balances, and immigration lower than that will 'increase the funding shortfall.' All told, 'the Trump administration's plans to drastically cut immigration and increase deportations would significantly worsen Social Security's financial outlook.' A less uplifting aspect of immigration involves undocumented workers. To get jobs, they often submit false Social Security numbers to employers — so payroll taxes are deducted from their paychecks, but they're unlikely ever to be able to collect benefits. In 2022, Rachamallu noted, undocumented workers paid about $25.7 billion in Social Security taxes. Trump's tariffs, meanwhile, could affect Social Security by generating inflation and slowing the economy. Higher inflation means larger annual cost-of-living increases on benefits, raising the program's costs. If they provoke a recession, that would weigh further on Social Security's fiscal condition. Trump also has talked about eliminating taxes on Social Security benefits. But since at least half of those tax revenues flow directly into Social Security's reserves, they would need to be replaced somehow. Trump has never stated where the substitute revenues could be found. Major news organizations tend to focus on the depletion date of the trust funds without delving too deeply into their significance or, more important, their cause. It's not unusual for otherwise responsible news organizations to parrot right-wing tropes about Social Security running out of money or 'going broke' in the near future, which is untrue but can unnecessarily unnerve workers and retirees. The question raised but largely unaddressed by the trustee reports is how to reduce the shortfall. The Republican answer generally involves cutting benefits, either by outright reductions or such options as raising the full retirement age, which is currently set between 66 and 67 for those born in 1952-1959 and 67 for everyone born in 1960 or later. As I've reported, raising the retirement age is a benefit cut by another name. It's also discriminatory, for average life expectancy is lower for some racial and ethnic groups than for others. For all Americans, average life expectancy at age 65 has risen since the 1930s by about 6.6 years, to about 84 and a half. The increase has been about the same for white workers. But for Black people in general, the gain is just over five years, to an average of a bit over 83, and for Black men it's less than four years and two months, to an average of about 81 and four months. Life expectancy is also related to income: Better-paid workers have longer average lifespans than lower-income workers. The other option, obviously, is to leave benefits alone but increase the programs' revenues. This is almost invariably dismissed by the GOP, but its power is compelling. The revenue shortfall experienced by Social Security is almost entirely the product of rising economic inequality in the U.S. At Social Security's inception, the payroll tax was set at a rate that would cover about 92% of taxable wage earnings. Today, rising income among the rich has reduced that ratio to only about 82%. That could mean hundreds of billions of dollars in lost revenues. The payroll tax is highly regressive. Those earning up to $176,100 this year pay the full tax of 12.4% on wage earnings (half deducted directly from their paychecks and half paid by their employers). Those earning more than that sum in wages pay nothing on the excess. To put it in perspective, the payroll tax bite on someone earning $500,000 in wages this year would pay not 12.4% in payroll tax (counting both halves of the levy), but about 4.4%. Eliminating the cap on wages, according to the Social Security actuaries, would eliminate half to three-quarters of the expected shortfall in revenues over the next 75 years, depending on whether benefits were raised for the highest earners. Taxing investment income — the source of at least half the income collected by the wealthiest Americans — at the 12.4% level rather than leaving it entirely untaxed for Social Security would reduce the shortfall by an additional 38%. Combining these two options would eliminate the entire shortfall. Social Security has already been hobbled by the Trump administration, Trump's promises notwithstanding. Elon Musk's DOGE vandals ran roughshod through the program, cutting staff and closing field offices, and generally instilling fears among workers and retirees that the program might not be around long enough to serve them. In moral terms, that's a crime. Those are the choices facing America: Cutting benefits is a dagger pointed directly at the neediest Americans. Social Security benefits account for 50% or more of the income nearly 42% of all beneficiaries, and 90% or more of the income of nearly 15% of beneficiaries. The wealthiest Americans, on the other hand, have been coasting along without paying their fair share of the program. Could the equities be any clearer than that?
Wall Street Journal
14 hours ago
- Wall Street Journal
The Social Security Iceberg Gets Closer
With all the enthusiasm of a madman, the U.S. continues to barrel toward history's most predictable crisis. Social Security is now expected to be insolvent in 2033, necessitating a 23% cut in benefits. The Medicare hospital fund will run out the same year, requiring an 11% spending cut. That's according to annual reports Wednesday by the official trustees. These projections are notably worse than last year's. The blow to Social Security benefits is two percentage points higher, and the default date is three quarters nearer. One factor cited by the trustees is that Congress, in its infinite generosity with other people's money, recently passed the deceptively named Social Security Fairness Act, topping up benefits for state and local government workers. The Medicare depletion day has moved three years earlier, owing to higher actual and expected costs. Those exact figures and dates move around somewhat, including based on how the economy is faring, so don't take them as gospel. But the larger picture, which has been obvious for years, is that America's retirement programs are on a unsustainable path and need to be reformed to be saved. Yet President Trump campaigned on never touching Social Security and Medicare. Perhaps he was sold a delusion that it would be possible to balance the books by going after fraud, such as all of those alleged 150-year-olds on benefits that Elon Musk kept insisting exist. Or maybe Mr. Trump thinks the political challenge is too great given that Democrats are utterly cynical in the way they accuse the GOP of pulling the plug on grandma.
