Alliance Alert: In 2015, the Cuomo Administration moved most OASAS and OMH community-based services into the state’s Medicaid managed care program— since that time, mental health and substance use recovery providers have experienced major struggles to provide timely access to care and continuity of care for the individuals and families we serve. We struggle with serious reimbursement delays and increasing mandates that require prior authorization and concurrent review for the services we provide. Reimbursement delays of this magnitude result in our inability to recruit and retain the workforce we need to serve the New Yorkers who need and deserve our services.
We are urging Governor Hochul to include a proposal in her SFY 2026-27 Executive Budget that removes or ‘carves out’ community-based outpatient, rehabilitation, and residential OASAS and OMH mental health and substance use disorder services from the state’s Medicaid managed care program. Please see below and act today!
CALL TO ACTION!
SEND LETTERS TO GOVERNOR HOCHUL ON
THURSDAY, NOVEMBER 6
EVERY NEW YORKER DESERVES TIMELY ACCESS TO MENTAL HEALTH AND SUBSTANCE USE SERVICES AND SUPPORTS
WITHOUT BARRIERS, MIDDLEMEN, OR DELAYS —FOR THE TENS OF THOUSANDS WHO RELY ON THEM DAILY.
Medicaid managed care is detrimental to New Yorkers struggling to obtain mental health and/or substance use disorder services and supports through New York’s public mental hygiene system. Insurer tactics that focus on increasing profits, rather than appropriately managing care, prevent providers from hiring needed staff, launching innovative programs, and competing for new employees in a challenging job market. Annual job vacancy rates hover around 35%, and annual turnover rates are between 20% and 30%. There are long waiting lists for services in many communities across New York.
Insurer tactics that delay/deny important services to Medicaid members, while they delay /deny reimbursement to community-based providers for services rendered months and sometimes years earlier, combined with a lack of robust oversight by state regulators, has forced community agencies to expend scarce resources chasing reimbursement and fighting with handsomely paid middlemen that fail to comply with federal and state parity and other laws, regulations, and contract provisions. The state is wasting taxpayer dollars by paying insurers millions while providers are forced to hire attorneys and additional staff just to fight with them, and all the while, New Yorkers in need of services linger on waiting lists.
New York State can save $400M/year by removing OMH and OASAS outpatient, rehabilitation, and residential services from the state’s Medicaid managed care program. This will open up access to care by ensuring Medicaid members with managed care insurance are not limited to receiving services from only those community agencies that have contracted with the Medicaid member’s insurer.
Let’s stop insurers from profiting off the backs of New Yorkers who need and deserve efficient and effective care, delivered by a culturally competent workforce that is well-prepared and eager to help.
New Yorkers can no longer wait for this critical reform.