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Officials point to direct‑hire county pilots and pay parity as keys to closing ISIP gaps
Summary
NYSOFA and New York City officials told lawmakers that hiring models that put personal care aides on county payrolls and baseline parity with Medicaid reimbursement can reduce turnover and shrink wait lists; witnesses called for baseline reimbursement increases rather than one‑time COLAs.
At the Assembly hearing on ISIP, New York State Office for the Aging Director Greg Olsen outlined local hiring experiments counties are using to address a home‑care aide shortage: 14 counties have pursued direct hiring or exclusive vendor arrangements so aides receive full‑time salaries, benefits and state retirement access as county employees. Olsen said those counties saw reduced turnover and, in some cases, elimination of local wait lists.
"If you're able to hire a personal care aide on the county dime, they are a full‑time worker... they are in the state retirement system," Olsen testified, tying the staffing model to improved retention and enhanced coordination with case managers. He said the state encouraged area agencies on aging to consider this model because traditional hourly vendor arrangements leave aides vulnerable and make recruitment difficult.
Witnesses and members also focused on reimbursement. Ryan Murray of the New York City Department for the Aging said city contractors deliver most NYC home‑care services under five named vendors and described a 0.55‑cent rate increase earlier in the year intended to match Medicaid parity; he warned that non‑baseline increases force providers to reallocate resources year over year. "We need this funding to be baselined in future years," Murray said, arguing that recurring baseline increases would prevent providers from prioritizing higher‑paid Medicaid cases over ISIP clients.
Advocates urged workforce investments alongside new service hours. LiveOn New York and the Association on Aging urged higher compensation, career pathways and pipeline development, plus flexible pilots that blend public and nonprofit roles. Several witnesses proposed expanding consumer‑directed options and county direct‑hire pilots as complementary strategies to raise staff retention and reduce waiting lists.
No formal policy was adopted at the hearing; committee members noted workforce solutions will need sustained, baselined funding rather than temporary allotments.
