Move from 700 unregulated middlemen agencies passing Medicaid dollars to consumers to 1 principal fiscal intermediary (FI) and 4 regional partners. This will save up to $1 billion in taxpayer dollars lost in inefficient administration of the program. Eligibility and ability to hire the personal assistant of your choice will not change.
Create a statewide network of 30 proven New York agencies who serve as facilitators. These are agencies focused on providing services for people with disabilities, in-language/culturally competent care, and rural care to ensure coverage across the state.

New York can create a sophisticated statewide registry of caregivers, allowing consumers and caregivers to be matched based on a range of criteria including specialized care, language, location, estimated transit time and more. The registry could also provide independently verified data for voluntary training

Caregiver rights can be protected by allowing consumer direct care providers to join a union. This will ensure quality standards are maintained for caregivers around wages, benefits, schedules, voluntary training and more. Caregivers experience high rates of wage theft - by coming together in a union, caregivers will be able to advocate for their needs. And caregivers and consumers together can build a powerful organization to advocate for consumer-directed care.

New York’s reformed CDPAP can include a robust Pre-Service Orientation program to train consumers and caregivers on the laws and obligations within consumer directed care, including minimum wage and overtime law, workers compensation, employment paperwork, Electronic Visit Verification, sexual harassment prevention, and more.