Alliance’s First Look at Governor Hochul’s 2024-2025 Executive Budget Proposal:
1.5% COLA and Minimum Wage Hike; Criminal Justice Reforms
Closure of up to 5 Prisons: Time to Close 5 State Hospitals!
Hospital Expansion, New Hospital Admission/Discharge Policies
Requiring Commercial Plans to Take Medicaid Rates
Supported Housing Stipends and Capital Funds
by Policy Director Luke Sikinyi and CEO Harvey Rosenthal January 17, 2024
Alliance Note: We are pleased to see Governor Kathy Hochul’s unremitting commitment to expand the amount and impact of mental health services again this year. The Governor possesses a very strong and sincere devotion to our community that has been very evident throughout a number of events that we’ve attended over the past year.
While there are a number of much needed new initiatives, the most pressing point is the crushing crisis faced by our sector and workforce and the lack of an adequate COLA to support their efforts. We don’t have sufficient funds now to attract workers to address the over 30% vacancy rate at most programs across the state: it’s almost impossible to imagine how we’ll staff the critically important new programs the Governor is proposing. While we appreciate the 1.5% COLA in the budget, the Executive and Legislature must make a substantive increase here, at minimum to meet the current 3.2% standard.
Elsewhere in the budget, the Governor is proposing to shutter 5 state prisons. Governor Hochul should follow suit in our hospital-heavy system in the same way that we closed 5 state psychiatric hospitals 30 years ago to create hundreds of millions of Reinvestment dollars that gave birth to the peer support and recovery sector. New York operates more state hospitals than any other state; in comparison, California operates 5 such hospitals in a state with twice the overall population (39 million). The Governor has regularly referenced the history we’ve had of state disinvestment: now is the time to re-adopt a policy of reinvestment to make better use of precious taxpayer dollars. Moreover, closing and consolidating 5 state hospitals will allow for full staffing and services at the other state hospitals.
The Governor’s budget also references the $7.5 Billion 1115 Medicaid demonstration waiver which aims to improve health equity by investing in safety net hospitals, improving integration of primary care and behavioral health, and addressing health related social needs. We look forward to working with DOH and OMH to see that these funds are best used in the community.
The Alliance will intensify our advocacy efforts to urge the legislature and Governor to include those member priorities that did not appear in the proposed budget, including Daniel’s Law Mental Health first responder pilots to support New Yorkers in mental health or substance use crisis, more peer bridgers to support people as they transition from hospital back to their communities, more peer run crisis respites to offer an alternative to unnecessary hospitalization and more Intensive and Sustained Engagement Team (INSET) programs to engage people who would otherwise be considered for Kendra’s Law court orders.
Attend the Alliance’s 27th Annual Legislative Day on March 5th! Join our fight to raise the COLA, expand community services so all New Yorkers have access to the care they want, make needed reforms to the criminal justice system, provide more access to voluntary alternatives to hospitalization, and give more people the opportunity to live and work in their communities of choice.
Here are more details of her 2024-25 Budget proposal:
As we said above, while we appreciate the 1.5% Cost-of-Living-Adjustment and $57 million in minimum wage hikes for OMH, OASAS and OPWDD providers, our field continues to be in an unmitigated free fall! We will be working arduously over the coming weeks with the Legislature, Executive and advocates to increase the COLA to the 3.2% Consumer Price Index.
There are some proposed measures that we do support including:
- New Recruitment and Retention initiatives that will focus on job marketing, creating a job bank, creation of a Behavioral Health Fellowship Program and new mechanisms to credential mental health paraprofessionals.
- Loan Forgiveness Program specifically for licensed mental health clinicians serving children and families ($4 million)
- Remove Degree Requirement for some state workers via a State Department of Civil Service Hiring for Emergency Limited Placement (HELP) program.
- The budget would allocate tens of millions of dollars to open another 125 State-operated inpatient psychiatric beds (including 15 for children and adolescents, 85 for adults, and 25 forensic) and 75 Transition to Home Unit (THU) beds in one State-operated and two community-based facilities. As we’ve repeatedly pointed out, far too often more hospitals beds result in far more trauma than more recovery and result in countless failed discharge plans and very high rates of recidivism, homelessness and incarceration.
The $50 million associated with putting up these beds would be far better redirected to promote a systematic expansion of community-based prevention, crisis support and hospital and jail and prison diversion models, including the use of INSET peer led engagement teams, the 988-crisis line, peer crisis stabilization, crisis respite and living room drop-in services.
- Compliance with New Guidance for Mental Health Admissions & Discharges ($7 million): We strongly support Governor Hochul’s plan to lower the number of people who fall through the cracks after being discharged from a hospital, with a much greater focus on screening for social determinants of health and the presence of complex conditions. At the same time, we are concerned that the required assessments for violence will press discharge planners to look for violent tendencies that do not exist.
We strongly support the Governor’s goal to divert more people with mental health issues from jails and prisons, most notably the $6.2 million to provide mental health specialists and peers in mental health courts. At the same time, we are urging the Governor and Legislature to enact the Treatment not Jail Act which establishes mental health courts in every county while removing the requirement of a guilty plea to enter into a much needed diversionary agreement.
Other such initiatives include:
- $2.8 million to provide housing and supports to individuals with mental illness experiencing homelessness and/ or involved in the criminal justice system
- $9.6 million to enhance and expand specialized Forensic Assertive Community Treatment (FACT) teams
- Establish a team within OMH that will work with mental health courts and providers to ensure individuals are connected to the services they need.
- $290 million to restore the effectiveness of the continuum of the criminal justice system, including community investment, crime prevention, law enforcement, prosecution, and reentry services.
- $2 million in additional State funding to increase the number of housing vouchers,
- Expand college programming in all state prisons.
- $1.3 million investment into the Justice Center’s Investigations Unit to support an additional 18 FTEs across six different titles, some of whom we hope will be used to maximize oversight of the enforcement of HALT legislation that banned the use of solitary confinement for members of our community.
We are pleased to see that the Governor budget explicitly funds last year’s commitment to expand housing investments:
- $43 million to increase stipends for over 17,000 OMH Supported Housing units to keep pace with rising property costs.
- $890 million capital investment for 3,500 new housing units over 5 years.
$119.5 million for an array of existing and new crisis and respite beds, home and community-based services waiver slots, supported housing, mental health urgent care walk-in centers, mobile engagement teams, first episode psychosis teams, family resource centers, evidence-based family support services, peer-operated recovery centers, suicide prevention services, community forensic and diversion services, tele-psychiatry, transportation services and family concierge services. Details pending.
Recovery Through the Lifespan
The budget proposes several provisions to improve mental health outcomes for New Yorkers of all ages. These included increased funding and initiatives for older adults, children and youth, and pregnant and postpartum New Yorkers. We thank Senator Samra Brouk, Senate Mental Health Committee Chair, for championing the new Maternal Mental health initiatives.
Maternal Mental Health
- Improve Maternal Mental Health. The Budget will focus on mental health and substance abuse issues during pregnancy, some of the leading causes of poor birth outcomes, by increasing access to comprehensive mental health screening tools in pregnancy and postpartum.
- $1.5 million annually to expand Project TEACH (Training and Education for the Advancement of Children’s Health)
Youth Mental Health
- 12 new youth Assertive Community Treatment (ACT) teams: $12 million
- Expanding peer-to-peer supports, $2 million
- Enhance Partial Hospitalization Program (PHP) children’s services rates by 25 percent, add new PHP programs.
- Make available OMH Social Media Resources for Youth and Caregivers .
Invest in New York’s Aging Population.
- Funding programs statewide to support aging in place and to fight financial exploitation, elder abuse, and isolation of the aging.
- Increasing funding for the Master Plan for Aging (MPA), a comprehensive, interagency vision for seniors living in New York State.
- $1.0 million to strengthen New York’s Enhanced Multidisciplinary Teams to enable them to better address cases of elder abuse and exploitation.
We are extremely pleased to see a commitment to:
- Revise and release a new Olmstead Plan in 2024: $250,000
- Boost New York’s Employment First policies for people with disabilities.
- Expand the Medicaid Buy-In Program for working people with disabilities,
- Increase the number of Civil Service Section 55-B positions for people with disabilities within the State workforce
- Allow greater flexibility for the performance of certain nursing tasks by unlicensed employees of providers certified by OPWDD in non-certified community-based settings, such as a person’s private home or apartment.
Addiction and Substance Use Services
- $5 million to support existing recovery community centers, which are currently funded by Federal grants that are expiring in October.
Medicaid and Commercial Insurance
We are excited to see how the groundbreaking Medicaid 1115 Waiver Amendment, which includes $7.5 billion in funding over the next three years, will enhance our ability to serve New Yorkers with complex conditions. The waiver cannot be another bailout for hospitals. Included here is:
- $42.2 million to increase reimbursement for services provided in DOH-licensed facilities and private practices treating mental health conditions.
- $74 million in Patient-Centered Medical Home enhancements for adults and children.
- $10.4 million to increase reimbursement rates for healthcare providers serving individuals with physical, intellectual, or developmental disabilities.
- $1 million to expand coverage for Adverse Childhood Experiences Screenings to all adults enrolled in Medicaid.
The Alliance is working on a more comprehensive summary, as well as a webinar with several experts, which will be made available to our members.
Require Commercial Insurance to pay at least the Medicaid rate for State-Licensed Outpatient mental health and substance use services!
Other Health provisions
- Improve Access to Primary Care.
- Increases funding for adult and pediatric enhancements for Patient-Centered Medical Homes (PCMH).
- Expands coverage for Adverse Childhood Experiences (ACES) screening to all adults in Medicaid.
- Increases rates for providers serving Medicaid members with intellectual, developmental, or physical disabilities and for adult and children’s mental health services provided in a hospital setting or private physician practice.
- Expand access to quality dental care.
- Continue the State Takeover of Local Medicaid Costs. The state will assume nearly $7.4 billion in costs that would have otherwise been incurred by localities.
Investment for the LGBTQIA+ Community.
- $12 million annual investment in sexuality-related programs.
Ease Access to Gender-Affirming Care.