Medicaid self-directed care programs allow participants or their representatives to have decision-making authority over personal and home assistance services. Many states have outsourced the administration of self-directed care programs to third parties known as fiscal intermediaries. Public Partnerships, LLC (PPL) is the largest provider of fiscal intermediary services in the US, primarily for self-directed care programs. As a fiscal intermediary, PPL provides financial management services across 18 states, running registration, payroll, time tracking, and benefits for personal
assistants through state self-directed home care programs. The company has lost or had contracts terminated for managing home care programs
in New Jersey, Washington, West Virginia, and Tennessee. While emphasizing customization of care and independent choice to Medicaid participants, PPL’s inflexible and disorganized transition of caregivers to its fiscal intermediary system has resulted in participants losing care.
The Consumer Directed Personal Assistance Program (CDPAP) was established in New York in 1995 in an effort to give disabled and chronically
ill New Yorkers autonomy over their care while reducing costs to the state associated with institutionalization. Fiscal intermediaries sprang up to handle payroll and compliance for caregivers, and by 2024, there were more than 600 across the state, each with an incentive to enroll patients. In 2023, New York Governor Kathy Hochul pushed to consolidate services under one fiscal intermediary, and in October 2024, PPL won the five year contract worth approximately $1 billion. PPL agreed to a $162 million wage-and-hour class action settlement with caregivers in southern New York earlier this year and faces a Department of Justice (DOJ) lawsuit regarding alleged Medicaid fraud. PPL now faces an additional wage theft lawsuit from workers in upstate New York.
PPL has experienced significant leadership changes since 2020. PPL has had at least seven changes in its CEO in four years, and in July 2025, PPL’s
president resigned. The New York Times reported that Senator Steven Rhoads, a Republican from Long Island, said on Thursday that he found the
leadership changes and the timing to be ‘incredibly odd’.” PPL’s current CEO, Miki Kapoor, who took the role in August 2025, also serves as an operating partner at Linden Capital, a private equity firm that owns at least 18 percent of PPL.
PPL is owned by private equity firms DW Healthcare Partners and Linden Capital Partners. Private equity-owned companies often exhibit cost cutting behaviors resulting in poorer quality products and services.
As states face growing pressure to implement new Medicaid requirements that depend on complex eligibility systems and frequent verification checks,
states may be incentivized to outsource that work to third party middlemen like PPL. PPL reports that it runs fifty programs that impact more than
700,000 Medicaid participants and their caregivers. The growing role of private equity in public health infrastructure calls for an increasing need for
oversight and accountability.
This report offers a summary of the issues raised in the state and federal lawsuits related to PPL’s contract in New York, dive more deeply into PPL’s pattern of concerning practices across other states, and detail recommendations for curbing future harm.