This article originally appeared in New York Focus, a nonprofit news publication that examines power in New York. Sign up for our newsletter here.
New York state will replace the company that provides health insurance to hundreds of thousands of home care workers next year.
The move comes after a series of articles in New York Focus revealed that the company, called Leading Edge Administrators, routinely underpays doctors, charges patients for treatments they promise to cover, attempts to terminate patients' insurance without notice, pockets money for low-wage workers, and funnels profits to shady charities.
Leading Edge, also known as Omni Advantage, was hired by care management company Public Partnerships LLC (PPL) earlier this year to oversee employee health benefits for the $11 billion CDPAP program.
CDPAP allows low-income seniors and disabled New Yorkers to hire a caregiver in their home. PPL, chosen by Hochul's government, has been running the program since April but has faced widespread criticism for unpaid salaries, disclosure of confidential employee financial information and poor customer service.
Home care workers and activists have harshly criticized PPL's health insurance services from the beginning. One of their main complaints is that most workers are required to pay for custom health insurance plans that don't cover basics like doctor visits and primary care, even if they already have other health insurance.
Full-time home care workers, who typically make about $40,000 a year, have the option to upgrade to a $2,500 annual plan, which doesn't cover anything until the enrollee pays $6,000 in out-of-pocket medical expenses.
That option is scheduled to expire in May, when PPL replaces Leading Edge with a new company that will manage the health care plans, PPL spokeswoman Meg Fitzgerald told New York Focus. The reasons for the switch are “confidential,” and PPL will “release details as they become available,” Fitzgerald wrote in an email.
Michael Kinnucan, a health policy expert who has studied PPL's health services, said PPL's announcement was “very good news” and reflected Leading Edge's “awareness of reporting on really serious issues and concerns.”
However, he called the current amendments a “deceptive settlement” and said they “slightly improve the dire situation that PPL has created and could completely resolve if PPL wants to do so.”
Kinukan suggested that instead of taking a portion of an employee's salary as health insurance premiums for the lower tier, the company could simply give that money to the employee in cash.
It remains to be seen whether alternative companies will offer better health insurance or whether PPL will allow workers to opt out of paying for insurance they don't want.
Fitzgerald said it is “likely” that after Leading Edge is replaced, a portion of employees' salaries will continue to be used to pay for benefits such as health insurance.
Meanwhile, PPL and Leading Edge are offering new, slightly improved health insurance plans starting January 1st. It covers more services than the current plan, but it's also more expensive at $3,000 per year for individuals. Available only to full-time home care workers.
“It took months of worker voices, litigation, legislative scrutiny, and relentless organizing to force even this small change to PPL,” said Ilana Berger of Caring Majority Rising, an activist group opposed to the transition. However, Berger added that the company “waited until just a few days ago to announce this change, and employees were only given a few weeks to register during their leave.”
“This is the same dysfunction we've been seeing in them all along,” she says.
Saba Nakai, a health assistant who works full-time to care for her disabled mother in Ossining, Westchester, said the new plan is too expensive for her to consider signing up for. “I can barely pay my mortgage and maintenance costs,” she said. “And all the bills are going up.”
