Key Takeaways
- • Private equity's presence in New York State home care sharply expanded in 2025, with PE-backed firms controlling around half of the state's home care delivery, according to Cornell ILR School research.
- • PE-backed home care agencies in New York received over $2.32 billion in Medicaid revenue in 2022, indicating that most of their home care revenue comes from Medicaid.
- • Dealmaking, debt refinancing, and dividend recapitalizations have allowed PE firms to extract wealth for themselves and their investors while loading agencies with excessive debt and risk.
- • Some PE-owned agencies, both local and national chains, have been penalized for wage theft, fraud, and serious safety violations, and some acquired agencies had records of labor and compliance violations before purchase.
- • The researchers attribute financialization in the sector to weak federal and state regulation of health and labor policy and opaque public and private payment systems.
Summary
A research project from the Cornell ILR School examines private equity's growing footprint in New York State's home care industry, the conditions that enabled it, and how PE ownership affects home care workers' jobs and the quality of care patients receive. The project produced two reports: a June report on the nature of PE's entry into New York home care and the policy and regulatory framework that allows it, and a September report based on a two-year study of the relationship between PE ownership and the quality of work and care.
According to the research, private equity has steadily built a presence in New York home care over the past decade, and that presence sharply expanded in 2025, when PE controlled around half of the state's home care delivery. The researchers describe a pattern of dealmaking, debt refinancing, and dividend recapitalizations that they say has allowed firms to extract wealth for themselves and their investors while placing excessive debt, and therefore risk, on the agencies themselves.
The analysis indicates that PE-backed agencies in New York derive most of their home care revenue from Medicaid, and that they received over $2.32 billion in Medicaid revenue in 2022. The researchers argue that the drive for rapid, outsized profits raises concerns about cost-cutting that could diminish care quality, job quality, and regulatory compliance. They note that New York's home care industry already has significant labor and compliance problems, including widespread wage theft, and that PE-backed agencies have perpetuated some of these practices.
The report also cites cases in which agencies were penalized for wage theft, fraud, and serious safety violations during PE ownership, both at local agencies and at national chains. In other cases, PE firms acquired agencies with documented records of labor and compliance violations, which the researchers say raises questions about buyers that have sophisticated due diligence processes. The research concludes that this wealth extraction has been enabled by weak federal and state regulation of health and labor policy and by opaque public and private payment systems.
According to the research, private equity has steadily built a presence in New York home care over the past decade, and that presence sharply expanded in 2025, when PE controlled around half of the state's home care delivery. The researchers describe a pattern of dealmaking, debt refinancing, and dividend recapitalizations that they say has allowed firms to extract wealth for themselves and their investors while placing excessive debt, and therefore risk, on the agencies themselves.
The analysis indicates that PE-backed agencies in New York derive most of their home care revenue from Medicaid, and that they received over $2.32 billion in Medicaid revenue in 2022. The researchers argue that the drive for rapid, outsized profits raises concerns about cost-cutting that could diminish care quality, job quality, and regulatory compliance. They note that New York's home care industry already has significant labor and compliance problems, including widespread wage theft, and that PE-backed agencies have perpetuated some of these practices.
The report also cites cases in which agencies were penalized for wage theft, fraud, and serious safety violations during PE ownership, both at local agencies and at national chains. In other cases, PE firms acquired agencies with documented records of labor and compliance violations, which the researchers say raises questions about buyers that have sophisticated due diligence processes. The research concludes that this wealth extraction has been enabled by weak federal and state regulation of health and labor policy and by opaque public and private payment systems.
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