Advocacy Request re: Requiring Commercial Insurers to Pay MH & SUD

February 2, 2024

ACTION ALERT

Please Take Action Today to Support SFY 2025 Executive Budget Proposal to Require Commercial Insurers to Pay MH & SUD / Addiction Providers at a Minimum, at Medicaid Rates

PLEASE MAKE 2 CALLS TODAY 

We are so pleased to see that Governor Hochul has included this critical proposal in her SFY 2025 Executive Budget to finally bring some parity to commercial rates for behavioral healthcare services with what is paid by Medicaid for the same services.

We are also pleased to share that stand alone legislation has been introduced to address this issue by Senate Insurance Chair Breslin and Assembly Mental Health Chair Gunther (S.8466/A.8839) which also demonstrates legislative support.
For too long, commercial insurers have been permitted to reimburse OMH and OASAS licensed/certified mental health and addiction agencies (on average) 50% of the state mandated Medicaid rate for the same, essential services provided to your constituents.  This must end this year and we need your help.

Please Make the Following 2 Calls Today to your State Senator and Assembly Member to urge their support for ensuring the inclusion of Part AA of the Health/Mental Hygiene Article VII Bill in their “one-house” budget bills and the final State Budget.  Please use the talking points provided (below) since the ask for each is slightly different due to a “sign on” letter Chair Gunther is circulating to her Assembly colleagues to demonstrate support.  Thank You!!

1) Call Your State Senator (switchboard number 518-455-2800):Introduce yourself as a constituent from their district and say you are calling to request the Senator’s support for an Executive Budget proposal to put an end to commercial insurers underpaying for mental health and substance use disorder care by requiring the plans to pay on par with Medicaid rates for the same services.  Tell them this is Part AA of the Health/Mental Hygiene Article VII Budget Bill and ask for their help to Ensure the Inclusion of this proposal in the Senate One House Budget and the Final State Budget.

2) Call Your State Assemblymember (switchboard number 518-455-4100): Introduce yourself from their district and say you are calling to request the Assemblymember’s support for an Executive Budget proposal to put an end to commercial insurers underpaying for mental health and substance use disorder care by requiring the plans to pay on par with Medicaid rates for the same services.  Tell them this is Part AA of the Health/Mental Hygiene Article VII Budget Bill and ask them to Sign On to the Letter to the Speaking Circulated 1/31 by Mental Health Chair Gunthercalling for Inclusion of this proposal in the Assembly One House Budget and the Final State Budget. The deadline is February 12th and Assemblymembers can sign on by letting Lena in Gunther’s office now at: dethoml@nyassembly.gov

Talking Points 

  • Commercial insurance reimbursement rates paid to community-based mental health and addiction agencies licensed or certified by OMH and/or OASAS is (on average) 50% of the state-mandated reimbursement rate for the same services provided to Medicaid beneficiaries. 
  • Wait lists around the state are filled with New Yorkers with commercial insurance because many providers must either limit the volume of commercial care they can provide or drop contracts with commercial insurers entirely. 
  • According to the Kennedy Forum, in most states, patients with private insurance have to go out-of-network for behavioral health care far more often than they do for other health care,  New York is no exception in this regard.  
  • Narrower networks are a notorious problem for mental health care, compounded by clinician shortages.  
  • 2023 Attorney General Report on Ghost Networks found commercial insurer health plan provider directories were deeply inaccurate; many plans advertised robust networks of providers however, up to 86% of the providers listed in many of the directories either do not exist, do not take commercial insurance, or the information is inaccurate.
  • Every New Yorker deserves on demand access to essential mental health and addiction services regardless of their insurance status.