State and federal investigators are examining more than 100 providers as New York weighs stronger safeguards or a broader redesign of a program serving about 45,000 Medicaid members.
New York has launched a coordinated Medicaid Social Adult Day Care fraud crackdown while ordering a full review of a program that provides daytime supervision, meals, activities and personal care to older adults and other people enrolled in Managed Long Term Care.
Gov. Kathy Hochul announced Tuesday that the state Department of Health, the Office of the Medicaid Inspector General, the attorney general’s Medicaid Fraud Control Unit and federal law enforcement partners have been investigating more than 100 Social Adult Day Care providers suspected of possible fraud or other illegal activity. The state did not identify the providers in its announcement, and suspicion is not proof of wrongdoing.
The review has two tracks. Investigators will continue pursuing suspected fraud, while health officials examine whether tighter rules can protect the program or whether participants should gradually move to other services. Recommendations are due to the governor by Dec. 31, 2026.
For families in Utica, Rome and the wider Mohawk Valley, the immediate message is not that Social Adult Day Care is ending. The announcement starts a review. Any statewide change, however, could affect how local Managed Long Term Care members receive daytime support and how family caregivers arrange safe care during work or other responsibilities.
What New York announced
According to the governor’s official release, the months-long investigation includes the state Health Department, OMIG, the attorney general’s office, the U.S. Department of Health and Human Services Office of Inspector General, the FBI and more than a dozen federal, state and local partners.
The state says the review is examining suspected conduct that can include kickbacks, money laundering, improper billing and claims for services that were not delivered. Officials did not announce new charges against the more than 100 providers referenced Tuesday. Any criminal case would have to proceed through the courts, where defendants are presumed innocent unless proven guilty.
Hochul also directed health plans to use prepayment review before certain claims are paid and to pursue payment suspensions when warranted. The Department of Health and OMIG must develop options for the program’s future, including stronger oversight, structural reform or a transition to other services for participants.
What Social Adult Day Care provides
Social Adult Day Care is a nonmedical Medicaid benefit available through New York’s Managed Long Term Care program. It can provide supervision, meals, personal care, social activity and a structured community setting for people who might otherwise be isolated or need more support during the day.
The state says more than 400 programs serve about 45,000 Medicaid members at an estimated annual cost above $500 million. The centers are not themselves enrolled Medicaid providers. Instead, New York’s 35 Managed Long Term Care plans administer the benefit and are responsible for contracting with and overseeing the centers.
That structure matters. Strong enforcement can protect Medicaid dollars, but abrupt disruption could also create hardship for people who rely on a center and for unpaid caregivers who depend on daytime support. Health Commissioner Dr. James McDonald said the review will keep protection of older adults and continuity of care as priorities.
Why the state says oversight is changing now
New York says it reviewed 418 Social Adult Day Care programs for compliance in 2025. From 2021 through 2025, OMIG investigated 387 subjects connected to SADC operations and referred about 100 matters to the attorney general’s Medicaid Fraud Control Unit for possible prosecution.
The state also points to recent criminal cases. Earlier this year, two people pleaded guilty in a $68 million scheme involving adult day care and home care. The Utica Phoenix previously reported on the charges underlying that case. In a separate federal case, two Queens men were charged in an alleged $120 million Medicare and Medicaid scheme involving a pharmacy and adult day care centers. Those charges are allegations, and the defendants are entitled to due process.
The state says Medicaid program-integrity work produced more than $15 billion in cost savings and recoveries over five years. That figure covers the broader Medicaid program, not only Social Adult Day Care.
New York has also tightened eligibility, certification, recordkeeping, staffing and provider-identification requirements. In July, the Health Department began a temporary moratorium on new Social Adult Day Care providers as part of a wider Medicaid provider revalidation effort. The Health Department says the moratorium does not remove existing providers or change access by itself. It is scheduled to remain in effect until January 2027 and may be extended.
What this could mean in the Mohawk Valley
The governor’s announcement did not accuse a specific Mohawk Valley provider or announce a regional closure. Local families should not assume their center is implicated. The most likely near-term effects are administrative: closer claim review, more documentation requests, stronger monitoring by health plans and possible payment delays when a claim is questioned.
Over time, the state review could change the mix of services available to members. If officials choose reform, plans and centers may face stricter standards and more frequent audits. If officials recommend phasing out the benefit, the state would need a careful transition plan so participants are not left without supervision, meals, transportation connections or personal care.
The stakes are especially high in communities where transportation is limited and the supply of home care workers is already tight. A daytime program can give participants social contact while allowing spouses, adult children and other caregivers to work or rest. Any replacement service would need to be available in practice, not only listed on paper.
The decision also lands during a broader debate over the future of public health coverage. The Phoenix has covered local efforts to defend Medicare and Medicaid access in Utica, as well as criminal cases in which prosecutors say public health funds were stolen. Both concerns can be true at once: fraud should be prosecuted, and people who depend on legitimate care should not lose it because of misconduct by others.
What members and caregivers should do
Keep care in place unless your plan gives you a formal change
Members should continue following their current plan of care unless their Managed Long Term Care plan or care manager provides different instructions. Keep copies of notices, service authorizations and the name and phone number of the person handling the case. If a center cancels service or asks a member to sign unfamiliar paperwork, contact the plan before agreeing to a change.
Families can ask four direct questions: Is my current service authorized? Is my provider still in the plan’s network? Will transportation or meal service change? Who is responsible for arranging a replacement if the program closes or the contract ends?
Anyone who suspects false billing, kickbacks or services billed but not provided can file an allegation with OMIG or call the Medicaid Fraud Hotline at 1-877-87-FRAUD (1-877-873-7283). A report should separate firsthand facts from rumors and include dates, provider names and documents when available. People should not put themselves at risk to gather evidence.
Official video
What happens next
The Department of Health, OMIG and other agencies are expected to deliver their recommendations by Dec. 31. Existing investigations and compliance work will continue while that review is underway. The moratorium on new providers remains in place through at least January 2027.
The key questions are whether prepayment review and stronger plan oversight can stop improper claims without delaying legitimate care, and whether the state can measure quality as closely as it measures spending. Any proposal to replace the benefit should identify the alternative services, the workforce needed to provide them, transportation arrangements and a timeline that protects participants.
Readers who use Social Adult Day Care, care for a participant or work in a local program can share how the service functions in the Mohawk Valley and what safeguards would protect both members and taxpayers. Please avoid posting private medical information or unverified accusations in public comments.
