[Alliance Enews] Gov Hochul's State of the State Message Offers a Mixed Bag

[Harvey Rosenthal]

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January 10, 2024                                                            Contact: Harvey Rosenthal 518-527-0564; Luke Sikinyi at 518-703-0264

New York State of the State Message a Mixed Bag
Strong Linkages to Violence; Strong Youth and Insurance Coverage Initiatives
More Focus on Criminal Justice Reforms; No COLA for the Workforce
More Hospital Beds vs More Community Services, A Medicaid Waiver Deal

Emphasis on Connecting Mental Illnesses and Violence
The State of the State message begins with "troubled individuals commit violent acts" and is followed up by a reference to "improving public safety by addressing serious mental illness." While we're sure the Governor's intent here is to calm a public that is frightened at rising rates of violence and not to stigmatize our community, this is precisely the way it will be taken by far too many. In an effort to 'crack down on violence,' Governors across the nation are feeling pressure to target people with major mental health challenges. Governor Hochul must stand up for us and resist that political pressure.
The research is clear that our community is responsible for as little as 4% of acts of violence and is 11 times more likely to be its victims (remember the tragic choking death of Jordan Neely<https://www.theguardian.com/us-news/2023/may/12/jordan-neely-new-york-social-services-support-mental-health> in a NYC subway car last May). We need to speak out against irresponsible media coverage that primarily presents us to the public only when violence has occurred, and causes our community to be scapegoated, stigmatized, surveilled, criminalized and coerced and to face increased dehumanization and discrimination. In that regard, we greatly appreciate that the Governor did not give in to calls to expand the use of overtly coercive outpatient and inpatient measures, including Kendra's Law.
Government must instead make a full-on commitment to addressing the social conditions that are at the heart of producing severe distress and despair, including homelessness and hunger, isolation and loneliness, needless hospital and jail recidivism and the purposelessness that comes with poverty.
The Governor offered a number of community-based program expansions to address core challenges last year. We must give these a little more time to come up and, at the fast rate the Governor is implementing them, it won't take much longer. But last year's program allocations must also be augmented by a second series of systematic investments in a continuum of peer led prevention (INSET), diversion and transitional services and supports (see below).

Workforce
We are extremely disappointed that the budget fails to include a Cost-of-Living Increase for community agencies and their workforce. We will be working with our colleagues to take strong action to press the Governor and Legislature to find the funds to provide us with an appropriate 3.2% COLA that matches the rise in the consumer price index.

Medicaid
Governor Hochul also used her address to announce and detail a new $7.5B Medicaid Waiver program<https://www.governor.ny.gov/news/governor-hochul-announces-groundbreaking-medicaid-1115-waiver-amendment-enhance-new-york> designed to fund new initiatives to address health disparities, advance social care networks, the workforce and the use of value  based contracting. See our preliminary analysis<https://rightsandrecovery.org/e-news-bulletins/2024/01/09/hochul-agreement-reached-on-new-yorks-new-1115-medicaid-waiver-some-details-available/> in yesterday's E News posting.

Criminal Justice
We laud the Governor's intent to lower the number of our people in jails and prisons (20% in all) and by extension, the completely unacceptable preponderance of people of color). Towards those ends, we urge her to make a major commitment to expanding the use of forensic peer support re-entry initiatives and the full enforcement of the HALT law's ban of the use of traumatizing solitary confinement with people with mental health challenges.
We also urge the Administration to fund mental health first responders in this budget rather than to wait another year or two to complete the process of Daniel's Law Task Force<https://omh.ny.gov/omhweb/daniels-law-task-force/>. We already know what works! New York must join cities across the nation including Los Angeles, Denver, San Francisco and New Haven that have implemented alternative to police first responder teams staffed by mental health, peer and EMT personnel.
As a member of the Treatment not Jails Coalition<https://nycds.org/wp-content/uploads/2021/12/Treatment-Not-Jail-Campaign-One-Pager-Dec-2021.pdf>, we commend the Governor's push for increasing the degree of diversion from criminal justice systems through the expansion of mental health courts. Preventing more people from cycling in and out of jails and prisons is a critically important way to reduce the criminalization of mental health, but we must guarantee those who could benefit from this diversion are not forced into guilty pleas to do so.
We also appreciate the use of peer health navigators in the courts to support people to succeed in the community, but not for the purposes of surveillance and coercion to accept services that have failed them in the past.
We know that New York is poised to negotiate a separate Medicaid waiver that can restore benefits to people 90 days before discharge from prisons and jails. This could allow forensic peer supporters to sufficiently develop relationships and discharge and follow up plans that will promote success community transition and reductions in recidivism.
Finally, Governor Hochul will increase access to transitional housing, so individuals have options other than shelter after being released from custody. These units will be served case managers who can provide assistance in obtaining permanent housing, employment, mental health and substance use treatment, and other individualized recovery goals.

Hospital Expansion and Discharge Plans

Last year, the budget added 150 new state hospital beds and has also brought 850 psychiatric beds online in community hospitals. As we've repeatedly pointed out, far too often more hospitals beds result in far more trauma than more recovery and result in countless failed discharge plans and very high rates of recidivism, homelessness and incarceration. The huge costs associated with putting up these beds would be far better redirected to promote a systematic expansion of community-based prevention, crisis support and hospital diversion models, including the use of INSET peer led engagement teams, the 988 crisis line, crisis stabilization, respite and residential programs and living room drop in services.
Nonetheless, the Governor proposes to add 200 more psychiatric inpatient beds:

  *   100 additional state hospital beds, 15 of which will serve children and adolescents
  *   3 additional 25-bed Transition to Home Units (THUs) for people who are experiencing homelessness.
  *   25 new forensic psychiatric inpatient beds
We strongly support Governor Hochul's plan to lower the number of people who fall through the cracks after being discharged from a hospital, with a much greater focus on screening for social determinants of health and the presence of complex conditions. At the same time, we are concerned that the required assessments for violence will press discharge planners to look for violent tendencies that do not exist.
To promote successful discharge plans, we are calling on the Governor to make peer bridgers available in every new unit, who will start and stay involved from admission to discharge and 9+ months thereafter and not to a string of 'warm handoffs' that fail to promote sustained engagement and trust.
Further, all people also must be assured of a place to live regardless of their status via low threshold Housing First beds (OMH has not provided sufficient information about the scope and nature of their implementation) and a place to go, often a clubhouse, recovery center or a job. Just as New York City is making a major investments in expanding clubhouse programs in the borough, OMH must be afforded the funds to bring some of them back upstate, revering a policy whereby the state closed over 30 upstate clubhouse programs in the 2000s.

Community Services
No major increases from last year's major investments in Certified Community Behavioral Health Clinics, Assertive Community Treatment teams, Comprehensive Psychiatric Emergency Programs (CPEPs), Critical Time Intervention, Crisis Stabilization Centers, Safe Options Supports (SOS) and peer led INSET teams and 3,500 units of housing, all of which are coming up at a very swift pace.

Youth Mental Health Initiatives
Governor Hochul proposes a very strong and detailed series of measures to help address the youth mental health crisis, including plans to:

  *   Expand school-based mental health clinics to all willing schools, with continued start-up funding, enhanced reimbursement rates, and enhanced enforcement to ensure all insurers pay adequately for school-based services, regardless of their insurance type or their insurance plan's network.

  *   Increase funding for Teen Mental Health First Aid training programs, which utilize peer ambassadors to engage teens who are disconnected.
  *   Expand the Youth ACT program to ensure teams are available to more youth and families.
  *   Expand access to all-day programs like the Partial Hospitalization model and Children's Day Treatment programs in schools to enable children to stay in their homes, supported by their families and caregivers, while receiving intensive care at school or within community-based treatment settings.
  *   Dedicate funding to Children's Community Residences, with a focus on youth with child welfare involvement, empowering reunification with families, and building networks as youth age into early adulthood.
  *   Expand the Community Mental Health Loan Repayment Program, with slots specifically for clinicians who work in child-serving agencies and treat children and families.
  *   Adopt the Stop Addictive Feeds Exploitation for Kids Act (SAFE for Kids Act), which will require social media companies to restrict addictive features and allow users under 18 to receive a default chronological feed from accounts they already follow.
  *   Develop educational resources, including an evidence-based educational series around digital wellness tailored for caregivers, and others covering topics such as the risks of social media use, understanding privacy and protecting personal information, and reporting cyberbullying and online abuse and exploitation.
  *   Establish a Youth Advisory Board at OMH to ensure youth-informed best practices continue to be incorporated in developing behavioral health programs and policies.
  *   Support providers participating in the state's Early Intervention program for children and toddlers with disabilities, and Department of Health-licensed providers and private practitioners treating children's mental health needs.
  *   Create a new and streamlined designation process for Children and Family Treatment and Support Services to make it easier for more providers to provide these critical mental health services for children.
  *   Increase support for DOH-licensed facilities and private practices treating mental health conditions and expand coverage for Adverse Childhood Experiences Screening to all adults enrolled in Medicaid.
  *   Double the number of Infant Toddler Mental Health Consultants located throughout the state at seven regional infant and toddler resource centers.
Increasing Insurance Coverage and Parity for Mental Health Services
We are very grateful for the Governor's actions to require commercial health policies to reimburse mental health and substance use disorder services at the same rate as Medicaid reimbursement. She would also strengthen mental health parity and address mental health provider network adequacy issues. She also will provide clarity on free mental health screenings and allow entities not governed by the Office of Mental Health to be reimbursed at the same level as OMH-governed entities for the same services.
Here are more details:

  *   Fund additional staff to bring enforcement actions and introduce legislation to double fines for insurers for noncompliance with parity requirements.
  *   Pursue legislation to require adequate reimbursement from commercial plans for OMH- and OASAS-licensed outpatient services at least at the Medicaid rate for comparable services.
  *   Promulgate network adequacy regulations for both commercial and Medicaid insurers to set standards to access mental health and substance use disorder services, including appointment wait times, and require them to provide out-of-network coverage at no additional cost if they cannot provide appointments within a specific number of days.
  *   Issue guidance to ensure plans cover mental health, primary care, substance use disorder screenings, and integrated settings without cost.
  *   Increase support for mental health services at Article 28 facilities and private practices.
  *   OMH will consult with the Departments of Health and Financial Services to issue new guidance to ensure commercial insurers update medical necessity criteria to incorporate the newest version of the Standards of Care for the Health of Transgender and Gender Diverse People into their plans.
2024 Olmstead Plan for New Yorkers with Disabilities
"In 2024, New York's Most Integrated Setting Coordinating Council will issue an Olmstead plan to ensure that all people with disabilities receive services in the most integrated setting appropriate to their needs. Under the direction of the Office of the Chief Disability Officer and its new Olmstead director, and following community outreach, this plan will include people with physical, sensory, developmental and/or intellectual, mental and behavioral disabilities."
An appropriate Olmstead Plan includes a detailed commitment of annual actions and investments that New York will make to see that New Yorkers with disabilities live and work in the most integrated setting, in keeping with the Americans with Disabilities Act. I've served on the state's Most Integrated Setting Coordinating Council since its start in 2002 and this long overdue action will result in the first Plan revision since 2013.

Improve Maternal Mental Health
Expand Mental Health Screenings: To better identify and treat mental health conditions in pregnancy and throughout the postpartum period, the Department of Health, in consultation with the Office of Mental Health, will increase access to comprehensive mental health screening tools.
Strengthen 988 Counseling for Pregnant New Yorkers and New Parents: The Office of Mental Health will create a specialized training for 988 providers related to maternal mental health issues, increasing overall acumen and competence in triaging this population.
Train Providers to Recognize and Treat Mental Health Conditions: TEACH Maternal Mental Health offers training to general psychiatrists who may ot have expertise in maternal mental health to increase treatment efficacy. Funding will e provided to expand Project TEACH Maternal Mental Health to include therapists, lactation consultants, WIC staff, home visiting nurses, and other frontline practitioners working with pregnant and postpartum New Yorkers. This will provide a warmline for anyone working with a perinatal individual to access expert consultation and get mental health support.
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