December 23, 2025

STATE BUDGET:  TAKE ACTION

Yesterday, we sent 300 letters to Governor Hochul (THANK YOU!!) in support of our carve out request.  Today (and before folks disappear for the holidays) PLEASE ask your staff, board members, colleagues and anyone else you can compel,  to take action by sending a letter to the Governor and in doing so, continue the momentum we gained yesterday.  

SEND A LETTER IN SUPPORT OF OUR CARVE OUT REQUEST TODAY!  

YESTERDAY morning the NYS Council posted a new letter stakeholders can send directly to Governor Hochul in just two minutes, using our Voter Voice platform.  

Here’s a direct link:   https://nyscouncil.org/advocacy-action-center/  to the that allows you / your members / other stakeholders to click on the box featuring the Letter and to send a fresh request to the Governor in support of increased access to care and the redirection of scarce resources that are currently being paid to middlemen that all too frequently delay or deny care, and delay or deny payment to community-based providers on the ground to support New Yorkers with significant mental health and/or substance use disorder challenges.  

Here’s that link again: https://nyscouncil.org/advocacy-action-center/

THANK YOU FOR YOUR ONGOING PARTNERSHIP!! 

Call Lauri if you need assistance:  518 461-8200

STATE BUDGET:  TARGETED INFLATIONARY INCREASE (TII) ADVOCACY CONTINUES

The letter (attached) was signed by a total of 143 mental health and substance use disorder prevention, treatment, recovery and harm reduction organizations around the state.  

THANK YOU to the many NYS Council members who joined the chorus of voices pushing for a 2.7% Targeted Inflationary Increase (TII).  The letter was transmitted to the Governor yesterday, 12/23 by the group of 10 associations/coalitions that work together on requests such as the TII (or what used to be called the COLA).

STATE BUDGET:  MAKING THE SAUSAGE 

Former state Budget Director Bob Megna, now the president of the Rockefeller Institute of Government, joins the show to explain how the Hochul administration is navigating lost federal funding.

We discuss the wiggle room in the state’s spending plan, the potential for cutting agency red tape, and how seriously to take projected holes from the Division of Budget. He also sheds some light on behind-the-scenes discussions about child care funding and the delivery of health care in the Empire State.

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Worth the read and an absolute advocacy priority for our association going into the coming Legislative session, to ensure we have a strong voice and our expertise is valued and sought out, as the state defines the universe of New Yorkers that would be exempt from coming Work Requirements, and how these decisions will be made.

As you may know, DoH is in the middle of implementing a new Medicaid eligibility system that is advertised as the step NYS needed to take to make eligibility decisions accurate and as close to real time as possible.  The state has a lot to lose if eligibility determinations are inaccurate – the coming implementation of Work Requirements also includes potential fines associated with inaccurate eligibility determinations that result in higher spending by the state and the federal government.

How Will States Implement the Behavioral Health Exemption to Medicaid Work Requirements?  The Commonwealth Fund, 12/22/25

ToplinesIn 2027, states must begin enforcing work requirements for people covered under Medicaid expansion, but those with a substance use disorder or disabling mental health condition are exempted.A proactive approach to implementing the behavioral health exemption to work requirements can help minimize impacts for Medicaid enrollees, the behavioral health crisis, and related long-term costs.H.R. 1, the tax and spending law passed in 2025, requires states to implement work requirements for expanded Medicaid populations. The law includes some exemptions, including for people with a substance use or disabling mental disorder. Starting in 2027, the work requirements will impact more than 20 million adults across 40 states and D.C., and in Georgia and Wisconsin through their waiver demonstrations. Effectively implementing the behavioral health exemption will be critical for states.The Centers for Medicare and Medicaid Services (CMS) must release implementation guidance by June 2026 with federal requirements for implementation. The Congressional Budget Office estimated that approximately 5 million people might lose coverage over the next 10 years, many of whom will remain eligible for Medicaid but who did not successfully complete the paperwork. Previous state Medicaid work requirement experiments cost tens of millions of dollars to implement.

Work Requirements and Behavioral Health

During a time of national mental health and substance use crises, states must ensure consistent coverage for people with behavioral health conditions. Today, approximately half of Medicaid enrollees who need behavioral health care are able to get it. Gaps in coverage and access can lead to suicide, overdose, and persistent disability. They also may increase costs in the long term as people require even more intensive services and become less able to work. Effective early care leads to better outcomes and lower costs; state approaches to implementing the new requirements should take this into consideration.To implement the H.R. 1 exemptions for people with a substance use disorder or a disabling mental disorder, states are required to use available data to verify exemptions, without making individuals provide additional information. Currently, states vary in their ability to automatically verify Medicaid eligibility and process applications in a timely manner, suggesting that there will also be variation in their ability to verify exemptions. States can avoid more disruptions in care if they can effectively verify exemptions using data.

Implementing the Behavioral Health Exemptions

CMS guidance will give federal requirements, but states could potentially identify people who should be exempt from the work requirements based on claims, administrative, and clinical data. Diagnostic codes associated with different services and electronic health record information can indicate whether a beneficiary previously received treatment for behavioral health conditions. Collaborations with different health insurers, providers, and information exchanges can also help streamline verification for people who previously received care outside Medicaid.In administering the exemptions, states can exempt anyone with a diagnosed substance use disorder but can only exempt people with “disabling” mental disorders. The design of the law indicates that this is meant to be a lower threshold than the level of disability needed to qualify for other public benefits. While following CMS guidance, states will use their unique assets, experiences, and other tools to put the disabling mental disorders exemption into practice.Mental health conditions cannot be determined to be disabling solely based on diagnosis. Almost all diagnoses can be disabling if untreated. For example, major depressive disorder is a common mental disorder but instances can range from mild to deadly. The same is true for service intensity. If a person uses only a modest amount of treatment or services, it could reflect low need, or it could indicate intense need and an inability to access care. The decision should also not be based solely on eligibility for special programs for serious mental illnesses. These specialized programs often enroll only a small proportion of people eligible due to complex requirements, so this would not identify everyone who would qualify for the exemption.Instead, effective implementation would use a mix of claims and other administrative data to identify people who have mental health conditions and are not otherwise meeting their work requirements. This may indicate that their mental health condition is disabling. This strategy is imperfect, as it may include some people with moderate diagnoses, but ensures that people who most need care are able to get it and it takes a preventive lens to avoid conditions exacerbating.Many people with disabling behavioral health conditions are not screened or in treatment, making them invisible in the data. For example, an individual may not know that a mental health condition is the cause of their decline in functioning and may not seek care. States can create screening programs for behavioral health conditions in community spaces, such as recreation centers, or try to identify people through mobile apps. Another strategy is attestation, empowering individuals to self-identify when they enroll in Medicaid. This can make sure that the state identifies everyone who falls within this exemption, while also helping people get the care they need.

Conclusion

CMS and states will need to consider how different approaches to implementing the Medicaid work requirements impact the behavioral health crisis and related long-term costs. States can begin to communicate their challenges and opportunities to CMS, which will promulgate federal guidance and work with states on waivers. A proactive approach can minimize the impacts for people with behavioral health conditions.———————————

HHS to nix Biden-era proposals, streamline health IT regs

December 22, 2025 05:40 PM CST, MODERN HEALTHCARE

The Health and Human Services Department is closing out 2025 by attempting to deregulate the health technology sector.

The Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology issued two proposed rules Monday that would scrap provisions of an unfinished health information technology rule from the previous administration and streamline HHS’ health IT certification program.

In August 2024, ONC under President Joe Biden released a proposed rule meant to improve interoperability between payers, public health organizations and providers. The proposal was meant to establish voluntary certifications for health IT software tools used by public health organizations and payers as required under the 21st Century Cures Act of 2016.

ONC finalized portions of that rule focused on patient privacy and information blocking policies in December 2024. On Monday, HHS said it is proposing to withdraw other outstanding policies that were not finalized by the agency under President Donald Trump.

This includes a proposal that would have required certified health IT vendors to implement application programming interfaces, or APIs, that ease data exchange between payers, providers and patients. HHS also suggested removing a proposed criteria that asked health IT vendors to exchange public health data.

The agency said it would eliminate these proposals due to concerns with clarity and cost.

Separately, ONC proposed a “deregulatory” rule that would pare down requirements for ONC’s Health IT Certification Program, a set of security and interoperability standards for health information technologies such as electronic health records. ONC is proposing to remove over 50% of existing certification criteria and tweak others.

The rule would also revise or remove certain information blocking policies, which exist to prevent provider interference with the access, exchange, or use of electronic health information.

The proposed rule is in line with a Jan. 31 executive order on deregulation from Trump that directs federal agencies to reduce unnecessary regulatory burden.