NYS Council Budget and Legislative Priorities

The NYS Council represents 100 community-based addiction and mental health prevention, treatment, and recovery provider organizations in local communities across New York.  Our members include non-profit freestanding organizations, counties that operate direct services, and the behavioral health divisions of general hospitals.

During the COVID-19 emergency, the number of New Yorkers seeking assistance for their mental health and/or substance use disorder challenges has skyrocketed. The NYS Disaster Distress Hotline, which provides crisis counseling and support to anyone experiencing emotional distress related to a disaster, was up 697% from June 2019 to June 2020. Drug overdose deaths in NYC increased by nearly 28% during the first quarter of 2020, according to NYS Department of Health data.

From January through March 2021, there were 440 overdose deaths, 41 more than the previous highest quarter, which was at the end of 2019. The number of deaths was up nearly 127%, compared with the first quarter of 2015 (Source: Crain’s), during the COVID-19 emergency period.

A statewide impact survey revealed the precarious financial condition of behavioral health agencies, with less than adequate cash on hand and increased COVID -19 related expenses for providers who have played a vital role since the onset of the pandemic.

  • 25% of the respondents have one month or less of cash on hand, 45% have two months or less of cash on hand, and 65% have three months or less of cash on hand;
  • On average, mental health and substance use agencies reported losing nearly one half million dollars in revenue since the pandemic; and
  • On average, providers had increased expenses of nearly $300,000 for the additional purchase of PPE, air filtration, and other supplies to increase the safety of the staff and individuals served during COVID-19.

Cuts to services will further jeopardize access to care which will lead to increased health disparities and continued access issues within our system.  Unfortunately, the upward trajectory of behavioral health issues is at an all-time high.

  • According to a recent CDC study, over one third of New Yorkers experienced depression or anxiety from April-July 2020. Across the US, 13% of individuals started or increased substance use, and 11% stated they had considered suicide in the last 30 days.
  • Drug deaths have risen an average of 13% this year compared to last year, according to mortality data from local and state governments collected by The New York Times.
  • Black individuals are twice as likely to be diagnosed with a serious mental illness (SMI) than their white counterparts and, along with people with SMI, are overrepresented in the criminal justice system. (Source: JAMA Psychiatry, July 2020).
  • The CDC has found that the proportion of children’s mental health-related ED visits among all pediatric ED visits in 2020 increased and remained elevated.

Many children have struggled throughout this pandemic with some facing the loss of a parent or loved one.  Even prior to the pandemic, there was a behavioral health crisis among children, with suicide the second leading cause of death among children age 15-19 and the third cause among children 5-14.  The ongoing lack of funding and severe workforce shortages have led to increased consumer costs, long waiting lists, and a backlog of children unable to access care.  Any cuts to programs and services will further exacerbate this.

Before we discuss our specific requests, let’s look at some of the funding that has already come in to NYS or that is expected to come in shortly:

TRACKING THE MONEY

Recent Federal Funding to NYS

  • 2020 -2021 Federal COVID-19 Relief to NYS (already received) à $27 billion
  • Increased FMAP: Medicaid eFMAP for January 2021 thru June 2021 (SFY 2021) à $497 million
  • SFY 2022 – eFMAP -à $995 million (Source: Citizen’s Budget Commission)

(*eFMAP = Enhanced FMAP (Continues as long as federal PHE declaration is in place)

FFY 2021 Federal Budget Deal (includes COVID Relief) included:

  • ADDITIONAL $1.65 billion (beyond base SAMHSA appropriation) for the Substance Abuse and Prevention Treatment Block Grant for all  states of which 50% must go to providers (From what we can see, NYS Executive budget proposal does not appropriate portion of additional funds for NYS)
  • ADDITIONAL $1.65 billion (beyond base SAMHSA appropriation) for the Community Mental Health Services Block Grant of which 50% must go to providers (From what we can see the NYS Executive budget proposal does not appropriate portion of additional funds for NYS)
  • $600 million for Certified Community Behavioral Health Clinics (CCBHCs)
  • $50 million for suicide prevention programs
  • $50 million for Project AWARE to support school-based mental health for children
  • $240 million for SAMHSA Emergency Grants to States
  • $10 million for the National Child Traumatic Stress Network
  • (Source:  National Council for Behavioral Health)

MH/SUD ‘Savings’ in Proposed FY ‘22 NYS Executive Budget Proposal

  • $30 million notwithstanding Reinvestment
  1. MH Bed Closures (200) – $22 million
  2. Rockland Psych Center Closure – $8 million
  • PERMANENT 5% Across the Board State Aid Reduction to MH Providers – $17.1 million
  • 1% Human Services COLA (deferred)

Anticipated New Revenue as discussed in Executive Budget Proposal

  • Legalization of Adult Use Recreational Cannabis:  $20 million for SFY 2022    When the market is fully mature, sales are expected to generate approximately $300 million in annual State tax revenue. (Source: CBC)
  • Mobile Sports Wagering Authorization: $49 million for SFY 2022. Enactment is projected to yield up to $500 million annually by fiscal year 2025. (Source: CBC)
  • SAMHSA Federal Block Grant increases to NYS associated with December 2020 Omnibus Federal Budget Deal/ & COVID Relief Package:

SAPT Federal Block Grant

Community Tx and Supports:    FY 21 = 82M       FY 22 = 153.15M

Prevention & Support:               FY 21 = 33M       FY 22 = 61.6M

Opioid Crisis Grants:                 FY 21 = 30M       FY 22= 30M

CMHS Block Grant

  •  Adult                                   FY 21 = 35.5        FY 22 = 73.1M
  •  Children & Families:           FY 21 = 7.5          FY 22 = 16.9

*In February 2021, the House passed a COVID Relief Package (in response to Biden American Relief Plan) that includes $3.5B for the SAPT block grant and the CMHS Block Grant. ($2.75B for each) across all states.  Senate is debating their bill (as of 3/4/2021).

Revenue from Settlements / Mandatory Taxes

  • McKinsey Opioid Settlement $600 million, approximately $32 million to NYS
  • Larger (anticipated) multi-state settlement targeting manufacturers and distributors of opioid and other drugs.
  • $34M – Opioid Excise Tax

Proposed or Existing Fund Accounts Under DOB and/or NYS Comptrollers Control

$245 million currently in Statewide Healthcare Transformation Account Fund that contains new funds for NYS associated with health plan business  transactions where a merger, consolidation or similar transaction results in new funds coming in to New York.  NYS Council continues to lead a broad coalition of associations representing community-based organizations from across the healthcare continuum of care.  We request a 25% set aside from all future disbursements from this account for community-based organizations (S.2531-Rivera/ A.264-Gottfried), and that the language for the set aside be included in Senate and Assembly one-house bills.

  • Thirty-day Executive Budget Amendment documents include a proposal in the PPEG Article VII language (Part UU) to establish a new account, the COVID 19 Extraordinary Relief Fund that would be funded with any revenues obtained via new tax proposals, as well as additional funds from existing tax proposals, and revenues enacted in the coming state budget agreement. Control would be vested between DOB and Office of the State Comptroller with legislative input.  The NYS Council opposes the establishment of such an account that, without the proper legislative checks and balances, could result in an unequal distribution of the funds.
  • NOTE:  On December 16, 2020, the Governor publicly announced the availability of $1.5 billion in funds, to be made available to New York‘s ‘agencies and organizations’ (after the state had withheld legislated funds for most of the year).  These agencies were to receive a portion of the $1.5 billion advance to “stay afloat” through the first quarter of 2021, according to Budget Division spokesman Freeman Klopott.  To date, no further information has been made available to mental health and/or substance use disorder agencies that have been devastated by the ongoing COVID crisis and who could certain benefit from access to these funds.


NYS COUNCIL “ASKS” IN RESPONSE TO FY22 EXECUTIVE BUDGET PROPOSALS


RESTORE STATE AID REDUCTIONS IMPLEMENTED IN 2020-2021, AND REJECT PROPOSALS TO IMPLEMENT FUTURE (PERMANENT) STATE AID CUTS

  • To avert program closures and accompanying reductions in service availability, the State must immediately provide full funding for mental health and addiction services and restore the 5% across the board (ATB) cut imposed during the 2020-2021 fiscal year, as well as any / all proposals for temporary or permanent state aid reductions in the Governor’s FY2022 executive budget proposal.
  • The 20% withhold, reduced to 5% Q1 2021, that has already negatively impacted both mental health and substance use disorder non-residential providers, as well as the proposed SFY 2022 5% cut on OMH non-residential programs for adults and children, should be rejected.

Cuts of this magnitude will devastate state funded behavioral health services that are the last resort for low-income individuals with disabilities and communities of color, who already face disproportionately high rates of poverty, food insecurity, housing and employment discrimination and criminalization well before the spread of the pandemic.

REJECT PROPOSALS TO “NOT WITHSTAND” COMMUNITY REINVESTMENT POLICIES / DIVERT BEHAVIORAL HEALTH SYSTEM RESOURCES

PROPOSED STATE PSYCHIATRIC CENTER BED CLOSURES/LOCATION CHANGES

  • The SFY 2022 Executive Budget proposes that $22 million in savings from proposed state psychiatric center bed closures be returned to the general fund, rather than returning savings to the community mental health system of care. We urge all lawmakers to oppose language in the executive budget proposal that would “notwithstand” or “freeze” prior commitments made by the state via the Community Reinvestment Act.
  • The SFY 2022 executive budget proposal recommends closing 8 beds at the Rockland Children’s Psychiatric Center, take savings from the proposal, and re-locate the beds in the Bronx.
  • Although no savings is attached to the proposal, the Governor has included language in his proposal that would implement a new Office, the Office of Addiction and Mental Health Services.  The proposal seeks to re-align the existing OASAS and the OMH.  While there is no fiscal associated with the first year of this multi-year effort, we would expect any and all savings (anticipated or otherwise) to be returned to the impacted systems of care.

 STABILIZE MENTAL HEALTH AND ADDICTION PREVENTION, TREATMENT AND RECOVERY ORGANIZATIONS

CHILDREN’S MENTAL HEALTH SERVICES

Over the years New York’s Children’s Mental Health system has not received the resources it needs to remain intact let alone to make the very significant transitions that are required to bring the pieces of the system together, to be the effective system of care our children and youth deserve.  There are fires burning everywhere.

The NYS Council supports a systemwide moratorium on any/all cuts to children’s programs and services.  In addition, we support smart investments to stabilize the continuum of care at a moment in time when the need has never been greater access to timely care more critical.  The NYS Council supports adding CFTSS services to the CHIP benefit, and bills introduced by Assemblyman Gottfried that would change the enabling language for CHIP to include EPSTD services (A 303 and A343)

SUPPORT (WITH CONCERN) EXECUTIVE BUDGET PROPOSAL ON TELEHEALTH

CONCERN:  The Governor’s executive budget proposal includes projected savings of $39.5 million in FY 2022 associated with implementation of this proposal.

Behavioral health advocates support the SFY 2022 Executive proposals to streamline the continued implementation of New York’s telehealth program, to include making permanent certain COVID-19 reforms to expand telehealth access.  We support the creation of interstate licensure, allowing an individual to receive telehealth services wherever they are located (subject to Federal approval) and authorizing Peers and CASACs to help deliver care through telehealth in OASAS settings.  However, the language falls short in the following areas:

  • Telehealth Rate Parity: “Audio only” and audio-video services must be reimbursed on par with face-to-face telehealth services. Providers continue to make significant investments in telehealth infrastructure, training, etc. and face ongoing costs in this area, including software and hardware. Rates must remain equal to in-person services to ensure continued availability of telehealth.
  • Include All Peers and Family Support Staff:  All peers who are eligible to be reimbursed for in-person service must be eligible for telehealth.  Peers are a proven part of treatment and recovery and should not be treated as a separate service that requires different regulations. All OMH and OASAS peers should be included in telehealth.

SUPPORT EXECUTIVE BUDGET MINIMUM WAGE PROPOSAL

SFY 2022 Executive budget includes funding to leverage $38.5 million to support minimum wage increases in OMH, OASAS, and OPWDD staff at non-profits. The current Executive budget proposal defers a desperately needed COLA that was scheduled to be implemented over the coming budget year.  Our workforce is a core part of the essential worker frontline staff that ensured lifesaving mental health and addictions care would be available throughout the pandemic, and it continues to do so.  At the very least, the behavioral health workforce deserves a minimum wage increase and providers should not be responsible for paying for it.  At least 80% of our workforce is women, and more than half are women of color.  At this point, at least 60% are living at or near poverty line (Source: 3for5 So Communities Thrive Campaign, February 2020). Behavioral health advocates restore the COLA and to (at the very least) support minimum wage increases paid for by the state and federal government.

REJECT DEFERRAL OF THE 1% COLA FOR THE HUMAN SERVICES WORKFORCE

  • Last year, the #3for5 campaign had hundreds of members statewide working with legislators to show how underpaid the not‐for‐profit sector is for their life saving work. This message continues this year as we acknowledge and support the great work of our direct care workers during COVID. They have been celebrated and praised for their work, but unfortunately, have not gotten what is most needed – additional pay increases. While we are appreciative that the State continues to support the increases in minimum wage, the State’s deferral of the COLA is the wrong message at the wrong time.

SUPPORT OUR WORKFORCE:  LOAN FORGIVENESS

  • A survey in 2017 revealed that between 35-40% of our direct care staff (those who work directly with care recipients) leave their jobs on an annual basis. Many are saddled with remarkable amounts of debt from educational loans sought to advance their careers.  But there is no career ladder to speak of in our organizations.  Staff can earn more working at a fast food company.  Given the magnitude of the debt our staff are burdened with (along with a host of other economic and social factors that marginalize them), and despite being motivated to work in and for our agencies, our valued staff cannot afford to stay with us.  We must support our workforce via loan forgiveness programs for our credentialed staff as well as those who want to go back to school to earn their degrees and specialize in mental health and substance use disorder care.

RAISE REVENUE RESPONSIBLY
It is imperative that revenue is raised responsibly by enacting proposals that are: well thought out, have as  top-priority the public health consequences associated with the proposals, and that address unintended consequences associated with implementation of these new initiatives to include additional prevention, recovery, and treatment resources.

EXECUTIVE BUDGET PROPOSAL:  ADULT USE MARIJUANA

The Creation of an Adult-Use Cannabis Program should only be enacted in the final budget if substantial revenue is dedicated to education, prevention, intervention, treatment, and harm reduction programs. This set-aside, as described in A1248/S854, should be equal to 25% of the revenue from the adult-use program and should be in a fund that is separate from the general fund.

Resources should be invested to moderate and/or mitigate the damages resulting from this new Law to include:

  • Impact to minors
  • Impact on pregnant and parenting women
  • Consequences associated with increased incidence and higher acuity of comorbid conditions (mental health physical health) due to increased availability and consumption
  • Increased rates of and consequences associated with impaired driving

ENSURE OPIOID SETTLEMENT FUNDS ARE DISTRIBUTED TO SYSTEMS OF CARE THAT ARE RESPONSIBLE FOR PROVIDING SERVICES TO IMPACTED NEW YORKERS

  • Lawmakers must ensure that funds from various settlements are set aside in a ‘lockbox’ that cannot be used for purposes other than for enhancing prevention, treatment, recovery and harm reduction services across the behavioral health system of care
  • Lawmakers must focus and study the short, medium and long-term impacts of the Opioid Epidemic to include the needs of families and children whose lives have been devastated as result of the Epidemic
  • Focus should be on amelioration, remediation and future resources required to eliminate the conditions that have led to the Epidemic
  • Significant resources should be invested in effective and powerful outreach and public education campaigns that are proven to change public perceptions and heighten awareness