Important Call to Action

July 8, 2025

Our next NYS Council Preparing for an Uncertain Future Learning Collaborative meeting with Josh Rubin and Cara Henley from HMA is coming up on July 16 from 10:00 – 11:00. I will send a link you can use to access the call on Monday morning (7/14). If you need assistance finding or inputting the information you need to complete the Excel Spreadsheet we sent you, now is the time to ask for help. Just give me a call at 518 461-8200. When we meet next week we will review your findings and (if there is time) we will discuss some of the critical activities and tasks (some of which are outlined in the article below) we might want to take on as an association, and other tasks and activities you want to build into your agency operations, in order to prevent or respond quickly to the beneficiary enrollment catastrophes we are likely to face in the not-too-distant future.

Rebuilding the Safety Net for Those with Behavioral Health Conditions: Urgent Action Needed for Potential Medicaid Disenrollees

Ron Manderscheid, PhD Engaged in national advocacy, training, and consulting to reduce disparities and promote equity.
July 8, 2025

Ron Manderscheid, PhD

Adjunct Professor

Johns Hopkins University

University of Southern California

Tragically, last week, Republicans passed the One Big Beautiful Bill Act on a strict party-line vote. This Act is a sweeping piece of legislation that, among many provisions, dramatically reshapes Medicaid. One of its most troubling effects is the mass disenrollment of vulnerable individuals, particularly people with mental health and substance use conditions, from their Medicaid coverage.

The Congressional Budget Office estimates that this Act will cut about $1.02 trillion from the Medicaid and Children’s Health Insurance Program by eliminating 10.5 million people from the Program by 2034. In addition, the Act also will trigger $490 billion in cuts to the Medicare Program between 2027 and 2034. Overall, about 16 million people are expected to lose their health insurance coverage.

In the wake of this legislation, millions now will face the prospect of interrupted care, lack of access to medication, and heightened risk of crises. Yet, there remains a powerful opportunity—and a moral obligation—for communities, states, providers, and advocates to act swiftly and strategically to soften the blow. This commentary outlines several concrete steps that can and must be taken now to support those who are at risk of losing their coverage.

Navigators on the Front Lines: Helping People Re-Enroll

One of the first lines of defense is re-enrollment assistance. Many individuals are likely to be disenrolled due to procedural issues—missed paperwork, outdated contact information, or a misunderstanding of eligibility. Rapid deployment of Medicaid navigators, peer specialists, and community health workers is essential.

States and nonprofits should establish enrollment hotlines, host in-person clinics, and fund mobile units to reach disenrolled populations. Assistance should be culturally responsive and multilingual to ensure equitable access.

Outreach Campaigns: Alert, Educate, Connect

Tens of thousands may not even know they’re losing coverage until they attempt to refill a prescription or access care. A coordinated public outreach campaign using texts, calls, social media, and trusted messengers can help.

Behavioral health providers, faith groups, schools, and recovery centers can play a vital role in disseminating accurate information about re-enrollment, appeals, and alternative coverage pathways.

Crisis Response Must Remain Uninterrupted

For individuals with serious mental illness, co-occurring disorders, or substance use conditions, access to care can be a matter of life or death. The 988-crisis line, mobile crisis teams, and peer-run services should remain available to people regardless of insurance status.

States should consider emergency bridge funding to support crisis response systems and community mental health centers that now will serve more uninsured individuals. Without such funding, the consequences could include increased emergency room use, jail incarceration, or suicide risk.

State Flexibility and Policy Innovation

Even under federal pressure, states retain discretion. State Medicaid agencies can extend or customize benefits or create state-funded safety nets for those no longer eligible.

For example, a state could establish a temporary behavioral health continuity fund or repurpose mental health block grant dollars to serve uninsured high-need individuals. Governors and state legislatures should act boldly to protect their most vulnerable residents.

Legal Pathways to Justice

Legal recourse may be available, particularly when disenrollment disproportionately harms individuals with disabilities or where due process was denied. Civil rights protections under the ADA and Section 504 of the Rehabilitation Act may be applicable.

Legal aid organizations, disability rights groups, and national nonprofits must mobilize to represent disenrolled individuals and challenge discriminatory or procedurally flawed implementation.

Keeping Providers in the Fight

The behavioral health safety net will be under enormous strain. Community clinics and Federally Qualified Health Centers (FQHCs) must be equipped to provide care to the newly uninsured. Sliding scale fee structures, donation-supported care, and charity care programs must be expanded.

Training frontline providers to support re-enrollment, offer coverage guidance, and advocate for patients is critical. Providers can also play a valuable role in data collection and storytelling, helping bring the impact of disenrollment into public view.

Building Coalitions for Advocacy

No single organization can carry this load alone. Rapid response coalitions—consisting of advocates, clinicians, policymakers, consumers, and researchers—can amplify efforts. Joint statements, media engagement, and community town halls can shift the narrative and demand policy change.

The disenrollment crisis must become part of the national conversation about equity and health justice. This will only happen if we elevate the voices of those most affected.

Tracking the Damage—and the Response

Data is key. States and counties should track disenrollment by race, age, diagnosis, ZIP code, and disability status. Behavioral health outcomes, such as suicide rates, hospitalization, or crisis line usage, should be monitored in real time.

These data should guide targeted interventions and support evidence-based advocacy for long-term reform.

Exploring Other Coverage Options

While re-enrollment in Medicaid remains the top priority, it’s also crucial to help people explore Marketplace plans (ACA). Veterans may be eligible for VA care, while some may qualify for Medicare, employer-sponsored plans, or school-based insurance for children.

Navigators and case workers should be prepared to assess all available options and assist with application and transition processes.

A Call to Action

The passage of the “One Big Bad Bill Act” represents a devastating setback for millions of Americans. We must rise to meet this crisis with coordinated action, compassion, and policy ingenuity.

Let’s be clear: We know who will be most harmed—low-income adults, people with serious mental illness, individuals in recovery from addiction, and children with special behavioral health needs. These are our neighbors and our friends.

By acting now, we can help to prevent suffering, reduce deaths, and begin to repair the broken trust in our health and social systems. In the process, we may even contribute to building a more resilient, people-centered system—one that recognizes health care not as a privilege, but a right.