Key Takeaways
- • The Private Equity Stakeholder Project (PESP) and Americans for Financial Reform Education Fund (AFREF) report finds that private equity-owned Public Partnerships, LLC (PPL) has documented payment failures, disrupted care, and failed program transitions across multiple states, not only New York.
- • PPL, owned by DW Healthcare Partners and Linden Capital Partners since 2022, is the largest U.S. provider of fiscal intermediary services for self-directed care programs, running systems for more than 700,000 Medicaid participants and caregivers across 18 states.
- • A federal court is considering final approval of PPL's $162 million settlement with nearly 200,000 New York home care workers, which PPL agreed to in June to resolve wage-and-hour claims.
- • A Pennsylvania state audit found the PPL transition produced nearly $7 million in additional costs in one year rather than the expected savings, and roughly one-third of participants failed to transition to PPL.
- • The report recommends enforceable quality standards for fiscal intermediaries, public financial and performance reporting, and guardrails against profiteering from Medicaid funding.
Summary
A report released by the Private Equity Stakeholder Project (PESP) and Americans for Financial Reform Education Fund (AFREF) argues that problems at private equity-owned Public Partnerships, LLC (PPL) extend well beyond New York, where a federal court is weighing final approval of PPL's $162 million settlement with nearly 200,000 home care workers. The report, titled "Public Partnerships, LLC: Private equity prioritized corporate profits over home healthcare workers and recipients," documents a pattern of payment failures, disrupted care, difficult program transitions and inadequate customer service in several states. In some cases, these problems led caregivers to resign or Medicaid participants to lose essential services.
PPL has been owned by DW Healthcare Partners and Linden Capital Partners since 2022. According to the report, PPL CEO Miki Kapoor is also an operating partner at Linden, which owns at least 18 percent of the company. PPL is the country's largest provider of fiscal intermediary services for self-directed care programs, running registration, payroll, timekeeping and benefits systems for programs serving more than 700,000 Medicaid participants and caregivers across 18 states.
The report cites several state-level findings. In Pennsylvania, thousands of caregivers were not paid promptly, some for months, and roughly one-third of participants failed to transition to PPL and lost access to self-directed services. A state audit found the transition produced nearly $7 million in additional costs in one year rather than the expected savings. In New Jersey, Disability Rights New Jersey received more than 115 complaints during PPL's first year administering two state programs, including missing or inconsistent payments, enrollment delays and unresponsive customer service. The report also states that PPL has lost or had contracts terminated in New Jersey, Washington, West Virginia and Tennessee, and has faced wage-theft cases involving workers in five states. In New York, advocates reported missing paychecks, enrollment problems and care interruptions after PPL became the sole fiscal intermediary for the Consumer Directed Personal Assistance Program.
PESP senior healthcare research coordinator Ryan Leitner said PPL's record "should be a warning as private equity expands into the companies that states rely on to administer Medicaid," noting that other states had documented missing paychecks and lost access to care years before New York awarded PPL a $1 billion contract. AFREF research analyst Hibba Meraay said the findings show that "when private equity targets home care programs as a source of reliable public revenue, workers and clients both suffer."
The report places PPL within a broader trend in which private equity firms have acquired Medicaid contractors that manage payments, claims and eligibility systems, providing access to government-backed revenue. It also notes that private equity-owned home care chains have increasingly dominated the sector. The report recommends that states establish enforceable quality standards for fiscal intermediaries, require regular public reporting on finances and performance, preserve participant choice, and adopt guardrails against profiteering from public Medicaid funding, and it calls for expanded unionization among home care workers.
PPL has been owned by DW Healthcare Partners and Linden Capital Partners since 2022. According to the report, PPL CEO Miki Kapoor is also an operating partner at Linden, which owns at least 18 percent of the company. PPL is the country's largest provider of fiscal intermediary services for self-directed care programs, running registration, payroll, timekeeping and benefits systems for programs serving more than 700,000 Medicaid participants and caregivers across 18 states.
The report cites several state-level findings. In Pennsylvania, thousands of caregivers were not paid promptly, some for months, and roughly one-third of participants failed to transition to PPL and lost access to self-directed services. A state audit found the transition produced nearly $7 million in additional costs in one year rather than the expected savings. In New Jersey, Disability Rights New Jersey received more than 115 complaints during PPL's first year administering two state programs, including missing or inconsistent payments, enrollment delays and unresponsive customer service. The report also states that PPL has lost or had contracts terminated in New Jersey, Washington, West Virginia and Tennessee, and has faced wage-theft cases involving workers in five states. In New York, advocates reported missing paychecks, enrollment problems and care interruptions after PPL became the sole fiscal intermediary for the Consumer Directed Personal Assistance Program.
PESP senior healthcare research coordinator Ryan Leitner said PPL's record "should be a warning as private equity expands into the companies that states rely on to administer Medicaid," noting that other states had documented missing paychecks and lost access to care years before New York awarded PPL a $1 billion contract. AFREF research analyst Hibba Meraay said the findings show that "when private equity targets home care programs as a source of reliable public revenue, workers and clients both suffer."
The report places PPL within a broader trend in which private equity firms have acquired Medicaid contractors that manage payments, claims and eligibility systems, providing access to government-backed revenue. It also notes that private equity-owned home care chains have increasingly dominated the sector. The report recommends that states establish enforceable quality standards for fiscal intermediaries, require regular public reporting on finances and performance, preserve participant choice, and adopt guardrails against profiteering from public Medicaid funding, and it calls for expanded unionization among home care workers.
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