Alliance Alert: We applaud Attorney General Letitia James for securing important reforms that will improve access to mental health and substance use services for EmblemHealth members. The investigation confirmed what many New Yorkers and providers experience every day: so-called “ghost networks,” where insurance directories list providers who are unavailable, not accepting patients, or not actually participating in the plan. When more than 80 percent of listed providers cannot be accessed, coverage exists on paper but not in reality.
Ghost networks reflect deeper problems within Medicaid managed care and commercial plans. People face long delays, repeated denials, and confusing provider lists while trying to get help during moments of crisis. These barriers disrupt services, force families to pay out of pocket, and place additional administrative burdens on community providers already struggling with workforce shortages.
The settlement’s requirements to improve directory accuracy, expand provider networks, ensure timely appointments, and provide restitution are important steps toward accountability. We are encouraged to see continued state action from the Office of Mental Health and Department of Health to strengthen oversight and improve access within the current system.
At the same time, this case underscores the need for structural reform. Behavioral health services continue to face unique access barriers, payment delays, and administrative obstacles under managed care. For these reasons, the Alliance joins advocates across New York in calling for a carve-out of behavioral health services from Medicaid managed care, so that funding flows more directly to community providers and New Yorkers can access services without unnecessary delays or bureaucracy.
Take Action: Urge Lawmakers to Support the Behavioral Health Carve-Out
With legislators back in their districts this week, now is a critical time to make your voice heard. We encourage advocates, providers, people receiving services, and family members to contact their Assemblymembers and State Senators and urge them to push legislative leaders to include the behavioral health carve-out in the upcoming one-house budget bills.
You can quickly send a message to your lawmakers through the NYS Council’s Action Center:
(The letter can be edited to reflect your experience or perspective.)
We are also working to elevate real stories from people and families who have faced barriers to accessing mental health or substance use services through Medicaid managed care, including long waitlists, denials, or difficulty finding in-network providers. Personal experiences are powerful tools for change. If you or someone you know is willing to share their story, please consider stepping forward so we can help ensure policymakers understand the real impact of these systemic barriers. If you are willing to share your experience, please call Lauri Cole at 518 461-8200.
New Yorkers should not have to navigate ghost networks or endless administrative hurdles to receive essential services. True access means real providers, timely services, and a system that puts people before paperwork. Your advocacy can help make that change possible!
FOR IMMEDIATE RELEASE
February 19, 2026
Attorney General’s Press Office/212-416-8060 nyag.pressoffice@ag.ny.gov
Attorney General James Secures Sweeping Reforms Improving Access to Mental Health Care for EmblemHealth Members
OAG Investigation Found Widespread “Ghost Networks” That Prevented New Yorkers from Accessing Mental Health Treatment
EmblemHealth Will Pay $2.5 Million Plus Restitution to Consumers, Expand Mental Health Network, and Submit to Independent Monitoring
NEW YORK – New York Attorney General Letitia James today secured more than $2.5 million from health insurer EmblemHealth (Emblem) after an Office of the Attorney General (OAG) investigation revealed the company repeatedly failed to ensure New Yorkers could access mental health care services. The investigation found that Emblem maintained inaccurate provider directories, overstated the availability of in-network mental health and substance use disorder providers, and failed to comply with state and federal behavioral health parity laws, leaving many New Yorkers unable to find timely, affordable care when they needed it most. Under today’s settlement, Emblem will pay $2.5 million in penalties and fees, provide restitution to members who were forced to pay out of pocket for mental health care, and implement sweeping reforms to improve access to mental health and substance use disorder treatment.
“As millions of New Yorkers struggle with anxiety, depression, and substance use disorders, ensuring access to quality, affordable mental health care is more essential than ever,” said Attorney General James. “Health insurers cannot mislead consumers with inaccurate provider directories while families are left without care. We are requiring Emblem to make meaningful changes so that New Yorkers can actually access the behavioral health treatment their insurance promises.”
Emblem covers approximately 1.5 million New Yorkers through commercial plans, Medicaid managed care, Child Health Plus, the Essential Plan, and New York City employee health plans. The OAG launched an investigation into Emblem in 2023 and conducted a secret shopper survey of mental health and substance use disorder providers listed in the company’s online directory. The investigation found that Emblem’s directories contained many errors, including listings for providers who were unreachable, no longer practicing, not accepting new patients, or not actually in the plan’s network. As detailed in Attorney General James’ report, Inaccurate and Inadequate: Health Plans’ Mental Health Provider Directories, OAG determined that more than 80 percent of surveyed behavioral health providers Emblem listed as accepting new patients were effectively unavailable – creating “ghost networks” of providers that exist on paper but not in reality. Emblem’s own surveys showed similar results.
As a result of OAG’s investigation, Emblem will pay $2.5 million in penalties, fees, and costs and establish a comprehensive restitution process to repay members who were wrongfully forced to pay out of pocket for mental health care services because they were unable to schedule an appointment with an in-network provider. In addition, Attorney General James is requiring Emblem to overhaul its policies and practices to ensure online provider directories are accurate and up to date. Emblem must:
- Correct listings within two business days of learning that information is incorrect or a provider is no longer accepting new patients;
- Put a link next to each provider listing that allows members and providers to report inaccurate listings directly;
- Require providers to verify directory information every 90 days and remove providers who fail to verify or are no longer available;
- Remove providers who have not submitted claims within the last 90 days from the directory unless they verify their continued participation;
- Implement new systems to track, monitor, and resolve complaints related to directory accuracy and access to care; and
- Conduct regular secret shopper surveys to assess access to care and publicly report the results.
If Emblem provides inaccurate provider directory information that leads a member to receive an unexpected out-of-network bill, the company must ensure the member pays only their usual copay or deductible.
In addition, Attorney General James is requiring Emblem to take steps to ensure members can access mental health and substance use disorder treatment appointments within specified time frames, including 24 hours for urgent care and 10 business days for an initial outpatient appointment. If a member is unable to secure a timely appointment with an in-network provider, Emblem must allow the member to see an out-of-network provider but only pay their in-network copay or deductible. The settlement also requires Emblem to develop and carry out a comprehensive behavioral health provider recruitment and retention plan to expand its network statewide and reduce administrative burdens on providers. An independent monitor will oversee the restitution process and Emblem’s compliance with these reforms.
This action is the latest in Attorney General James’ ongoing effort to protect New Yorkers’ access to mental health care and take on mental health ghost networks. In December 2025, Attorney General James won a lawsuit protecting over $1 billion in mental health grants for students and young people. In August 2025, Attorney General James took action to overhaul MVP Health’s mental health ghost network. In April 2025, Attorney General James secured a landmark settlement with WMCHealth to expand access to inpatient psychiatric care in the Hudson Valley and overhaul how the hospital system treats patients experiencing mental health crises.
This matter was handled by Assistant Attorneys General Michael Reisman and Carol Hunt, with assistance from Assistant Attorney General Gina Bull, under the supervision of Health Care Bureau Chief Darsana Srinivasan. The Health Care Bureau is part of the Division for Social Justice, which is led by Chief Deputy Attorney General Meghan Faux and overseen by First Deputy Attorney General Jennifer Levy.
###