The Trump administration is acknowledging an error made in a recent social media video and letter to New York’s Democratic governor accusing the state of Medicaid fraud.
The Centers for Medicare & Medicaid Services told the Associated Press Administrator Dr. Mehmet Oz’s claim that roughly five million New Yorkers receive personal care services was an error. The actual number is about a tenth of that – about 450,000 people.
This comes a week after New York sent a response letter to CMS, obtained by BTPM NPR, telling the agency their calculation was inaccurate.
“Your letter vastly overstates the expansion of New York’s utilization of PCS [Personal Care Services], claiming inaccurately that nearly 75% of Medicaid beneficiaries received PCS in 2025, when in truth only about 6% received PCS. Overall, your letter conflates growth in the Medicaid program with fraud,” New York's letter to CMS said.
The letter, which was signed by Amir Bassiri, the New York State Medicaid director, and Frank Walsh, the Acting Medicaid inspector general, is dated April 3. Earlier in the letter, the state points out “New York’s Medicaid program serves more than 6.7 million residents.”
Six percent of 6.7 million is 402,000 people. The state said the 6% includes the state’s Consumer Directed Personal Assistance Program.
“It's without explanation and without apology,” said Michael Kinnucan, the health policy director of Albany-based think-tank Fiscal Policy Institute.
Kinnucan was first to point out that CMS' number was likely incorrect. While Kinnucan, who studies and writes about Medicaid in New York, didn’t have the data CMS was using, he used a sample of available data to question their estimate. CMS still hasn’t explained how they came to their estimate.
“If you're wrong by a factor of 10 in the headline claim in your anti-fraud letter, like, why should the public rely on any number that you give?” Kinnucan told BTPM NPR on Friday.
Kinnucan believes CMS added up the number of “total unique beneficiaries” reported each month over the time period they analyzed. However, “total unique beneficiaries” aren’t new beneficiaries each month. They can include people who stay in the home care or personal care service month to month.
As an example, he looked at Western New York Independent Living, or WNYIL, an independent living center out of Buffalo. WNYIL served as a fiscal intermediary for the previous iteration of New York’s Consumer Directed Personal Assistance Program in 2024. They would manage and pay the workers of beneficiaries of self-directed home care.
Each month, they had a little over 1,000 “total unique beneficiaries” receiving home care. If you add them up over six months, it would look like 6,000 people received care, when in reality, many of the people in a home care program stay with the same provider over a long period of time.
“If you had a spreadsheet showing the number of unique people who had used your toothbrush in each month of the year, it would say, you know, January, one person, February, one person, and so forth,” Kinnucan shared, as an analogy. “And you couldn't then add that column up and say, well, 12 unique people used your toothbrush. It was the same person.”
Todd Vaarwerk, Western New York Independent Living’s Chief Policy Officer, explains Kinnucan’s math makes sense.
“Not only am I chief policy officer at WNYIL, but I was a consumer of WNYIL’s fiscal intermediary, and I can tell you, I didn't leave the [fiscal intermediary] every month and come back in so that I could be counted again," Vaarwerk, who has a disability and uses home care, said.
WNYIL was a fiscal intermediary until New York State moved from over 600 companies administering the Consumer Directed Personal Assistance Program, or CDPAP, to only one in 2025.
CDPAP is the state’s largest personal care program, which allows disabled people to hire, train and self-direct aides paid through a fiscal intermediary. Those aides are often friends, neighbors or other people the disabled client is familiar with.
The alternative option is agency-based personal care services, where agencies assign aides to clients.
Vaarwerk points out, New York has made moves to reduce costs and utilization of home care. New York has stated that the move to a single fiscal intermediary in CDPAP is a cost-saving measure.
Additionally, in the fall of 2025, the state implemented a new “three ADL rule,” as advocates call it. Essentially, the state raised how many activities of daily living a person cannot do alone before they are eligible for home care. These activities include things like getting dressed, bathing and eating.
“We can’t turn around and say the parameters currently are not stringent,” Vaarwerk said.
Vaarwerk adds that while the previous guidelines allowed more people to access care, disabled people see that as a cost-saving measure, because it may allow them to not end up in a facility long-term.
“Advocates for people with disabilities have been very clear about the fact that services in the community are cheaper and more effective than services provided in an institution,” said Vaarwerk.
Kinnucan said he is concerned the focus on Medicaid fraud is rooted in different intentions.
“If I'm being honest, I think there are folks in the administration who just think home care for people with disabilities and elderly people is too expensive, and they would like to stop funding it,” Kinnucan said.
Kinnucan points out Dr. Oz has mentioned home care is something “our families would normally do for us, like carrying groceries,” which makes him question if Dr. Oz sees home care as something that shouldn’t be handled by Medicaid.
“Really in the background of this is not really the question of, ‘how can we root out fraud?’ It's the question of ‘does the administration just want to get rid of Medicaid home care?’” Kinnucan said.
