CMS gives New York 90 days to fix Medicaid oversight as Staten Island adult day operators are charged

What happened

On Wednesday, October 21, the Centers for Medicare & Medicaid Services (CMS) issued a compliance warning letter to New York for failing to oversee its Medicaid program. CMS Medicaid director Dan Brillman said the state has 30 days to respond and 90 days to come into compliance. "If New York can't produce a corrective action plan, the question shifts from how to fix it to whether it can be fixed at all and should this even continue," he said. CMS deputy administrator Kim Brandt said audits of 15 social adult day care centers found billing for people who were not participants.

A day earlier, the Staten Island District Attorney charged the owner and program director of an adult day care center on Forest Avenue with billing government programs and long-term care companies more than $530,000 for services never provided between April and August 2026. Both were released, and lawyers for both women say they deny the charges.

New York's health commissioner said the state has recovered more than $15 billion in Medicaid funds since 2021 and referred more than 100 suspected fraud cases to the attorney general.

What it means for families

Families getting care through Medicaid are not losing benefits because of this letter. But a state under federal pressure usually tightens checks: more documentation, more reassessments, and slower approvals for managed long-term care (MLTC) and adult day programs, even for honest providers and families. Picture a mother who attends a social adult day program three days a week: her family may be asked to confirm attendance, or the program may face an audit. So far the cases announced involve programs in New York City.

This is a New York story. Families anywhere in the state who are applying for MLTC or home care should plan for extra time and keep their paperwork complete.

What to do this week

• If a parent attends adult day care, keep a simple record of the days they actually go.
• Never sign attendance or service sheets for days or hours that didn't happen, and report recruitment offers of cash or gifts to the state Medicaid Inspector General.
• If a Medicaid or MLTC application is pending, keep copies of everything you submit and follow up in writing.

Sources

• New York has 90 days to fix fraud mismanagement, CMS says (Daily Caller)
• Staten Island adult day care operators charged in Medicaid fraud case (CBS New York)

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