March 13, 2025
STATE BUDGET
Note on recently released Assembly and Senate one-house budget bills and specifically regarding the (proposed) Targeted Inflationary Increase (TII) (some are still calling it a COLA) for Human Services:
- Governor proposed 2.1% TII in her executive budget proposal with no bifurcation as to how eligible agencies can use the funds
- The Senate proposed a 7.8% increase in funding, and earmarks over half of the increase to be used for wage enhancements. Specifically, the Senate would expand the reach of the COLA to include the following state agencies: OCFA, OMH, OASAS, OPWDD, OTDA, and NYSOFA, and 3.8% may be used for any inflation related costs deemed necessary by the provider (similar to the Governor’s proposal, but more funding), while 4% is specifically set aside to increase direct care workers’ wages. Note: According to the Senate this does not mean workers will receive a 4% salary increase, but that over half of the proposed increase in funding must be used specifically for wage enhancements.
- The Assembly one-house bill also proposes a 7.8% increase in funding with no strings that we can see.
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Federal Advocacy
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Breaking News re: probationary federal workers (Note: My thought here is to share this information with you as you may be working to recruit and hire federal workers, or they may be coming to you in your local communities – one can hope!)
(Politico, 3/13/25) – A federal judge on Thursday ordered federal agencies to reinstate tens of thousands of probationary employees who were fired amid President Donald Trump’s turbulent effort to drastically shrink the federal bureaucracy.
U.S. District Judge William Alsup described the mass firings as a “sham” strategy by the government’s central human resources office to sidestep legal requirements for reducing the federal workforce.
Alsup, a San Francisco-based appointee of President Bill Clinton, ordered the Departments of Defense, Treasury, Energy, Agriculture and Veterans Affairs to “immediately” offer all fired probationary employees their jobs back. The Office of Personnel Management, the judge said, had made an “unlawful” decision to terminate them.
The order is one of the most far-reaching rejections of the Trump administration’s effort to slash the bureaucracy and is almost certain to be appealed.
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OMH RFP
The New York State Office of Mental Health is pleased to announce the release of the Adult Forensic ACT and Treatment Apartment Program Request for Proposals.
OMH is committed to investing in community-based services through the development of a specialized Forensic Assertive Community Treatment team, joined with the Treatment Apartment Program.
Through this funding opportunity the awarded agency will develop one 68-capacity FACT team and one TAP with 30 units in New York City to better meet the mental health and housing needs of the SMI population involved in the criminal justice system.
The Adult Forensic ACT and Treatment Apartment RFP can be found on the OMH website under https://omh.ny.gov/omhweb/rfp/2025/fact-and-tap/index.html
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OMH RFP
The New York State Office of Mental Health has issued a request for proposals for Transitional Housing for Individuals who are Justice Involved. This community-based housing will support individuals with a serious mental illness who are currently involved in the criminal justice system, pending release, or recently released from incarceration, or subject to community supervision. Based on the need for additional treatment apartment housing opportunities for this population OMH will award funding for the development and operation of up to 10 transitional treatment apartment housing programs throughout New York State. In addition to a mental illness, individuals may also have a substance use disorder, physical health care needs, or a combination of all three.
The entire RFP can be found on the OMH website.
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Governor Hochul Announces Awards for ‘Step-Down’ Programs for Hospitalized New Yorkers Living With Mental Illness and Developmental Disabilities
Governor Kathy Hochul on Tuesday announced awards to establish five ‘step-down’ programs to help adults living with co-occurring mental illness and intellectual or developmental disabilities safely transition back into their community following care within an inpatient setting. Administered by the State Office of Mental Health, the $85 million in conditional funding over five years will help service providers develop enhanced ‘step-down’ programs that couple critical time intervention teams with transitional housing to ensure these individuals can live in independent settings once they are discharged from a hospital or other inpatient settings. The providers in New York City and Long Island will receive $2.1 million in operating funding and $652,216 state aid annually over five years to run the programs. The providers from the Western New York, Central New York and Hudson River Valley regions will receive awards of up to $1.9 million in operating funding and $604,042 in state aid annually over five years. Read more here.
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RESOURCE
From the Center for Health Care Strategies:
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RESOURCE
Protecting Youth Mental Health: The Role of Families in Addressing Social Media’s Impact on Self-Harm and Suicide
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Social media can serve as a platform for self-expression and connection, but excessive or problematic use has been linked to increased anxiety, depression, and suicidality in adolescents, as seen in Emma’s story. Families play a critical role in mitigating these risks by fostering open communication, setting healthy boundaries, and seeking professional help when necessary to support their child’s mental well-being. |
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CHAMP
The NYS Council is a proud Project partner for CHAMP – the Community Health Access to Addiction and Mental Healthcare Project (you may know it as the MH and SUD Ombuds Program) where our own Ryan Johnson, CHAMP Project Specialist deserves tons of credit for his amazing ability to simultaneously conduct extensive outreach and engagement activities designed to spread the word about CHAMP across the State while he remains available to CHAMP Hotline staff seeking technical assistance on matters related to the mental health and substance use disorder systems of care, and how to access these benefits through various insurance programs. Ryan also conducts training for CHAMP staff and just recently completed a project that provides lots of information re: the CCBHC Program in NYS to include info on the mission and availability of CCBHC Demo and grant services statewide so Hotline specialists will have the information they need to make referrals to these and other NYS Council agencies when the need arises. Would you like Ryan to facilitate an education program for your staff? Do you have an upcoming conference or other community event where Ryan would be a welcomed addition to the exhibitor / tabling group? As an example, today Ryan is downtown exhibiting at the NYS Problem Gambling conference.
You can contact Ryan at: ryan@nyscouncil.org
THANK YOU RYAN!
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Nothing NYS Council members in NYC don’t already know, but I thought this was an interesting article for our Political Types, from Politico:
| Cuomo’s penchant for wielding power would be limited in the mayor’s office |
| The former governor is running for a seat with considerably less authority than the one he held for more than a decade. |
| By Bill Mahoney, Joe Anuta | 03/13/2025 12:18 PM EDT |
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ALBANY, New York — As governor, Andrew Cuomo used his considerable power to such expansive effect he once blocked his nemesis — then-Mayor Bill de Blasio — from euthanizing a loose deer in Harlem. The standoff, which resulted in the buck’s stress-induced death, illustrates a fundamental and abiding truth about power in the Empire State: Albany can overrule City Hall on practically anything. That dynamic stands to haunt the former governor as he runs to become the next mayor of New York City, a job with far less authority than he’s used to. Not only is a mayor largely captive to leaders in Albany — think “Tin Cup Day,” when municipal executives beg state lawmakers for cash each February — the city job is met with balance-of-power checks everywhere a mayor turns. Mayors have less control over their budgets than governors do. They have to contend with more institutional checks on their power, like a Department of Investigation that works with state and federal prosecutors on municipal probes. They routinely face an aggressive press corps that is larger than its state capitol counterpart. The city’s legislative body can more easily override a veto, both structurally and politically, than the state’s. And New York City government, with some 330,000 employees, has been historically harder for a politician to wrangle. Cuomo’s time as governor was defined by his aura of being New York’s ringmaster: His control was so absolute he once created a wide-reaching commission to police state government, only to block it from probing his allies. And with such consolidation of power, supporters and critics alike bought into the idea that state government did nothing without his say so. As a result, few decided to risk his vengeance. If elected mayor, his penchant for power grabs, tendency to stoke fear in foes and intricate knowledge of how to use the levers of government will be tested in ways they never have been in his long political career. And it will force him into a role reversal of epic proportions with Albany lawmakers and Gov. Kathy Hochul. “I have lost a bet with a lot of people since last year,” said state Sen. Gustavo Rivera, a dedicated Cuomo foe who wagered the former governor wouldn’t run. “The reason is that I could not imagine any single opportunity where he would ask Kathy Hochul for anything.” The former governor’s team contends the adjustment wouldn’t present a problem for Cuomo, and that the transition would even play to his strengths. “This is the same guy who built the Second Avenue subway, the Moynihan Train Hall and the new LaGuardia and JFK Airports,” Cuomo’s campaign spokesperson Rich Azzopardi said. “He’s a manager, and the bottom line is that the city is in crisis and needs to be managed.” Rivera disagreed. “The mayor is considered a creature of the state,” he added. “And [Cuomo] knows better than anybody how that can be abused by a governor.” Indeed, perhaps the biggest check on Cuomo — a Democrat leading polls ahead of the June 24 primary — would be his own detailed playbook on how to make life miserable for the occupant of Gracie Mansion. The owner of an alleged dartboard with de Blasio’s face on it, Cuomo rarely missed an opportunity to belittle his city counterpart. “It’s hard for me to work with an administration that is hyper-political and is not competent,” he said when summing up de Blasio’s tenure. He routinely cut de Blasio out of major decisions, once giving the mayor’s team just 15 minutes notice before telling the public he would shut down the subways in advance of a 2015 blizzard. The next month, he blocked the city’s plan to redevelop a railyard after de Blasio attempted to repay the favor by giving minimal warning. In the 2018 budget alone, Cuomo mandated the city find $418 million to contribute to the subways, gave the state the power to use eminent domain to develop the neighborhood around Penn Station and required that the city obtain state approval for its plans to address homelessness. Covid-19 only exacerbated that dynamic. In April 2020, when the mayor decreed city schools would remain closed for the rest of the academic year, Cuomo brushed it off as merely the “the mayor’s position.” The governor didn’t declare that schools were closed for another three weeks. “That’s his opinion,” Cuomo said. “It’s my legal authority in this situation.” He wasn’t technically wrong. Underpinning the former governor’s actions was an enormous structural advantage: Governors have the power to remove mayors, something Cuomo reminded the public of that same year. In Hochul, Cuomo would have a more mild-mannered state leader than he was for de Blasio. But while her style doesn’t match his, she’ll still hold more cards. During Cuomo’s 11 years at New York’s helm, nothing empowered him more than the state’s budget process, which greatly favors the executive branch and allows governors to push major legislation not explicitly tied to fiscal matters. His spending plans contained an overhaul of New York’s bail laws, increases to the minimum wage, congestion pricing, a plastic bag ban and an attempt to destroy the progressive Working Families Party. Compare that to some of de Blasio’s signature accomplishments. He ran on a promise to tax the rich to fund an expanded pre-kindergarten program, a version of which was eventually enacted and serves as the legacy-defining achievement of a mixed tenure. But Cuomo did not embrace the wealth tax, instead passing pre-k as part of the state budget. The election-year shift allowed Cuomo to dictate details and claim credit. Even when it came to something as administerial as a mayor’s control over the city school system or changing the municipal speed limit from 30 miles per hour to 25, de Blasio — and mayors before and after him — needed Albany’s approval. The power imbalance extends to groveling. A key step to securing state funding is the mayor’s appearance every year for “Tin Cup Day” in Albany, where they endure hours of questions from rank-and-file legislators about their budget priorities — something Cuomo was unwilling to do when his office was one floor below the legislative chambers. Now, in what would be a karmic twist, the former governor would likely have to spend time in the hot seat, a prospect many state lawmakers would undoubtedly relish. “It would probably be the best-attended local government hearing in history,” Assemblymember Ed Ra, a Republican, said of the possibility. “There would be a lot of legislators who would welcome the opportunity to question him in a public setting.” Cuomo’s first list of mayoral policy proposals underscores this power differential. In a campaign guidebook on his affordability plans, 15 of the 26 ideas he’s floating might need approval from the state. “Andrew Cuomo’s plan calls for increasing the threshold of the Mansion Tax to $2.5 million,” his website says. It isn’t the first time the idea has been floated — de Blasio wanted to raise the threshold to $2 million in 2017. “It never went anywhere in January and it hasn’t gone anywhere since,” Cuomo said while pooh-poohing the idea later that year. The only meaningful check on the actions of a politician who bent state government to his will came in the form of 11 accusations of sexual misconduct — accusations Cuomo vehemently denies. Attorney General Letitia James detailed them in a 2021 report. Even then, James could only conduct her probe when Cuomo gave her the power to do so. He wound up resigning before the Legislature followed through on plans to impeach him. Prior to that, the former governor was virtually untouchable. He sidelined the state inspector general’s office for the duration of his tenure. He also stripped Comptroller Tom DiNapoli’s office of the power to probe many state contracts. In his first year in office, Cuomo pushed the Legislature to approve an oversight body called the Joint Commission on Public Ethics. Known commonly as JCOPE, the entity was widely perceived as being controlled by the governor; Cuomo’s appointees were able to block investigations into his administration, and the first three executive directors were alums of his team. In 2013, Cuomo created a separate body called the Moreland Commission and tasked it with investigating ethics in state government. Cuomo blocked the entity from investigating his allies and agreed to dissolve it in exchange for the Legislature’s approval of minor campaign finance reforms — actions that led to a federal probe, though investigators were unable to make a case that Cuomo had acted illegally. “It’s my commission. My subpoena power, my Moreland Commission. I can appoint it, I can disband it. I appoint you, I can un-appoint you tomorrow,” he said of his ability to meddle with the commission’s work. “I can’t ‘interfere’ with it because it is mine. It is controlled by me.” A Mayor Cuomo would have to contend with many more eyes on City Hall as well. The city’s Department of Investigation commissioner stood beside federal prosecutors as they indicted Mayor Eric Adams last year. Leaders of the agency are appointed by mayors, but have historically operated with a wide berth. The Conflicts of Interest Board admonished de Blasio over his fundraising practices for a nonprofit that promoted his agenda. The Civilian Complaint Review Board hears cases of alleged police misconduct, though Adams, a former NYPD captain, pushed out a board chair who had been critical of his administration and has largely ignored the body’s recommendations. City Council members haul commissioners into oversight hearings far more often than their state counterparts. City comptrollers — who unlike their state equivalent are term limited and tend to run for mayor — train a team of auditors on the administration. And while mayors enjoy immense control over the city budget, local bean counters must adhere to stricter accounting practices compared to the state and are monitored by the Financial Control Board, a vestige of the 1970s fiscal crisis that Cuomo mused about employing during the pandemic. The Independent Budget Office and several other fiscal watchdogs also keep tabs on the city’s spending. Mayors are under far more scrutiny from the New York City press corps, too. Cuomo repeatedly disappeared from public view for long stretches when the going got tough — an act that’s harder to pull off in the more cramped confines of City Hall. The City Council can create challenges Cuomo never had to deal with in Albany. Mayoral vetoes are occasionally overridden by the unicameral body, but only two governors have had vetoes overridden since 1873 by the more politically diverse state Assembly and Senate. And at a basic level, the sheer complexity of city government makes it less conducive to central management. There are, of course, many ways Cuomo could exercise power. Mayors have a prominent bully pulpit and vast control over their agencies, the budget process and contracting. And they appoint a majority of members to ostensibly independent bodies like the Rent Guidelines and Campaign Finance boards. While many of these entities have remained largely independent, some observers fear a strong executive could chip away at that. Head of government ethics group Reinvent Albany John Kaehny predicted a shift under a Cuomo mayoralty, saying, “The idea that these norms of civilized, above-board behavior are going to keep the COIB, the CFB and DOI safe — it’s hard to see that.” |
GOP Plans to Slash Medicaid Would Worsen Overdose Crisis
- by Alexander Lekhtman March 13, 2025
Republicans, in control of the White House and both chambers of Congress, aim to cut trillions of dollars in federal spending. Despite promises from President Donald Trump and other GOP leaders not to cut widely popular entitlement programs, Medicaid—providing health care to many millions of people on low incomes—is certain to be slashed if cuts are made on anything like that scale. Among those who depend on Medicaid, millions of people who use drugs rely on it for access to treatment, medication and overdose-prevention resources.
On March 11, the House narrowly passed a stopgap spending bill. It largely maintains Biden-administration spending levels but makes certain cuts, boosts funding for immigration enforcement and the military, and gives Trump more leeway over spending. The Senate would need to approve it by March 14 to avoid a federal government shutdown; Senate Democrats plan to oppose it.
But what comes after will be far more consequential. A separate Republican budget resolution, which passed the House on February 26, is essentially the party’s wish list. As CBS reported, it sets the goal of producing legislation to cut at least $1.5 in federal spending, while cutting $4.5 trillion in taxes and raising the debt ceiling by $4 trillion.
The bill instructs the House Energy and Commerce Committee—with oversight of Medicaid—to find at least $880 billion in cuts over a decade. Republicans have avoided saying explicitly that they will cut Medicaid, knowing how many of their own constituents need the program. But the Congressional Budget Office released an analysis on March 5 confirming that there is no way to make such large spending reductions without cutting Medicaid.
“There is no way people don’t lose coverage, and you’re doing that in return for billionaires getting a tax break.”
Mona Shah, senior director of policy and strategy at Community Catalyst, a health justice organization, said that Medicaid cuts are imminent unless voters, activists and organizations can exert sufficient pressure.
“Our goal is to make this unlikely,” she told Filter. “The point [we are] making is that Medicaid is a lifeline for millions of people. Over 72 million individuals receive Medicaid, and $880 billion is a massive cut to the program. There is no way people don’t lose coverage, and you’re doing that in return for billionaires getting a tax break.”
All states participate in Medicaid, and most make households with incomes up to 138 percent of the federal poverty line eligible. According to the McCourt School of Public Policy at Georgetown University, since the Addiction Equity Act of 2008 and the Affordable Care Act (ACA) of 2010, “Medicaid has served as a workhorse to improve access to appropriate substance use care.”
People who use drugs are not a small portion of Medicaid recipients: Around one in five people on Medicaid have a diagnosed substance use disorder. The ACA, which expanded Medicaid eligibilty, increased their access to treatment and more. Services vary state by state, but many cover counseling, residential care, community-based support and mobile crisis services, as well as the overdose-reversal drug naloxone and FDA-approved medications for opioid use disorder.
“Medicaid is key to addressing substance use disorders and the overdose epidemic. It’s the single largest payer of both mental health and substance use disorder care.”
Deborah Steinberg, senior health policy attorney at the Legal Action Center, which advocates for health equity, said that in many cases, Medicaid provides better coverage for people who use drugs than Medicare or private insurance.
“Medicaid is key to addressing substance use disorders and the overdose epidemic,” she told Filter. “It’s the single largest payer of both mental health and substance use disorder care. It’s a lifeline because it provides the services people need and often to a far better degree than other insurance programs.”
“Because states can adapt it to fit their needs, we’ve seen states do such important things with Medicaid,” Steinberg continued. “They’re providing crisis services, peer support, services that address social determinants of health—all components of what people need for prevention, treatment and recovery.”
It’s therefore highly probable that slashing Medicaid would result in an increase in overdose deaths, which have been declining nationally. Such an effect would be racially disproportionate. Members of Black and Latinx communities have not shared in the national decline in overdose deaths, and are disproportionately likely to be enrolled in Medicaid, so cuts would hurt them the most.
“States won’t be able to cut back on mandatory benefits, but there are so many ‘optional benefits’—most types of providers and treatment are optional.”
Other ideas put forth by Republicans, like eliminating provider taxes, would essentially defund individual states’ Medicaid programs. Medicaid involves state and federal governments footing the bill through a cost-sharing mechanism that varies by state and the services provided. As Georgetown explains, provider taxes are collected by state governments from health care providers to help fund a state’s share of Medicaid. If the federal government restricts or eliminates use of this funding source, it could jeopardize as much as $630 billion in Medicaid spending over a decade.
“States are going to be in a really tough spot,” Steinberg said. “They either have to find a way to make up the difference, by cutting other necessary services and supports, or raising taxes, or they’ll have to make cuts to their Medicaid program to account for this reduced funding from the federal government. If they have to do that, they won’t be able to cut back on mandatory benefits, but there are so many “optional benefits”—most types of providers and treatment are optional.”
Yet another idea proposed by Republicans is to add work requirements to Medicaid, making recipients prove they have a job in order to receive health care. “It’s common sense,” said House Speaker Mike Johnson. “Little things like that make a big difference not only in the budgeting process but in the morale of the people. You know, work is good for you. You find dignity in work.”
But an analysis by KFF showed that already 92 percent of Medicaid recipients are either working, in school or caring for a dependent.
“You’ll hear conversations about adding work requirements, which is really unnecessary, burdensome reporting requirements asking individuals to report every month that they’re working,” Shah said. “Two states that tried this, Georgia and Arkansas, ended up wasting millions on consultant and administrative costs to set this up. People either unnecessarily lost coverage or didn’t enroll at all.”
A common Republican tactic is to cite the need to cut “waste, fraud and abuse,” which Johnson and other House Republicans have claimed are ruining Medicaid. Edwin Park, a health policy expert at Georgetown University’s McCourt School of Public Policy, debunked the claim in a conversation with NPR. The figure cited by Johnson, of $50 billion in Medicaid fraud annually, is untrue. That number is a measure of “improper payments,” relating to errors in documentation or procedure for payments issued. This doesn’t represent a finding of fraud or payments that shouldn’t have been made.
“The reality is there is very little fraud and abuse in Medicaid,” Shah said. “It’s one of the slowest growing health care programs, Medicaid spends less per enrollee than Medicare or even private insurance. It is already a very lean and cost-effective program.”
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