New York leaders intend to implement changes to a Medicaid home care program by the spring, but the state health commissioner on Thursday said there could be flexibility in the six-month timeline if necessary. 

Health Commissioner Dr. James McDonald's comments come after continued pushback from disabled and elderly New Yorkers who rely on the Consumer Directed Personal Assistance Program — a $9 billion Medicaid home care program that allows family members to help their relatives live independently.

State leaders are finalizing the details of a five-year contract with Public Partnerships LLC, slated to oversee CDPAP and more than 250,000 enrolled New Yorkers starting April 1.

"The transition will take as long as it takes, as long as everyone is safely transitioned," McDonald told Spectrum News 1 at an unrelated event Thursday. "I think it's possible to be done in six months, but we're flexible. We'll see how everything goes."

The commissioner said upcoming changes to remove over 600 fiscal intermediaries that handle the program's payroll are needed after reports of widespread fraud. The program in New York has grown more than 1,200% in the last eight years, he added.

"We have more fiscal intermediaries in New York state than [programs in] the entire United States combined," McDonald said. "This is about what is the next step for the program to make sure it's protected and enduring."

The company, which has served consumer direction programs for 25 years, will work with dozens of FI subcontractors to accommodate New York's large program.

"All told, we are looking at this transition to [include] likely more than 50 fiscal intermediaries who will be our statewide partners," said Maria Perrin, PPL's chief growth and strategy officer. "Our aim is to have many fiscal intermediaries in each region so consumers can have choice."

The FIs will be subject to state approval to take effect by mid-2025, according to Gov. Kathy Hochul's office. 

Perrin declined to say the price tag of the five-year contract. The state is expected to publish details of the final agreement in the coming days.

The deal has PPL moving its headquarters to New York from Georgia, which was part of the proposal it submitted to the Health Department, according to Hochul's office. McDonald and Perrin said the state did not offer the company any incentives to make the move.

"We have not been given any financial incentives, or otherwise," Perrin said, adding most of PPL's employees will be concentrated in New York when the changes take effect.

Dozens of disabled people who use the home care program came to Albany on Tuesday — irate over the state's decision to contract with PPL and sticking with the six-month deadline.

Advocates with the Alliance to Protect Home Care and Caring Majority Rising marched down the concourse shouting "Gov. Hochul, you don't care!"

They held demonstrations during the state's third annual Disability Rights & Employment Awareness Month, or DREAM, symposium, and disrupted speeches by Lt. Gov. Antonio Delgado and Health Commissioner McDonald. Program recipients are furious, and concerned, about PPL's history losing contracts to manage consumer directed programs in other states.

"I'm afraid for my future; I'm afraid for my home care workers," said Jose Hernandez, who interrupted Delgado.

Delgado's office declined to comment.

Hernandez was paralyzed in a diving accident at age 15 and has used CDPAP since 2006.

"It's sad that the Hochul administration doesn't see people with disabilities," Hernandez said. "I'm not Jose Hernandez under her administration, I'm a number. And right now, she's trying to reduce my number."

The health commissioner and Kimberly Hill Ridley, the governor's chief disability officer, held a private meeting Tuesday with concerned program recipients.

Hundreds of people have delivered angry letters to Gov. Hochul's offices in Albany and Manhattan this week, as well as Assembly Speaker Carl Heastie and Senate Majority Leader Andrea Stewart-Cousins' offices. 

Several Democratic lawmakers also sent a letter to the Health Department about their concerns to change the program.

The lawmakers voted for the changes in the last state budget. Changing the timeline or implementation would require additional action by the Legislature, which is not expected to reconvene until January.

McDonald on Thursday would not answer questions about PPL's past issues of pay delays for home care workers or wage theft suits in other states, but said New York's competitive process was done correctly.

Perrin said many of the issues advocates have cited about PPL's past were based on problems with program setup or happened years ago, and the company has successfully completed 50 other implementations in the last decade.

"Obviously, when you do as many implementations as we have, each time you learn," she said. "Each time, you get better and stronger."

The company operates in 21 states and was reawarded its contract in Colorado earlier this year.

The health commissioner said he will work with the company to ensure a smooth transition in the coming months.

"Don't assume the worst," he said. "When you really get right down to it, the program is going to be enduring. It's a way to keep maintaining this program."

Assemblyman John McDonald, a pharmacist and the health commissioner's brother, said the state must get CDPAP under control after years of exponential growth and fraud. He and other lawmakers will be involved with regular briefings as the transition takes place.

But he agrees it will likely take more than six months to remove hundreds of middlemen and avoid disruptions in services to patients.

"I've had residents tell me, 'I was getting paid just to sit with my mom at night and watch TV, but it wasn't necessary,' " the assemblyman recalled Thursday. "That's not in the best interest of taxpayers; it really isn't. For those who are offended by that, I can't apologize."

More than three quarters of of New York's CDPAP enrollees live in New York City. PPL submitted recommendations to the state to implement the changes in different groups of the state's population over the next six months. 

Representatives with Gov. Kathy Hochul's office referred questions about choosing PPL to a prepared statement the governor released earlier this week.

“We’re committed to protecting home care users, supporting caregivers and ensuring the vital CDPAP program continues serving the New Yorkers who rely on it," Hochul said. "Our plan will deliver a stronger CDPAP and leverage a diverse, statewide partnership to ensure the high-quality, personalized care that New Yorkers need.”

State leaders will hold meetings with home care users and caregivers, elected officials and other ongoing review as part of the transition process before the new partnership takes effect.