Peeling the Budget Onion Layer by Layer

February 2, 2023

Good afternoon,

1) Below is an outline of funding that the Governor has proposed as part of her $1 billion multi-year plan to overhaul NYS’ Continuum of Mental Health Care, followed by an update on the OMH, OASAS, and DOH budgets of interest from our review of the Aid to Localities Budget Bill.  
$1 Billion Plan to Overhaul NYS’ Continuum of Mental Health Care: $890 million in capital and $120 million in operating funds to:

  • Establish and operate 3,500 new residential units for New Yorkers with mental illness
  • 1,500 supportive housing units
  • $25 million in capital and $7.3 million in operating costs for 60 community step-down housing units in NYC
  • $60 million in capital and $121.6 million in operating funding to expand outpatient services (12 new comprehensive psychiatric emergency programs, tripling the number of Certified Community Behavioral Health Clinics to 39, 42 additional Assertive Community Treatment teams, 8 additional Safe Options Support teams, and expanding capacity at 20 Article 31 clinics).
  • $2.8 million to expand Intensive and Sustained Engagement Treatment program.
  • $3.3 million invested in the Individual Placement and Supports Program.
  • $20 million to expand mental health services in schools, $10 million to expand school-based wraparound services, $12 million for HealthySteps and home-based crisis intervention teams, and $10 million in grants to suicide prevention programs targeting high-risk youth.

Aid to Localities OMH Budget Highlights (S4003/A3003)

  • All Funds spending increased by nearly $100 million with an increase in Adult Services by approx. $80 million and Children’s Services by approx. $18 million.
  • Increased funding for community non residential mental health programs, with multiple appropriation line increases ($14 million, $18 million, $15 million increases)
  • $5 million in increased funding for psychiatrists and psychiatric nurses and other clinicians across programs
  • $400,000 for new FarmNet Peer to Peer program
  • $25 million in new funding for 9-8-8 Crisis Response System
  • $31 million and $14 million in new funding for the community mental health emergency program
  • $50.637 million for OMH COLA
  • $6.5 million for OMH minimum wage support
  • $3.25 million for new IPS Program
  • $2.8 million for new INSET program
  • $4.5 million for supportive housing services
  • $10 million in new funding for youth suicide prevention
  • $5 million for High Fidelity Wraparound Services for Children
  • $1.7 million in increased funding for Community Mental Health Block grant services

Aid to Localities OASAS Budget Highlights (S4003/A3003)

  • All funds spending decreased by approximately $240 million
  • $148,000 in increased funding for Chemical Dependency Services
  • $4 million in increased funding for Outpatient Medicaid services
  • $5 million increase in residential services
  • $2 million increase in Crisis services
  • $17 million decrease in problem gambling, chemical dependency and treatment supports
  • $2.7 million for OASAS minimum wage support
  • $13.3 million for OASAS COLA
  • $50,000 increased funding for Jail-based SUD services
  • $3.5 million in increased funding to MH/SED Ombudsman for total of $8.5 million plus additional appropriation of $1.5 million
  • $123,644,000 from the Opioid Settlement Funding with the following sub-schedule:

Sub- schedule
Reserved for Municipalities .. . . . 20, 183,000
Harm Reduction . . … . . . … . . . … . 23, 005 , 000
Treatment .. . ….. . ….. . ….. . .. 12, 659,000
Investments Across the Service
Continuum . . . . . . . . . . . . . . . . .16, 554 , 000
Priority Populations ….. . ….. . 15 , 154, 000
Housing . . … . ….. . . . . . . . … . . . . 10, 285,000
Recovery . …. . . …. . . …. . ….. . 10 , 285,000
Prevention . ….. . .. . . . . ….. . .. . . 7 , 547 , 000
Transportation ….. . ….. . ….. . . 5,477 , 000
Public Awareness .. . .. . .. . .. . .. . .. 1 , 704, 000
Research … . . . … . . . … . . . … . . . … 791,000
Total of sub- schedule . . . … . . 123, 644 ,000

  • Additional funding for Prevention and Support Programs ($2.6 million and $11 million)
  • $2 million in new funding for chemical dependency, prevention, treatment
  • $4 million in new funding for campaign around legal use cannabis


Aid to Localities NYSDOH Budget Highlights (S4003/ A3003)

  • Provides $7,785,000 for Opioid Prevention and Treatment (up from $450,000)
  • Includes $33.75 million for CCBHC expansion
  • Includes $33.75 million for Eligible Certified Community Behavioral Health Clinics for Indigent Care Program

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2) See attached press release from the Governor’s Office with her comments during an event in the Bronx this morning that celebrated the investments for the mental health system that are embedded in the executive budget proposal released yesterday. 

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3)  NYS Executive Budget, Key MH/SUD Insurance Provisions include:

  • Network Adequacy
    • Includes a mandate for the development of network adequacy regulations that include standards for:
      • appointment availability for initial visits, follow-ups, and visits following hospital/ED discharge
      • Time/distance standards that consider geographic region, service delivery patterns, and telehealth availability
      • Out-of-network referrals at in-network cost sharing when in-network providers are not available.
  • Parity
    • Includes a private right of action for individuals to sue commercial insurers for actual damages when injured due to a parity violation.
  • Other Insurance Coverage
    • Requires insurers to reimburse school-based MH services from satellite Article 31 clinics at least at the same rate that Medicaid pays (APG government rate)
    • Requires insurance coverage of mobile crisis intervention
    • Insurance coverage of medically monitored crisis residential facilities
    • No concurrent review for adults in the first 30 days of inpatient/residential MH treatment
    • Requires insurers to use clinical review criteria that is designated by OMH. (You may remember a couple of years ago, legislation passed requiring clinical review criteria to be approved by OMH. Many criteria used by various insurers were not approved, but they were given extensions to continue using it).
    • Requires coverage with no prior authorization of Naloxone.

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3)  Regarding the Medicaid Buy-In for Working People with Disabilities (please share with entitlement counselors, advocates, etc.):  

PART N      EFF. 1/1/25  

$60 mill annually 

(P. 288 Health and Mental Hygiene (HMH) Bill ) 

The Good:

  • Removes age limit of 65  
  • Resource limit increased to $300,000 other than retirement accounts.   
  • INCOME limit –increase to 2,250% FPL non-MAGI (10 x the current threshold)
  • Exempt income and resources from responsible relatives  (ie spousal refusal not required) 

The Not-So-Good

  • Capped at 30,000 eligible participants.  
  • New stricter definition of ’employment’ – must be at least minimum wage and work 40 hours/month.  
  • Will charge a monthly premium if income over 250% FPL (after non-MAGI income disregards)
    • 250% FPL – 300% FPL = $347/mo 
    • 300% – 400% FPL          $518/mo 
    • 400% – 500% FPL          $779/mo 
    • > 500%                         $1449/mo 
  • Presumably someone could avoid the premium by using a pooled trust instead, but then would probably need to use the regular Medicaid asset limit not the enhanced asset limit.
  •  
  • All subject to requesting waiver from CMS 

Part I – Section 15 (Bill start at p. 220)
Amends PHL 3614-c to eliminate wage parity in CDPAP in NYC, Nassau, Suffolk and Westchester and replaces it with a subsidy to purchase health coverage on NYSOH.