A New Era for Home Care

Strengthen Home Care Workforce Operations - Streamline training, onboarding, and administrative function

February 8, 2026 FAIR Access Initiative, Inc. 51 Maryland Street Dix Hills, NY 11746 Chairpersons, Ranking Members, and Members of the Legislature, My name is Sasha Guillaume, and I am the Founder and President of the FAIR Access Initiative, a provider-led association representing home care agencies across New York State. It is an honor to represent our members and to submit this testimony to the Members of the Legislature on their behalf. The mission of FAIR Access Initiative is to strengthen the home care industry by working in partnership with the Legislature, the Executive, and the Department of Health as responsible stewards of the Medicaid program. Our focus is on identifying inefficiencies, reducing waste, and improving long-term sustainability, not expanding programs or increasing spending. FAIR Access was formed in the wake of the CDPAP transition, which exposed the risks created by a fragmented and disunified industry response. When cost growth, operational complexity, and oversight concerns reached a tipping point in the Consumer Directed Personal Assistance Program, the resulting policy response was sweeping and centralized. Regardless of one’s perspective on that outcome, it demonstrated that when provider-led solutions are absent, corrective action can be broad and disruptive. FAIR Access exists to prevent that pattern from repeating elsewhere in home care. Today, fragmentation continues to drive unnecessary Medicaid spending. Multiple entities often assess, document, supervise, and manage care for the same patient. These overlapping assessments and care planning functions can be streamlined to eliminate repetitive services that result in Medicaid paying multiple times for the same work. FAIR Access proposes a Universal Nursing Assessment, built on the existing UAS-NY, completed once and securely shared across authorized providers. This is not a new program. It is a structural efficiency that recognizes work already being performed and eliminates redundancy. We also support an Integrated Home Care Ecosystem that aligns plans, providers, and care managers around shared assessments, reconciled care plans, and interoperable data. Better alignment improves continuity of care while reducing administrative duplication and unnecessary cost. FAIR Access Initiative also sees significant opportunities to reduce redundancy through greater workforce regulatory alignment. While workforce stability is at its core a care issue, it is also a critical fiscal issue. We can build upon existing Department of Health eligibility and credentialing infrastructure to centrally manage in-service and continuing education requirements through a secure registry accessible to providers. This would eliminate repetitive training requirements for staff working across multiple agencies, while maintaining consistent standards and compliance. Additionally, FAIR Access seeks to work collaboratively with Albany to address the unintended consequences of misaligned mandates that have led to unnecessary litigation and destabilization of provider networks. Conflicting regulatory standards, particularly in live-in care, have reduced participation in one of the most cost-effective alternatives to institutional placement. FAIR Access Initiative is not here to ask for new funding. We are here to partner with the State to identify waste, improve transparency, and ensure that legislative mandates align with operational and fiscal realities.  Our goal is to offer provider-led solutions that protect Medicaid dollars and to work collaboratively as trusted stewards of a program that New York’s most vulnerable residents depend on. Thank you for the opportunity to submit this testimony. Regards, Sasha Guillaume, President FAIR Access Initiative, Inc.