What happened on Oct 20: the NY adult day care Medicaid investigation
- A joint investigation by federal and state agencies. The FBI and the U.S. HHS Office of Inspector General worked with NY's Department of Health, the Office of the Medicaid Inspector General (OMIG), the Attorney General's Medicaid Fraud Control Unit, and more than a dozen other partners. Together they targeted more than 100 social adult day care (SADC) providers suspected of possible fraud (Governor Hochul's Oct 20 announcement).
- Where: NY1 reported agents at a provider in Flushing, Queens, and at two locations in Brooklyn. A source told NY1 the activity also reached Manhattan and Staten Island (NY1 report on the adult day care investigation).
- The ~$2.4B audit figure: the FBI said an audit found Medicaid paid about $2.4 billion for these services from January 2019 through October 2024. Investigators are looking at whether some of that money was stolen (NY1).
- Who uses SADC: about 45,000 Medicaid members statewide, through more than 400 programs (Governor's announcement).
- 35 MLTC plans doing prepayment review: SADC runs only through the state's 35 Managed Long Term Care plans. The Governor directed those plans to review SADC claims before paying them (Governor's announcement).
- The DOH review: the Health Department must consider every option, including phasing out the benefit and moving participants to other services. Its recommendations are due by Dec 31, 2026 (Governor's announcement).
- Federal scrutiny of home care is rising, e.g., California: on the same day, CMS deferred another $1.2 billion in Medicaid reimbursements to California, citing fast growth in its personal care program. Officials offered no evidence of fraud (Los Angeles Times on the California Medicaid deferral).
The investigation is about specific providers suspected of wrongdoing. It is not a finding about adult day programs in general, and it doesn't mean your parent's program did anything wrong.
Is social adult day care closing in New York? What's changing vs. only proposed
Happening now (Governor's office): - The state's 35 Managed Long Term Care (MLTC) plans must run prepayment review on SADC claims, and they can suspend payments. - No new SADC providers can open. That moratorium started in July 2026 and runs until January 2027, and it may be extended. - Enforcement and compliance checks continue.
Only proposed or under review: - The Health Department is weighing options, from stronger oversight and reform to phasing out the benefit and moving participants to other services. Recommendations go to the Governor by Dec 31, 2026. Nothing about the benefit's future has been decided.
What WNY families may notice: slower approvals, extra paperwork, or re-reviews from the plan while prepayment review rolls out. That's a process change. It doesn't mean anyone is under suspicion.
Adult day program Medicaid cuts in NY: 5 steps if days are cut or it closes
- Call the MLTC plan's care manager. SADC is available only through MLTC, and the plans oversee the providers (Governor's office). Ask what the plan will authorize instead and how long that will take.
- Get any change in writing. Ask for the reduction or closure notice, the dates, and the plan's proposed replacement.
- Write down what the program covered. List the hours, meals, transportation, supervision, and personal-care help. That's the gap you need to fill.
- Line up backup for the first two weeks. That could mean family shifts, a neighbor, or paid help while the plan responds.
- Ask about other services (see below) instead of waiting for the program to reopen.
Alternatives to adult day care in Buffalo and Niagara County
- Medical model adult day health care. This is a separate, licensed program for people who need health services during the day. Ask the MLTC plan or your parent's doctor whether it fits. Eligibility is set by the program and the plan.
- Home care and CDPAP. Medicaid personal care or the Consumer Directed Personal Assistance Program (CDPAP) may cover in-home help, and under CDPAP the family chooses the aide. Approval depends on an assessment. Since Sept 1, 2025, adults seeking these services for the first time must meet New York's Minimum Needs Requirements. That means needing at least limited hands-on help with more than two daily activities, such as bathing or dressing. For a person with a dementia or Alzheimer's diagnosis, it means needing at least supervision with more than one. People already authorized before that date stay under the old rules (NYS DOH: CDPAP eligibility; MLTC Policy 25.04).
- Your county aging office. In Erie County, that's the Erie County Department for the Aging, which also runs Going Places transportation. In Niagara County, it's the Office for the Aging / NY Connects. Ask about caregiver support, meals, and non-Medicaid programs. Statewide information is at NYSOFA.
- Respite. Short-term breaks for family caregivers. Ask the county aging office what's available locally.
Already on our site: Senior support in Erie & Niagara counties · Aging in place in Buffalo
How HOMEWARD helps bridge the gap
HOMEWARD helps WNY families put a plan together when the routine breaks. We map out the hours the program covered, sort through Medicaid and private options with you, and coordinate help at home through licensed local partners. We're not a home care agency, and we don't provide medical care.
Next step: Book a Free 15-Minute Call, use Request a call back below (the existing quick-callback form), or tell us what's going on with Mom or Dad (the existing contact form). You can also take the Free 2-Minute Snapshot.
FAQ
Is social adult day care closing in New York? No decision has been made. The Health Department is reviewing the social adult day care benefit and will send recommendations to the Governor by Dec 31, 2026. One option is phasing it out and moving participants to other services.
Does the NY adult day care Medicaid investigation affect programs in Buffalo or Niagara Falls? Reported enforcement activity was in New York City (Queens, Brooklyn, Manhattan and Staten Island). The new prepayment review applies to all 35 MLTC plans statewide, so WNY families may see slower approvals or re-reviews. None of that means a local program did anything wrong.
What should I do about adult day program Medicaid cuts in NY if my parent's days are cut? Call the MLTC plan's care manager, ask for the change in writing, and ask what other services the plan will authorize.
Is medical adult day care the same as social adult day care? No. Social adult day care is a non-medical benefit covering supervision, meals, activities and personal care. Medical model adult day health care is a separately licensed program for people who need health services. Eligibility differs.
What are the alternatives to adult day care in Buffalo? Medical model adult day health care, Medicaid home care or CDPAP (if your parent qualifies), respite, and programs through county aging offices. The Erie County Department for the Aging, Niagara County's Office for the Aging / NY Connects, your parent's MLTC plan, and HOMEWARD for planning and coordination.
Sources
- Governor Hochul: joint effort to crack down on fraud in Social Adult Day Care (Oct 20, 2026)
- Spectrum News NY1: More than 100 adult daycare providers targeted in Medicaid fraud investigation (Oct 20, 2026)
- Los Angeles Times: Feds hold back an additional $1.2 billion in California Medicaid reimbursements (Oct 20, 2026)
- NYS Department of Health: CDPAP eligibility and Minimum Needs Requirements
- NYS Department of Health: MLTC Policy 25.04
Need a backup plan for daytime care?
Start with the free HOMEWARD Snapshot or a 15-minute call. We will help you map the hours the program covered and line up next steps with licensed local partners.