News and Info for NYS Council Members, 5/5/25

May 5, 2025

Last week during our Thursday morning Member Support call, I discussed the CCBHC eGrant Program and the fact that, at the present time, it is in the crosshairs of federal grant termination discussions.  Later that day I sent all members a summary of what we discussed on the call with a summary of where the EGrant and Demo Programs currently stand (the Demo is not currently at risk although the state is going to submit a SPA to CMS that would allow NYS to bring the Demo services into the state’s Medicaid Plan since the federal statute carrying the federal Demo Program expires on 9/30/25.)
Below are two docs that discuss the process CCBHC Demo agencies may want to pursue in order to try and expand their current CCBHC Demo footprint by applying for administrative approval to include an additional clinic (that otherwise meets the requirements described in the documents) into your Demo constellation, thereby drawing down a PPS rate.  This may be helpful if you have an eGrant and a Demo and you want to try to protect the eGrant clinic from the ravages and impulses of the federal government.  If you think this is something you would like to pursue, I would act swiftly by contacting the CCBHC mailbox and raising your flag.  I am not suggesting that this is a sure fire way to avoid the possibility that the eGrant Program may go away, and (as we stated last week) right now it is only SAMHSA eGrant cohorts 8 & 9 that are caught up in the fight to preserve the SAMHSA CCBHC EGrants Program that is currently under fire.
I would be happy to talk it over if you wish.  I’m at 518 461-8200 at your convenience.
L.
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Federal Budget
Last week the White House released its ‘skinny’ discretionary spending recommendations for federal budget year 2026-2027.  The document is as much a discussion of Trump policy priorities as it is a chess move on the federal budget game board.  Trump’s domestic policy agenda will hinge on the ability of Speaker Johnson and Senate Majority Leader John Thune (R-N.D.) to walk a fine line between GOP hardliners who want to see deep spending cuts and more moderate members who are hesitant to cut services that their constituents rely on. Nowhere is that dilemma more pronounced than in the House Energy and Commerce Committee, which oversees Medicare and Medicaid, and is tasked with finding over $800 billion in cuts under the House budget blueprint. Members have floated cutting the federal share of Medicaid payments to states that have expanded programs under the Affordable Care Act, as well as an alternative plan known as “per capita caps” that would shift the cost burden onto the states for any coverage beyond the federal allocation. Still, some GOP members worry that either plan would risk healthcare services for millions of low-income Americans. Rep. Don Bacon (R-Neb.), a moderate Republican from Nebraska, indicated that he would not support a bill that cuts more than $500 billion, and Rep. David Valadao, who represents the highest percentage of Medicaid recipients of any House Republican, said even that may be too much. Valadao declared, “I still think $500 billion is a lot, depending on how they score things. It might be all foo-foo numbers just to make people happy.” Even if Johnson gets his divided caucus behind a single bill, the Senate will still have to reconcile that with the budget blueprint they passed earlier this year, which does not prescribe the level of cuts House Republicans are eyeing. 
 
(Fierce Health, 5/5) On Friday, President Donald Trump released a document that outlines the ways he wants Congress to allocate money to federal health care programs. The so-called skinny budget proposal contains less information than a draft of the budget that was leaked in late April. However, the total amount of cuts to healthcare agencies aligned with the proposals laid out in the leaked document 

This is the first official look at the executive branch’s vision for healthcare spending after its massive reductions in force and reorganization of the Department of Health and Human Services. 

Congress will ultimately set the discretionary funding levels for healthcare programs, and it does not have to follow the outline of the President. 

“The administration is saying in their budget they want to give states the flexibility to decide how to spend money,” Jennifer said. “It’s sort of from the perspective that states know what their needs are… the other view as well is that could mean that some states may not spend money.”

Chrissie Juliano, executive director of Big Cities Health Coalition, said that shifting funding to states could create disparities in who gets funding. The effects will depend on the specifics of how the federal government shifts funding responsibilities to states. The primary areas that the budget proposes this is in some CDC grants and public health preparedness and responses initiatives. 

“The best way to address local needs is to work with local health departments and their community partners to support the community’s resource needs, which includes not just funding, but also the type of subject matter expertise that is being decimated at the federal health agencies,” Juliano said. “Every level of government has a role to play in protecting and promoting the public’s health.”

The numbers outlined in the fiscal year 2026 budget request are for discretionary spending, which are the spending levels Congress sets each year through the appropriations process. The document does not include spending wishes for mandatory spending, which include Medicare and Medicaid. 

“Mandatory is for programs that are in the law that basically say the federal government is going to pay for this program for whoever is eligible … even if it’s Medicaid and the cost of prescriptions goes up, we still cover it,” Jennifer Kates, Senior Vice President at KFF and Director of Global Health & HIV Policy, told Fierce Healthcare.

Kates continued: “Discretionary spending is a very different type of spending. It requires Congress to appropriate money every year for these programs and that money it appropriates, it may not be enough to cover everybody who needs the program, whereas if all of a sudden there were more people eligible for Medicaid, they would automatically get covered.”

Here are the top line numbers of President Trump’s FY2026 budget request. The numbers represent changes to the budgets of healthcare agencies compared to 2025 spending levels: 

>Adds $500 million to the Make America Healthy Again Initiative

The new initiative, spearheaded by Health Secretary Robert F. Kennedy Jr., has its own budget line item in President Trump’s budget request. The request says that HHS’ MAHA Initiative will use the half billion outlay for “nutrition, physical activity, healthy lifestyles, over-reliance on medication and treatments, the effects of new technological habits, environmental impacts, and food and drug quality and safety,” the budget document says.

It also outlines an initiative whereby the federal government will send MAHA food boxes “that would be filled with commodities sourced from domestic farmers and given directly to American households.” 

>Adds $5.4 billion to the Department of Veterans Affairs for medical care and electronic health record modernization.

>Subtracts $1.73 billion from the Health Resources and Services Administration

HRSA would see significant cuts under Trump’s preferred budget. The cuts he outlined include Ryan White HIV prevention efforts not related to medications and other programs like workforce training, maternal and child health programs, and family planning programs.

>Subtracts $3.5 billion from the Centers for Disease Control 

Consolidates funding for Infectious Disease and Opioids, Viral Hepatitis, Sexually Transmitted Infections, and Tuberculosis programs into one grant program funded at $300 million. It also eliminates a slew of “unnecessary and duplicative programs.”

>Subtracts $17.97 billion from the National Institutes of Health

“NIH has broken the trust of the American people with wasteful spending, misleading information, risky research, and the promotion of dangerous ideologies that undermine public health,” the document says. It cites the COVID-19 lab leak theory and DEI-related grants as reasons for the massive cuts.

The document says it wants to refocus NIH into five entities: the National Institute on Body Systems Research; the National Institute on Neuroscience and Brain Research; the National Institute of General Medical Sciences; the National Institute of Disability Related Research; and the National Institute on Behavioral Health.

It would eliminate funding for the National Institute on Minority and Health Disparities. 

NIH would retain $27 billion for research, the budget document proposes.

>Subtracts $1.07 billion from the Substance Abuse and Mental Health Services Administration

>Subtracts $129 million from the Agency of Healthcare Research and Quality

>Subtracts $674 million from Centers for Medicare and Medicaid Services (CMS) Program Management

>Subtracts $240 million from Administration for Strategic Preparedness and Response (ASPR) Hospital Preparedness Program

>Subtracts $180 million from the new Administration for a Healthy America—Sexual Risk Avoidance Program and Teen Pregnancy Prevention Program, HHS Office on Women’s Health, HHS Office of Minority Health 

The Federation of American Hospitals’ President and CEO, Chip Kahn, cautioned Congress to move forward carefully to maintain the integrity of healthcare programs. 

“With the release of the President’s budget and proposed changes to our country’s health infrastructure, it’s critical that Congress tread carefully as it considers drastic Medicaid cuts that would eliminate millions of Americans’ coverage and access to care,” Kahn said in a statement. “The budget, Congress’s proposed Medicaid cuts, and the impending expiration of the enhanced tax credits should be considered as a whole with the health of our communities, patients’ coverage, and hardworking Americans’ access to care at the forefront.”

United for Medical Research slammed the nearly $18 billion in cuts to the NIH. 

“The cuts proposed to the National Institutes of Health budget are shocking and would be devasting to the NIH, researchers doing groundbreaking work, patients and families hoping for cures, and America’s economy,” United for Medical Research said in a press release. “If they were to occur, the United States would be giving up our global leadership in biomedical research to competitor nations along with all the benefits our leadership brings to U.S. citizens, our economy, and our national security.”

Association of American Medical Colleges (AAMC) likewise decried the proposed cuts to NIH as “stunningly impractical” and said it would rescind the nation’s position as the leader in biomedical research. AAMC said a $1 billion cut to HRSA is shortsighted in light of the healthcare workforce shortage.

“If enacted, the preview of the president’s budget request released today would yield to cancer, Alzheimer’s, diabetes, and other health threats facing Americans by dismantling federal support for medical research, public health, and health professions education that keeps the country healthy,” Chief Public Policy Officer of the AAMC Danielle Turnipseed said in a statement. “Retreating on health issues where we have made progress and where so many depend on their government to offer promising cures is not the American way.” 

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STATE BUDGET:  INVOLUNTARY COMMITMENT

To address public safety concerns, Governor Hochul has apparently secured a deal that changes New York’s involuntary commitment law.  The changes codify legal guidance previously released by the state by expanding the category of medical professionals able to determine that a person is “at a substantial risk of physical harm” because of their inability to meet basic needs. The deal also includes roughly $180 million in funding for psychiatric services, staffing, and beds in New York City. Another $122 million is provided to sustain an increased presence of police officers in the subway, including officers on every MTA overnight subway train. 

Legislative leaders have agreed to a state budget framework that loosens the legal standard for involuntary commitment of the mentally ill — a major victory for Gov. Kathy Hochul and a sign that political winds on the issue are shifting to the center.

The exact language has not yet been released, but it will specify that individuals can be involuntarily committed if they are at “substantial risk of physical harm due to the inability to meet their basic needs,” Hochul’s general counsel Brian Mahanna told reporters last week.

The move effectively codifies 2022 guidance from the state Office of Mental Health, saying that individuals “who appear to be mentally ill and who display an inability to meet basic living needs” could be taken against their will to a hospital for a psychiatric evaluation.

It will be paired with several related reforms, including more stringent hospital discharge requirements and state-funded pilot programs dispatching unarmed first responders to mental health emergencies, according to two people with direct knowledge of the matter, who were granted anonymity to share details of the deal.

The spending plan will also use $160 million to open 100 more inpatient psychiatric beds in New York City for individuals involved with the criminal justice system, Hochul said.

Other investments include $16.5 million to bolster the court-ordered mental health treatment apparatus under Kendra’s Law and an additional $2 million for the Office of Mental Health’s workforce.

The shifting approach remains contentious, though.

“The governor sees her proposal as a win, but I think, frankly, too many New Yorkers will end up losing,” Assembly Mental Health Chair Jo Anne Simon told POLITICO. “I don’t like the idea of compromise when that means that we’re doing something that I feel is fundamentally flawed. On the other hand, sometimes people need to see that it’s fundamentally flawed.”
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How New York City Routinely Fails to Pay Nonprofits It Relies On

The city owes at least $1 billion to nonprofits for more than 7,000 unpaid invoices, according to a new report. The organizations provide critical services to vulnerable New Yorkers.

NYT gift article here:  
 
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State Attorney General Letitia James says she plans to sue the U.S. Department of Health and Human Services to block cuts to key programs for low-income Americans, people with disabilities and people contemplating suicide, Gothamist reports.
 
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Health care union president ousted in upset election
 
By Maya Kaufman | 05/04/2025 09:16 AM EDT, Politico
 

NEW YORK — Longtime labor leader George Gresham was toppled by his former lieutenants in a contentious race to lead the nation’s largest health care union.

Gresham, who became president of 1199SEIU United Healthcare Workers East in 2007, lost his reelection bid by a resounding margin to challenger Yvonne Armstrong, who leads the union’s long-term care division, according to data reviewed by POLITICO.

Gresham’s defeat ushers in a new chapter for the union, which represents 450,000 health care workers across five East Coast states and was once a powerhouse in New York politics.

It is very rare for union heads to lose internal elections in New York, a state in which labor holds outsize power in local politics. 1199SEIU helped elevate Bill to Blasio to the mayoralty when he was lagging in the polls 12 years ago, and it recently endorsed Andrew Cuomo for mayor.

Armstrong and her second-in-command, Veronica Turner-Biggs, will take the reins as the organized labor movement and the health care industry contend with the Trump administration’s attacks on collective bargaining rights and Congressional Republicans’ expected Medicaid cuts.

Armstrong and Turner-Biggs, who ran as the Members First Unity Slate, will also preside over an internal reckoning. The union is conducting an independent review of Gresham’s spending, after a nine-month POLITICO investigation revealed that he had long used members’ dues money to benefit himself, his family and political allies. The House Committee on Education and the Workforce subsequently asked the U.S. Department of Labor to investigate.

“Because of your courage—your heart, your hustle, your belief—we now have the chance to lead our union into a new chapter: one rooted in transparency, unity, and real member power,” the Members First Unity slate wrote in an Instagram post announcing the outcome.

In a Facebook post published early Sunday by Gresham’s 1 Union 1 Future slate, he congratulated the victorious candidates and recalled his path from rank-and-file member in housekeeping at New York-Presbyterian Hospital to union president.

“No matter who you voted for, at the end of the day we are all part of our precious 1199 family, and I know that we share the same deep love for our union and the labor movement,” Gresham wrote in the statement. “It has been the honor of my lifetime to serve as your President for the past 17 years.”

“Our solidarity as 1199 members is today more important than ever,” he added. “We have major work cut out for us in the coming weeks and months to fight back against federal cuts to Medicaid, to negotiate the strongest contracts, and to defend the most vulnerable in our communities.”

The union said early Sunday that official results from the election, which was conducted under the supervision of American Arbitration Association, will be posted shortly.

Gresham’s term as president ends in June.
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Marijuana linked to thousands of annual Long Island emergency room visits, data shows

David Olson, Newsday, May 5, 2025 5:00 am
 
Thousands of people end up in Long Island hospital emergency rooms each year for marijuana-related problems that include psychosis, nausea and severe stomach pain, according to state data and hospital officials, a reflection of what experts say is widespread unawareness of the drug’s potential dangers.

A small but worrying number of cases involve young children who find gummies and other products that look like candy and unknowingly ingest cannabis, doctors say. More cases involve teenagers: People 15 to 19 have by far the highest rate of emergency department visits and hospitalizations in New York of all age groups, state data shows.

Penalized in the past by prison sentences, marijuana is viewed much more positively than a few decades ago, polls show. Increasing legal use of marijuana for medical conditions, and the legalization of cannabis for recreational use in New York and 23 other states, have left many people the mistaken impression that marijuana is harmless, experts say, leading them to overconsume.

“We have this notion of, ‘Oh, it’s benign. My grandfather used it,’” said R. Lorraine Collins, director of the Center for Cannabis and Cannabinoid Research at the University at Buffalo and a public health professor there. “It’s not your grandfather’s cannabis anymore. It’s way more potent.”

WHAT NEWSDAY FOUND

  • More than 4,500 people ended up in Long Island hospital emergency departments in 2024 for what the state calls cannabis syndrome, a reflection of what experts say is a lack of knowledge of the potential negative effects of marijuana.
  • Heavy, long-term use of marijuana can lead to nausea, vomiting and severe stomach aches. Overconsumption, even once, can lead to paranoia, psychosis or anxiety. Young children can experience breathing problems.
  • Experts say people can consume marijuana responsibly, but it’s easier than in the past to overconsume because cannabis is far more potent. The THC concentration in cannabis has risen from 1.5% in 1980 to 30% or more today.
Even before New York legalized recreational marijuana in 2021 and most of the state’s legal dispensaries opened more than three years later, cannabis-related emergency department visits and hospitalizations rose significantly, state data indicates. But some numbers have appeared to either stabilize since then or declined.

 

As with alcohol, most people who use marijuana never experience severe physical or psychological problems or develop dependence.

“It is a substance that can be responsibly used,” Collins said.

But as with alcohol, it can be harmful if misused.

Cases of “cannabis poisoning” statewide tripled between 2016 and 2022, from 931 to 2,875, according to the latest available state health department data, which is based on diagnostic codes.

“Cannabis poisoning” involves accidental ingestion or overconsumption that can lead to symptoms such as nausea, vomiting, decreased blood pressure, anxiety, paranoia or psychosis, said Amy Burnett Heldman, spokeswoman for the Council of State and Territorial Epidemiologists, whose criteria the state follows.

On Long Island, the number of hospital emergency department visits for what the state calls “cannabis syndrome” rose from 3,923 in 2019 to 4,590 in 2021 before falling and then rising again, to 4,562 in 2024, state data shows. The state is still refining what “cannabis syndrome” encompasses, and it did not provide pre-2019 data because of data quality and other issues, department spokeswoman Cadence Acquaviva said in an email.

Differences in terminology and data-gathering make some cannabis health statistics appear inconsistent, making it more difficult to identify concrete trends.

Although emergency department visits for cannabis poisoning rose every year between 2016 and 2022, the number of hospitalizations was going in the opposite direction. Hospitalizations rose sharply between 2016 and 2019, before falling even more sharply through 2022.

The drop in hospitalizations may in part be because more people are using legal marijuana that is safety-tested in laboratories, so they know what they are getting, said Dr. Jay Itzkowitz, emergency department chair at Mount Sinai South Nassau hospital in Oceanside.

Before legalization, some patients bought marijuana on the street that was “either not pure or mixed with other substances that you’re not sure of,” he said. “So sometimes people would think they’re getting regular marijuana and it’s laced with something else.”

What doctors, substance abuse providers are seeing

Whether the marijuana is bought legally or illegally, emergency department visits sometimes are because of one-time use — such as when someone consumes too much and experiences psychosis — or are linked to heavy, long-term use, which can lead to severe stomach pain and nausea, doctors say.

Marijuana can potentially cause a range of physical and psychological problems, but “the perception of risk is so low right now,” said Nassau Health Commissioner Dr. Irina Gelman. 

Because cannabis can be used for medical reasons, is naturally grown and is legal, people believe “it must be fine,” she said in an interview.

“That’s something that we are working against with education and outreach, because just because it’s legal does not mean it’s safe.”

Edibles are a particular problem, because consumers misjudge how much cannabis they are ingesting, physicians say.

At Nassau University Medical Center in East Meadow, people suspected of having cannabis-related symptoms sometimes deny they use marijuana, “but when you test them, they’re positive,” said chief medical officer Dr. Grace Ting.

“People don’t want to admit that’s the problem, or they’re addicted and they don’t want to stop,” she said.

Doctors now are more aware of cannabis-related symptoms and more likely to ask patients about their marijuana use, she said.

Dr. Sanjey Gupta, executive director of emergency medicine for Northwell Health, said he sees far more cannabis-related emergency department cases than when he started in emergency medicine 25 years ago. A key reason, he said, is much higher concentrations of THC in marijuana, the compound that causes a high.
In 1980, the concentration typically was less than 1.5%, research shows. Today it is often more than 30%.
A Newsday review of websites of legal cannabis dispensaries on Long Island found that most cannabis flower products, which are smoked, had 20% to 35% THC concentrations, and vapes had up to 97%.

“There’s a race to see who can produce the highest potency products to get you the highest for the longest period of time at the cheapest price,” said Jeffrey Reynolds, president and CEO of the Garden City-based Family and Children’s Association, which provides substance use services. “And that’s not a winning formula when it comes to public health.”

Greater potency means more potential for addiction, car accidents and psychological and physical problems that lead to emergency department visits, he said.

Some of those getting higher than expected are older adults who may not have used marijuana for decades, in part because they didn’t want to seek out an illegal dealer. With legalization, they are comfortable going into a licensed store, Reynolds said. Surveys show that, in the era of expanded legalization, marijuana use is declining among adolescents but increasing significantly among middle-age and older adults.

Edibles pose biggest problem

Collins said to help combat the effects of overconsumption, New York State should set limits on THC concentrations, although not so low as to steer people to illegal sellers. The state has no limits on flower, vapes or tinctures, which are liquid extracts, but in 2023, New York limited the amount of THC in edible products to 10 mg, as well as banned packaging that is designed to appeal to minors.

THC amounts listed on illegal products are unreliable and not tested, so users may get higher than they expected, Collins said.The biggest potential problem with overconsumption comes from edible gummies, cookies and other products, said Dr. Andrew Monte, a professor of emergency medicine at the University of Colorado Anshutz Medical Campus and a medical toxicologist who studies cannabis.

Monte was the lead author of a 2019 study that found that eating cannabis products made someone 33 times more likely to end up in the emergency department than someone who inhaled marijuana. Still, most patients had inhaled cannabis, because it was much more popular.

Smoking marijuana produces almost immediate effects, while with edibles, users often feel nothing for at least a half hour, so they may eat more and get much more impaired than expected, which can cause psychosis, extreme anxiety and other problems, Monte said. Children and sometimes adults may unknowingly eat a cookie or other product that they did not know contained cannabis, he said. 

In addition, the high produced by edible cannabis lasts much longer, so people are more likely to get worried and go to the hospital than if they had smoked marijuana, he said.

Although edible products are more likely to lead to extreme intoxication, inhaled products are more likely to cause the severe stomach pain, nausea and vomiting that can afflict heavy users.

“It literally is your body trying to reject this substance,” Collins said.

Among the most serious effects of cannabis consumption are in children.

“Because they’re smaller, they’re going to have more effects from a smaller dose,” Monte said.

Edibles and other forms of cannabis can lead to over-sedation in young children that can make it more difficult for them to breathe adequately because “their airways are much smaller and their reserves are much less,” said Dr. Carl Kaplan, chief of pediatric emergency medicine at Stony Brook Children’s Hospital.
Adolescents intending to get high are sometimes not prepared for its effects, Kaplan said. He cited the dozen 13- and 14-year-olds from William Floyd Middle School in Moriches who in March were sickened by consuming gummies that they knew contained cannabis. Eleven were taken to hospitals for treatment.
“It’s quite substantial the amount of THC you can get in one small candy,” Kaplan said.

Is state doing enough?

Education about cannabis is critical in preventing accidental ingestion and overconsumption, but critics said the state hasn’t done enough to warn New Yorkers of the potential negative effects.

Acquaviva, the health department spokeswoman, said the state has educational materials on safe storage of cannabis, impaired driving and other topics and is currently working with the Office of Cannabis Management and other agencies “to identify and address additional gaps in public education.”

Lyla Hunt, the cannabis office’s deputy director of public health and education, pointed to a campaign launched last month that includes decals with QR codes in licensed dispensaries, universities, transit hubs, state visitor centers and other locations that link to educational materials warning about potential health risks. The state also is mailing materials to organizations and individuals that request them, she said. Past efforts have included paid ads online and on buses and billboards and social media campaigns, she said.

But Collins said the campaigns have not gone far enough. Much of the state’s effort is focused on materials that people must access via websites, rather than messages easily accessed on broadcast and other outlets, she said.

“I’m not seeing the mass public messaging that needs to be happening,” she said.