New York is the largest Medicaid-spending state in the dataset at $145 billion. That's more than California ($129B) despite having half the population. The reason is almost entirely one billing code: T1019 — "personal care services per 15 minutes."
New York's T1019 spending: $74.6 billion. That's 51% of the state's total Medicaid expenditure in a single code.
The next highest state for T1019 is Massachusetts at $8.4 billion — less than one-ninth of New York. After that: Missouri ($6.2B), New Jersey ($4.2B), Virginia ($4.2B). The dropoff is staggering.
What T1019 Pays For
T1019 covers personal care services: bathing, dressing, meal preparation, light housekeeping, and other activities of daily living for Medicaid beneficiaries who need help living at home. Every state funds some version of these services. What makes New York different is scale — and a specific program.
New York's Consumer Directed Personal Assistance Program (CDPAP) allows beneficiaries to hire their own caregivers, including family members and friends. The program was designed to give patients more control over their care and keep them out of institutional settings. By most accounts, it has achieved that goal. It has also become the single largest line item in the state's Medicaid budget.
The Growth Trajectory
T1019 spending in New York has nearly tripled over the period covered by this dataset:
| Year | NY T1019 Spending |
|---|---|
| 2018 | $5.6B |
| 2019 | $9.0B |
| 2020 | $11.7B |
| 2021 | $12.4B |
| 2022 | $13.8B |
| 2023 | $16.2B |
| 2024 | $16.0B |
From $5.6 billion in 2018 to $16 billion in 2024. Growth continued even after state legislators began raising concerns and proposing reforms. The 2024 plateau may reflect recent program changes — or simply an incomplete year in the data.
Geographic Concentration
The spending isn't distributed evenly across New York. As documented in the Brooklyn personal care analysis, 318 providers in Brooklyn alone account for $31.8 billion in T1019 billing. Queens, Manhattan, and the Bronx add tens of billions more.
The top T1019 providers nationally are almost all in the New York metro area:
| # | Provider | Location | T1019 Paid |
|---|---|---|---|
| 1 | Tempus Unlimited, Inc. | Stoughton, MA | $5.46B |
| 2 | Freedom Care LLC | New Hyde Park, NY | $3.00B |
| 3 | Public Partnerships LLC | Latham, NY | $2.70B |
| 4 | American Business Institute Corp | Flushing, NY | $1.62B |
| 5 | Premier Home Health Care Services Inc | New York, NY | $1.30B |
Freedom Care, the #2 biller, was founded in 2016 and has grown to $3 billion in T1019 billing in under a decade. American Business Institute Corp — a curious name for a home care provider — bills $1.6 billion out of Flushing, Queens.
What This Means
None of this data, by itself, indicates fraud. CDPAP serves hundreds of thousands of New Yorkers who genuinely need help with daily living. The program exists because the alternative — nursing home placement — is both more expensive and less humane. Many of the people receiving care through CDPAP are elderly, disabled, or chronically ill, and their family caregivers are often providing labor that would otherwise go unpaid.
But the scale of the spending — $74.6 billion, more than the total Medicaid budgets of most states — and the rate of growth have drawn scrutiny. Governor Hochul's administration attempted to restructure CDPAP in 2023, consolidating fiscal intermediaries. Federal investigators have charged multiple providers with fraud in the program. The Minnesota autism diagnosis scheme that partially motivated the release of this dataset had similar structural features: legitimate service type, explosive growth, geographic concentration.
The question isn't whether personal care services are valuable. They are. The question is whether the systems that deliver them — the billing infrastructure, the oversight mechanisms, the entity proliferation — are adequate to the scale of money flowing through them. At $16 billion a year and climbing, New York's T1019 spending deserves scrutiny regardless of whether any given claim is fraudulent.
Explore the data: T1019 nationally · New York billing codes · Brooklyn providers