Home Health Aides Will Get New Medical Insurance

This story originally appeared in New York Focus, a nonprofit news publication investigating power in New York. Sign up for their newsletter here.

New York State will replace the company providing health insurance to hundreds of thousands of home care workers next year.

The move comes after a series of New York Focus stories found that the company, called Leading Edge Administrators, routinely underpays doctors, bills patients for care it has promised to cover, attempts to cancel patients' insurance without notice, pockets money that is meant for low-wage workers, and directs profits to a shady charity.

Leading Edge, which also goes by the name Omni Advantage, was hired earlier this year by Public Partnerships LLC (PPL), a care management company, to oversee health insurance for employees of the $11 billion CDPAP program.

CDPAP allows low-income elderly and disabled New Yorkers to hire their own in-home caregivers. PPL, selected by the Hochul administration, has run the program since April, and has faced extensive criticism for missing paychecks, exposing employees' sensitive financial information, and poor customer service.

Home care workers and activists have heavily criticized PPL's health insurance offerings from the outset. One of their key complaints has been that most workers are required to pay for a custom health insurance plan that doesn't cover basics like hospital visits and primary care, even if they already have other health insurance.

Full-time home care workers, who generally make about $40,000 a year, have the option to upgrade to a plan that costs $2,500 annually and covers nothing until enrollees spend $6,000 on medical bills out of pocket.

This option will end in May, when PPL replaces Leading Edge with a new company to manage its health care plan, PPL spokesperson Meg Fitzgerald told New York Focus. The reasons for the switch are "confidential," and PPL "will make more details available when we have them," Fitzgerald wrote in an email.

Michael Kinnucan, a health policy expert who has studied PPL's health care offerings, said that PPL's announcement is "very good news" and "reflects an acknowledgement of the reporting about the really serious problems and concerns" with Leading Edge.

However, he called the current fix "window dressing" that "makes a marginal improvement in a disastrous situation that PPL created and that PPL could fully solve, if it wanted to."

Rather than taking a cut of workers' salaries to pay for bottom-tier health insurance, the company could simply give workers that money in cash, Kinnucan suggested.

It remains to be seen whether the replacement company will offer better health coverage or whether PPL will let workers opt out of paying for insurance that they don't want.

Fitzgerald said that it is "likely" that a portion of workers' paychecks will continue to go toward paying for benefits such as health insurance, even after Leading Edge is replaced.

In the meantime, PPL and Leading Edge are offering a new and slightly improved health insurance plan starting January 1. It covers more services than the current plans, but is more expensive: $3,000 a year for an individual. It is only available to full-time home care workers.

"It took months of workers speaking out, lawsuits, legislative scrutiny, and relentless organizing to force PPL to make even this minor change," said Ilana Berger from Caring Majority Rising, an activist group that opposed the shift to PPL. But, Berger added, the company "waited until just days ago to announce this change, giving workers only a few weeks to enroll during the holidays."

"It's the same dysfunction we've seen from them all along," she said.

Saba Nakhai, a health aide in Ossining, Westchester, who cares for her disabled mother full time, said that the new plan is too expensive for her to consider enrolling. "I can barely pay the mortgage and maintenance," she said. "And all the bills are going up."

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