New York State will replace the company managing health insurance for hundreds of thousands of home care workers next year, following repeated reports of mismanagement and underpayment.
Leading Edge Administrators, also known as Omni Advantage, has been accused of underpaying doctors, billing patients for covered services, attempting to cancel policies without notice, misappropriating funds intended for low-wage workers, and funneling profits to a questionable charity, according to investigations by New York Focus.
The firm was hired earlier this year by Public Partnerships LLC (PPL), the care management company overseeing the $11 billion Consumer Directed Personal Assistance Program (CDPAP). The program allows low-income elderly and disabled New Yorkers to hire their own in-home caregivers. PPL, chosen by the Hochul administration, has faced criticism for delayed paychecks, exposure of employees’ financial information, and poor customer service since assuming control in April.
Home care workers and advocacy groups have been vocal in condemning PPL’s health insurance offerings. Many employees are required to enroll in a custom plan that excludes basic services like hospital care and primary care, even if they already have other coverage. Full-time workers earning roughly $40,000 annually can upgrade to a plan costing $2,500 per year, which still requires $6,000 in out-of-pocket expenses before coverage begins.
The current arrangement will end in May when PPL introduces a new health insurance provider, according to spokesperson Meg Fitzgerald. She said the reasons for the change are confidential, with further details to be released later.
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Michael Kinnucan, a health policy analyst who has examined PPL’s insurance offerings, called the decision “positive news” that acknowledges serious problems with Leading Edge. He cautioned, however, that the move is only a “marginal improvement” in what he described as a flawed system created by PPL, suggesting the company could provide workers with the equivalent cash instead of deducting wages for inadequate coverage.
It remains unclear whether the replacement insurer will provide better benefits or allow employees to opt out of coverage they do not want. Fitzgerald indicated that some paycheck deductions for benefits, including health insurance, are likely to continue even after the transition.
Meanwhile, PPL and Leading Edge are introducing a new health plan starting January 1. The plan offers broader coverage but costs $3,000 per year and is available only to full-time home care workers.
Activists criticized the timing and cost of the new plan. Ilana Berger of Caring Majority Rising said, “It took months of worker advocacy, lawsuits, and legislative pressure to force even this minor change,” adding that the company announced it only weeks before enrollment, during the holiday season.
Saba Nakhai, a full-time caregiver in Ossining, Westchester, said the plan remains unaffordable. “I can barely cover the mortgage and maintenance, and all the bills keep going up,” she said.