NYAPRS Note: True to her word, Governor Hochul’s 2023-24 budget proposal includes an historic and comprehensive investment in mental health services. We are very pleased and excited to see the Governor’s strong support for a number of longtime NYAPRS member priorities that are included here: housing, employment, criminal justice reforms, crisis and outpatient services.
We are especially grateful for the Governor’s commitment to expanding the landmark INSET peer crisis engagement and support team initiative that is setting a national standard for voluntarily engaging individuals who had previously rejected services by providing that uniquely trustworthy, empathetic and reliable relationship with a peer who has been there and who meets them where they are, both in terms of what they want and where they live.
NYAPRS and the MHA of Westchester created this approach, which has engaged 80% of a group who would otherwise have been taken to court and placed on a Kendra’s Law order. But the law is clear that court ordered treatment should only be used as a last resort and in the least restrictive setting. Every county should have a program like INSET as that first resort that can make all the difference in helping people in crisis and diverting them from avoidable, expensive and traumatizing incarceration or hospital admissions.
The budget adds 1,000 hospitals beds but simply adding more hospital beds will not solve New York’s mental health crisis and may well continue New York’s record of failed discharges and recidivism, especially if they are involuntary. Once people are admitted, it is essential that people leave with someone to walk with them into the community and provide up to a year of support: we call them peer bridgers. It is also essential that people are afforded a place to live that will accept not exclude them because of active struggles with symptoms and/or addiction: we call those housing first beds. We believe some of OMH’s new beds are indeed housing first ones and are awaiting clarification. Finally, it’s essential that people have a supportive place to go, often a clubhouse or peer recovery center. We greatly appreciate the inclusion of a higher level of accountability around discharge practices and expansion of the CTI teams but we must ensure that the needs identified above are met.
We also are very troubled by the return to the past symbolized by rebuilding beds on state hospital campuses, a terrible alternative to providing an appropriate complement of community crisis stabilization and respite services.
The huge disappointment here is a 2.5% COLA, despite a climate where the consumer price index rose by 8.5%. Mental health and addiction recovery service providers will speak with one loud voice in the coming weeks and will call on the Governor and Legislature to do due justice here. Adding all of the services below will provide false hope without an adequate COLA, as agencies already are struggling with high job vacancy rates! Our workforce is stretched beyond thin.
Several weeks ago, I was unable to find a crisis apartment or respite bed for a women in grave crisis, simply because the agencies that ran those programs couldn’t find staff to work there. The result was a completely avoidable involuntary admission and injection.
Make no mistake here though: Governor Hochul deserves our great gratitude for her unprecedented investments in services for New Yorkers with major mental health, addiction and trauma recovery challenges. We look forward to working together with her and the legislature to build on the strong start she has afforded us and make it the budget of a lifetime.
NYAPRS First Look at Governor Kathy Hochul’s 2024-24 Executive Budget Proposal
WORKFORCE
Cost Of Living Adjustment (COLA).
-
The Executive Budget includes a 2.5 percent COLA to OPWDD, OMH, OASAS, Office of Children and Family Services (OCFS), Office of Temporary and Disability Assistance (OTDA), and the State Office for the Aging (SOFA) community providers.
-
The bill would require local government units or direct contract providers receiving this COLA to account for their use of the funds and would authorize agency commissioners to recoup funding if it is not used consistent with statute or appropriation.
Minimum Wage Hike
-
an additional $38 million in State funds to support minimum wage increases, including indexing minimum wage to inflation, for staff at programs licensed, certified, or otherwise authorized by OPWDD, OMH, and OASAS.
Recruitment and Retention of Psychiatrist, Psychiatric Nurse Practitioners and Other Licensed Clinicians in mental health programs licensed by the NYS Office of Mental Health: $14 million
Qualified Mental Health Associate Title
-
Very promising: the Governor creates a degree in counseling in substance use that is a combination of school and in person work experience, helping create the ability for paraprofessional in the field to be able to utilize school and hands on experience to help support individuals and they move towards their recovery
HOUSING
Create New Residential Programs
This includes:
-
500 new Community Residence – Single Room Occupancy (CR-SRO) beds,
-
900 Transitional Step- Down Beds,
-
750 permanent Supportive Housing beds.
These come with $890 million investment in capital funds.
Also
-
600 licensed Apartment Treatment beds and 750 scattered site Supportive Housing beds that don’t require capital investment.
Increase Support for Existing Residential Programs.
-
The FY 2023 Enacted Budget made a two-year commitment of an additional $104 million – $65 million in FY 2023 and another $39 million in FY 2024 – for existing community-based residential programs and included legislation to extend property pass-through provisions to include OMH’s supported housing
ALTERNATIVES TO COURT MANDATED OUTPATIENT SERVICES
Expand INSET Program.
-
$2.8 million to create 3 new INSET alternative to Kendra’s Law AOT teams that will offer peer-based outreach and engagement for adults who might otherwise be taken to court and placed on a coercive treatment order. NYAPRS and the MHA of Westchester designed this landmark model, which has successfully engaged 80% of a group who had previously rejected traditional services.
EMPLOYMENT
Expansion of the Medicaid Buy In for Working New Yorkers with Disabilities which allows New Yorkers with disabilities to work and keep their Medicaid This bill would make statutory changes to expand the Medicaid Buy-In program for working people with disabilities by
-
Increasing the resource level and income limit for eligibility for this 250% of the Federal Poverty Level (FPL) to 2,250% of the FPL and would incorporate premiums on a sliding income scale for incomes 250% of the FPL and greater. The program would also remove the age limit, currently set at 65 years old and would exempt income from responsible relatives when determining the disabled applicant’s income eligibility level.
The program would be capped at 30,000 eligible participants.
This bill will result in a cost to the State of $60 million annually.
Individual Placement and Supports (IPS).
-
$3.3 million for the implementation of the Individual Placement and Support (IPS) program
CRIMINAL JUSTICE REFORMS
Doubling Investment in Alternatives to Incarceration.
-
$15.7 million in additional State funding, for a total of $31.4 million, to support the alternatives to incarceration (ATI) program that provides pretrial release services, community service programs, employment focused services, defendant screenings, and probation violation residential centers. Investments will be targeted to divert individuals with mental health needs and substance use disorders from incarceration.
Triple Investment in Reentry Services
-
$7.7 million in additional State funding, for a total of $11.5 million, to reduce repeat or further offenses by meeting the behavioral, health, employment and educational needs of individuals returning to their communities after incarceration.
HOSPITALS
1,000 inpatient psychiatric beds which is part of a multi-year plan to increase operational capacity at mental health facilities.
-
850 currently offline inpatient psychiatric beds at public hospitals licensed under Article 28
-
150 new State-operated inpatient psychiatric beds.
IMPROVED ADMISSION AND DISCHARGE PLANNING
-
50 New Critical Time Intervention Teams (Wrap around services from discharged practices for housing and job support)
-
Development of comprehensive standards for discharges from hospitals
OUTPATIENT SERVICES
-
12 new Comprehensive Psychiatric Emergency Programs, including $60 million in capital funding
-
42 new Assertive Community Treatment teams
-
8 new Safe Options Support teams
-
42 new Health Home Plus Care Managers:
-
start-up funding and operating costs for expanded clinic capacity at 20 sites.
-
26 new Certified Community Behavioral Health Clinics (CCBHC) The Budget will establish joint licensure by OMH and OASAS for these programs and create an Indigent Care Program to protect providers from uncompensated care.
CRISIS SERVICES
Support the Development of the 988 Crisis Hotline
-
$60 million to build on last year’s investment of $35 million
Strengthen Suicide Prevention and Emotional Supports.
-
$10 million in grants to suicide prevention programs targeting high-risk youth
Enhance Children’s Mental Health Programs.
-
additional $12 million in the Healthy Steps program and Home-Based Crisis Intervention (HBCI) teams.
MEDICAID
-
Creation of a new Statewide Health Care Facility Transformation Program Statewide V)
Enhance Eating Disorder Program
-
$3.1 million to bolster treatment of individuals with eating disorders. Investments will support three existing Comprehensive Care Center for Eating Disorders (CCCED) and OMH will pursue Medicaid coverage for licensed residential eating disorder programs.
Interagency Coordinating Council for Services to Persons who are Deaf, Deafblind, or Hard of Hearing
-
$250,000 to restore the Interagency Coordinating Council for Services to Persons who are Deaf, Deafblind, or Hard of Hearing, within the Office of the Chief Disability Officer (CDO). The CDO will help coordinate council operations, engage with stakeholders across the State, gather data, and formulate policies to serve the community.
MENTAL HEALTH PARITY
Commercial and Medicaid Coverage Expansion
Legislation will require New York State-regulated insurers to cover and reimburse for behavioral health services, including medications for substance use disorder and telehealth payments for behavioral health and developmental disability services.