New York is staring down a slow-burning crisis within its home care system. One that has been festering for months, permeating courtrooms, media reports, whistleblower testimonies, and even social media.

Yet, despite the magnitude of this disruption and the profound implications for tens of thousands of disabled and elderly New Yorkers, Governor Kathy Hochul’s administration continues to act as if everything is perfectly under control.

The reality is far from that.

At the heart of the turmoil is New York’s sweeping overhaul of the Consumer Directed Personal Assistance Program (CDPAP), the Medicaid-funded initiative that empowers patients to hire caregivers of their choice, often their own family members.

For years, the program operated with a network of fiscal intermediaries to handle payroll, training, and administrative tasks.

In a bid for modernization, Hochul’s administration has opted to dismantle this network and replace it with a single statewide fiscal intermediary; a private contractor known as Public Partnerships LLC (PPL). This move was pitched as a boost to efficiency, cutting costs, and improving oversight.

Instead, it has resulted in one of the most chaotic implementations in recent memory.

Caregivers began to encounter problems almost immediately: delayed paychecks, missing payments, unaccounted hours, and unsatisfactory support lines that left them waiting endlessly for assistance.

Some reported going weeks without pay, while others described the sheer panic of elderly or disabled clients realizing that the new state system could not guarantee their continuity of care.

Local news stations have documented this unfolding disaster, showcasing caregivers detailing financial hardships, patients stranded in uncertainty, and administrative failures that left families confused about who was responsible for their care.

If this disruption occurred in other sectors of the healthcare system, the public outcry would likely be overwhelming. In home care, however, those affected are the least visible: caregivers struggling to make ends meet and homebound patients whose suffering rarely makes headlines.

But recently, this issue has gained traction beyond the shadows.

A brief, explosive clip shared by the Libs of TikTok account sparked an online wildfire, amassing over six million views. The clip exposed testimonies and reports revealing just how deeply flawed the state’s transition has been.

Whistleblowers and industry leaders caution that the entire restructuring was predicated on unrealistic assumptions about capacity and oversight, particularly the misguided idea that a single entity could effortlessly take on the workload once managed by many.

They assert it couldn’t, and it didn’t.

Courts have intervened on several occasions, issuing temporary restraining orders and urging adjustments as the state struggles to stabilize this transition. Federal authorities are now investigating aspects of the program’s overhaul, including the contracting process and the influence of politically connected interests.

Additionally, concerns have been raised about whether the bidding process that led to PPL’s selection adhered to competitive and transparent standards.

Meanwhile, insurers involved in the CDPAP program have voiced their own disturbing concerns. Several have accused the new statewide contractor of enforcing rigid, non-negotiable reimbursement models—an approach some legal experts warn could border on anti-competitive.

The tension has escalated to such an extent that discussions about antitrust implications and state oversight are reverberating among policy analysts and attorneys.

Through all of this, the Hochul administration has struck a public posture that the transition’s problems are temporary inconveniences, just an unfortunate but manageable side effect of modernization. That framing is increasingly difficult to accept.

When caregivers go unpaid for weeks, when patients risk losing the only people who can safely care for them, when courts and federal investigators start circling, “temporary inconvenience” stops being an honest description.

What’s more troubling is how little attention the crisis is receiving in Albany. Lawmakers have issued statements, demanded briefings, and aired concerns, but there has been no unified public reckoning with the scope of the failure. For an $11 billion program serving some of the state’s most vulnerable residents, silence should not be an option.

And yet, that silence persists.

The state’s home-care system has reached a point where the real question is no longer whether the transition went wrong, because that much is clear. The question now is how long Albany will continue to insist that everything is fine while families, workers, and insurers say otherwise.

The public may not yet understand the full scale of what is happening. But as the testimony mounts, as the lawsuits grow, and as the federal spotlight intensifies, it is becoming harder for New York’s leaders to avoid the obvious: this is a crisis created by policy choices, not bad luck. And the people paying the price are the ones with the least ability to fight back.

At some point, the outrage will catch up. The only uncertainty is whether the state will fix the damage before or after that happens.

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Michael Busler is a public policy analyst and a professor of finance at Stockton University in Galloway, New Jersey, where he teaches undergraduate and graduate courses in finance and economics. He has written op-ed columns in major newspapers for more than 35 years.