September 30, 2025

The NYS Council just sent the following request to state leaders on behalf of a group of 15 associations/coalitions working together to secure a carve out of mental health and substance use disorder services from the state’s Medicaid managed care program, fyi.  

See below and attached.

———- Forwarded message ———
From: Lauri Cole <lauri@nyscouncil.org>
Date: Tue, Sep 30, 2025 at 8:59 AM
Subject: Request to Carve Outpatient Behavioral Health Services out of Managed Care in SFY 2027 Executive Budget

Good morning:

On behalf of the 15 associations / coalitions represented on the letter (attached) that collectively represent the vast majority of OASAS and OMH licensed, certified or registered community agencies, and the millions of New Yorkers they serve each day, I am writing with an urgent request for the upcoming SFY27 Executive Budget proposal to include language that removes outpatient mental health and substance use disorder services from the state’s Medicaid managed care program.   Under Medicaid managed care, New Yorkers with significant mental health and/or substance use disorders continue to suffer as access to care remains elusive due to persistent waiting lists for services while MCOs delay or deny reimbursement to these providers, leaving them in peril and unable to recruit and retain the workforce they need to meet increased demand for care.  

Despite contractual requirements to do so, most MCOs fail to spend the majority of the funds they receive from the state, on actual care for Medicaid beneficiaries. Failing to meet Behavioral Health Expenditure Targets is just one of the myriad ways insurers fail to comply with the laws, regulations and contract provisions governing the carve-in of our services, and deprive our systems of care of hundreds of millions of dollars.  New York State does not robustly enforce these requirements, sending a message to health plans that they can continue to employ tactics that are in direct opposition to the intent of the Program.

In light of these issues and in anticipation of potentially damaging federal policy and fiscal changes, New York State can no longer afford to employ middlemen who employ tactics that extract scarce resources from our systems of care without adding value, without delivering on their commitments, and without fear of robust enforcement by state regulators.  

We need your help and request that you return the responsibility for reimbursement of these benefits to the state’s Medicaid Fee for Service system as soon as possible.  

Thank you for your consideration in this important matter.

Respectfully, 

Lauri Cole, Executive Director
NYS Council for Community Behavioral Healthcare
Lauri’s Cell:  (518) 461-8200
lauri@nyscouncil.org