January 26, 2025

1)  Attached please find a chart prepared by the National Council for Non-Profits that tracks all of the Executive Orders issued by the new (Trump) administration.  
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2)  Announcement from MRT Listserv, Friday, 1/24:Subject: FW: New York State Department of Health Launches State Medicaid Health Equity Regional Organization (HERO) Initiative

The New York State Department of Health has announced launch of the State Medicaid Health Equity Regional Organization (HERO), a core initiative under New York’s current 1115 waiver amendment, approved by the Centers for Medicare & Medicaid Services (CMS) in 2024. Establishing a HERO is part of the waiver amendment’s multi-pronged approach to strengthen the integration of social services and health care delivery. 

United Hospital Fund (UHF) will coordinate HERO strategies with the goal to functionally bridge public health, social services and health care delivery. UHF will collaborate with the New York State Medicaid Program, healthcare providers, community stakeholders, and academic partners to understand effective regionally focused approaches to addressing the social needs of Medicaid beneficiaries, such as food insecurity, housing instability, and lack of transportation.

The full press release can be found at the following link: New York State Department of Health Launches State Medicaid Health Equity Regional Organization (HERO) Initiative. More information about New York’s current Health Equity Reform waiver amendment can be found under the MRT 1115 Waiver Amendments tab here. 

 Thank you.  

Medicaid Redesign Team (MRT) Updates

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3) House GOP leaders are passing around a more extensive list of ideas to cover the cost of a massive tax cut to the wealthiest Americans. (See attached document that is described by the NY Times as a “menu of options” to achieve the offsets necessary to fund Trump’s agenda.) 

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3)  ATTACHED please find a joint statement issued by 11 statewide associations and coalitions who are working together to deliver a significant investment of financial resources for mental health and substance use disorder providers to help them address critical workforce shortages and ever increasing costs associated with operating these essential programs and services.  More to follow.
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Robert F. Kennedy Jr. and the Treatment of Drug Addiction

Sally Satel, Jan 15, 2025, REAL Clear Health, Opinion section

If Robert F. Kennedy Jr. is confirmed as the next secretary of the Department of Health and Human Services, and if he carries out even part of his agenda, he will be a consequential — and controversial — cabinet secretary. I am concerned about some of his stances, including his record of objecting to vaccines, but in other areas, starting with addiction, his vision and values could transform lives.

As the medical director of a methadone clinic in Washington, D.C., I have a vested interest in Kennedy’s policy suggestions; so does the nominee himself. His own heroin addiction began when he was a teenager, following his father’s assassination, and ended in his arrest at age 29. He was given two years’ probation for felony possession and spent time in rehab. He has regularly attended 12-step meetings since.

Over the course of last year, Kennedy laid out, in speeches, interviews, and a documentary released last June called Recovering America, a heartfelt though incomplete agenda for managing the drug crisis. Here’s my analysis of his plans.

Tough love

At the premiere of Recovering America, Kennedy summarized his approach: “The government has a role in actually pressuring the addict, to say, ‘We’re not going to tolerate you on the street anymore,’ to do tough love… We’re going to clean up your neighborhood… and if we can’t talk you into helping yourself, you are going to prison, you’re going to jail, until you choose some other option.”

Like Kennedy, I favor benign paternalism when addicts are in a dire clinical state or when public order is jeopardized. Addiction and the criminal justice system are closely intertwined — people seeking and using illegal drugs often commit theft and violate public nuisance laws. These crimes warrant a societal response.

In Recovering America, Kennedy endorses the essential practice of diversion – alternatives to jail that send individuals to drug treatment programs. In the nation’s 4,000 drug courts, a type of diversionary program, judges mandate a form of treatment for a period of one to two years while the addicted offender is closely supervised, including via routine urine testing, and his progress monitored.

If someone in a drug court program violates its rules, swift and decisive, but not severe, penalties are imposed — such as brief incarceration. Once participants complete their program, their criminal record is expunged — a major incentive to participate. Studies show that this approach — call it “tough love” if you like — reduces substance use and recidivism.

Wellness Farms

The “other option” Kennedy favors consists of rural therapeutic communities, or “wellness farms,” which would be funded by two sources: revenue from work done on these farms, and federal taxes from the legal sale of marijuana “that is designated specifically for drug treatment and rehabilitation.”

In these communal, pastoral settings, recovering addicts live for several years, learn marketable skills, perform vigorous physical work, and participate in a self-sustaining community with its own gardens, livestock, and small businesses. “Ultimately,” Kennedy said, “recovery is through community. It’s the only road to recovery.”

At the Other Side Academy, a wellness farm in Colorado featured in the documentary, 45 percent of its residents are still there after two and a half years, and the re-arrest rate among those with a criminal past is just 14 percent. By graduation, everyone has a job. Four in five who elect to stay a full three years are drug-free, crime-free, and employed six years after graduation.

A review of 23 studies of therapeutic communities found that while participants benefit — for example, they consume fewer drugs, experience less depression, and are more likely to be employed — these outcomes are comparable to other, less expensive outpatient approaches.

In my experience, such programs can almost always be strengthened by allowing patients to take medications for addiction, such as methadone or buprenorphine. Many programs do not allow this. Treatment of psychiatric conditions (this often means arranging for a visit with a psychiatrist) while in care and assisting patients to transition directly to housing and support services after graduation would also be important.

Still, I am drawn to the idea of the immersive rehabilitation experience. Some people simply need physical containment in an environment insulated from ambient drugs to help them break the cycle. All the better when places like The Other Side Academy are free to participants and the taxpayers.

A Bad Medicaid Rule

The vast majority of substance abuse treatment, including long-term residential care, is financed by federal, state, and local government. But because of a misguided bureaucratic rule, residential treatment facilities cannot accept Medicaid payments unless they have 16 or fewer beds.

This crippling limitation is called the Institutions for Mental Diseases Exclusion. It was put in place in 1965 as part of the original Medicaid law, which was passed during an era of swift deinstitutionalization. This movement had been accelerated by RFK’s well-meaning uncle President John F. Kennedy to prevent warehousing people with severe mental illness.

In Recovering America, Kennedy mentions lifting the IMD exclusion. Successfully convincing Congress to do so would make him a hero. Advocates and experts have tirelessly lobbied lawmakers to repeal the provision. Repeal would open much-needed treatment beds to people who are severely addicted or have serious mental illnesses that make them dangerous to themselves and others.

FDA-approved Medication

Kennedy has been quiet on methadone, a 60-year-old mainstay medication that reduces overdose death by about half. It is no “cure.” Rather it suppresses opioid withdrawal and reduces craving so that the patient can begin the arduous work of recovery.

Similarly unclear is Kennedy’s attitude toward buprenorphine, usually sold as Suboxone. Drew Pinsky, a physician and addiction specialist with whom Kennedy is close, is a vocal buprenorphine skeptic, citing the difficulty of weaning off of it after months or years. (A legitimate point, but buprenorphine remains valuable to many.)

Attempts to discourage the use of these medications or interfere with their availability would be a disaster. For a sizable percentage of people addicted to opioids, the medication-free model can increase the risk of overdose, possibly even more than receiving no treatment at all.

Conclusion

In Kennedy’s eyes, addiction is a human drama, an attempt to manage existential pain of some kind: “Addicts have a unique opportunity for redemption because they have been to hell,” he said in an interview. I embrace a version of this view. But policymakers should also know that the current gold-standard medications for addiction, as well as psychological interventions, such as cognitive behavioral therapy, can be invaluable.

People who have recovered from addiction often have a fierce commitment to helping fellow addicts. But they can be too attached to the methods by which they themselves achieved sobriety. At a press conference, Kennedy spoke of getting “addicts into all the different forms of treatment that are now available.” I am hopeful, then, that he will use his power to fortify the existing array of clinically proven interventions and support high-quality investigations into new approaches.

Sally Satel is a psychiatrist and senior fellow at the American Enterprise Institute. This is a condensed version of her article in The Free Press that also discussed GLP-1 receptor agonists, cannabis, and psychedelics.

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4) See the Press Release (below).  I was struck by the Governor’s response to the interviewer challenging her on the topic of on-the-ground workforce needs as the Governor continues to highlight her child care budget proposal. See the yellow highlighted area (below).  

AUDIO & RUSH TRANSCRIPT: GOVERNOR HOCHUL IS A GUEST ON SPECTRUM NEWS’ ‘CAPITAL TONIGHT’ WITH SUSAN ARBETTER

Governor Hochul: “I’m putting money back in people’s pockets — over $5,000 if you have three little kids, and it helps cover the cost of school lunches and breakfast, which is universal. We’ll have that in my Budget as well as covering the costs of everything. You know, the child care, helping with the middle class tax cut and the inflation rebate that acknowledges that families are paying 19, 20 percent more for everything — little kid sneakers, and backpacks and all the things they need to raise a child that I know more than most”

Hochul: “Your family is my fight. And when I said that during my State of the State, I was sincere in whatever I can do to understand your struggles, help lift them a little bit — with direct money over $5,000 under the plan I put forth, but also just all the different ways we can just reduce the stress in your lives, because I’m a mom, I’m a fairly new grandmother and I see the stress that my kids are under in raising the little ones, and it’s hard out there, and I want them to know I understand it more than any Governor in the State of New York ever has.”

Earlier today, Governor Kathy Hochul was a guest on “Capital Tonight” with Susan Arbetter on Spectrum News. The Governor discussed the 2026 Executive Budget, expanding access to affordable child care, restricting smartphones in schools statewide, addressing the housing shortage and more.

AUDIO: The Governor’s remarks are available in audio form here.

A rush transcript of the Governor’s remarks is available below:

Susan Arbetter, Spectrum News: First of all, thank you so much for sitting down with us, we really appreciate it.

Governor Hochul: Glad to be back on the show, Susan.

Susan Arbetter, Spectrum News: So, the Child Care Availability Tax Force has been meeting for about seven years, and in December, they released a series of recommendations and you accommodate one of those recommendations in your Executive Budget — at least one — the child care tax credit, and that’s going to help a lot of families. There is a recommendation that is not included in your Executive Budget, and that is investment in the child care workforce. It doesn’t contain a temporary workforce grant in the last two Budgets that you included. Why did you opt not to follow this particular recommendation of the task force?

Governor Hochul: We’re looking at it holistically. First of all, I do also want to get to universal child care — that is the goal, and we would be nation-leading that approach, recognizing that all of our families need help so that moms and dads can get to work, and children are in good environments like where we are here today. So, you have to look at it over a series of years.

The other thing I have to do before we build up the workforce even more is to make sure we have brick and mortar facilities. I put $110 million dollars into building and renovating buildings so we can accommodate this, and then we’ll be able to — when we get to universal childcare — we will have much more demand for workers. So, workers are important. We’ve increased wages over a number of years. We have worked to try and encourage more people to go into this profession, but they’re absolutely right that there has to be this element of a place to take care of the children — tax credits for families, $1,000 for a child under the age of four.

Up until I became Governor, that number was zero. And so, I focused hard on giving money to families, knowing that their biggest cost is child care; $21,000 a year for average families — that’s impossible for a lot of struggling parents.

Susan Arbetter, Spectrum News: Because of the low salaries, there are people on the task force who are very worried that the expansion of the access to child care is being threatened — sort of low salaries equal not enough child care. And you mentioned the $110 million for the housing and Child Care Availability Task Force went around and spoke to a lot of child care providers in the State. And one of the people said, “I worry that building more child care centers without the fiscal support for the workforce and operations is going to result in empty buildings.”

Governor Hochul: You need to build capacity first — think about the logic behind what we’re doing. We want to ultimately have so there’s not a single child in the State of New York who does not have available to them high quality, accessible child care. I have to have places to put these children. You put those in first, and meanwhile, you can be developing the workforce to fully take time to build.

So it’s part of a continuum of how we’re taking an approach that many other states are not leaning into. I have put more money, $7 billion toward child care — my very first Budget just a few years ago — because as a mom who had to give up her job because there was no child care when I needed it a long time ago, I understand this personally.

So we’re doing everything we can — and more than other states are doing — to address this crisis for families.

Susan Arbetter, Spectrum News: Is there going to be– are you open to putting some permanent child care workforce supports in the Budget?

Governor Hochul: We’ll continue talking about this. Again, there’s no one right answer. It’s a holistic approach to it, and I’m proud that we’ve leaned into this, and no one can question my commitment to making sure we have affordable, accessible child care in the State of New York.

Susan Arbetter, Spectrum News: There are a bunch of rules around child care that the folks at the Child Care Availability Task Force want to change. Some of those rules were in bills that you vetoed in December — rules that would help parents who, for example, are in the gig economy. And you said that these have a budget — they have a fiscal implication, so you wanted to do them within the Budget. They’re not in your Executive Budget.

Governor Hochul: Well, this is also something I hope the legislators understand. When they pass legislation outside the Budget that has a fiscal or, in simple words, it’s going to cost money — how do you expect me to do that outside the Budget? So, it’s truly a waste of time for them to do this. And they also have their one-houses — it’s an opportunity for each house to present it, and then the negotiations start.

Our Budget is my vision, but it also ultimately does change by the end of the process as we weigh in the different interests and work with our leaders. So, we’re in that process now. Absolutely right.

Susan Arbetter, Spectrum News: Yeah. At what point would you ever consider, for example, a tax to raise a tax for child care? Vermont did this with its payroll tax recently. Is that on the horizon at all?

Governor Hochul: I’ve said I’m not interested in raising income taxes, because we are a high-tax State, I recognize that. And I have been cutting taxes, and we have the largest middle class tax cut in about 70 years, is what I’m proposing — the tax rate will go down.

And I’m putting money back in people’s pockets — over $5,000 if you have three little kids, and it helps cover the cost of school lunches and breakfast, which is universal. We’ll have that in my Budget as well as covering the costs of everything. You know, the child care, helping with the middle class tax cut and the inflation rebate that acknowledges that families are paying 19, 20 percent more for everything — little kid sneakers, and backpacks and all the things they need to raise a child that I know more than most.

So, we’re trying to help them by giving them $500 back for their families. So, we’re looking at everything holistically.

Susan Arbetter, Spectrum News: Your Executive Budget proposes to create something called the New York Coalition for Child Care, and it seems like — and you correct me if I’m wrong — it seems like the goal is to identify a sustainable funding stream to implement universal child care, just like you said. Is that accurate?

Governor Hochul: Yes, so that’s why I wanted to bring together all the voice in this, and the business community has an important role to play. Let’s look at the Micron example — Micron is a huge win for us. Other states fought hard to win 15,000 jobs that will be happening in Syracuse underway already. But when we spoke to them about getting State support with our Green CHIPS bill, which gave them assistance to build semiconductors here, I said I also want child care — I want to make sure that we have an opportunity for more women to go into these high-paying tech jobs.

I want to have communities of color represented, but they’re struggling. So they literally, literally right now, are building an on site child care center. This, to me, is the model, and that’s why we’re talking about what the commitment of the business community is, because this is great for families, but it’s also great for your workforce. Your employees will not have to worry about childcare if it’s on site or in a little community like a downtown where my mom started a business — that there could be one storefront where people can drop their kids off and all the local businesses participate and contribute to that.

So, it’s not something that can just be on the shoulders of government or families alone. That’s why this task force is going to convene all the stakeholders and chart the path forward.