As budget negotiations come down to the wire, there is pronounced uncertainty surrounding the future of Gov. Kathy Hochul’s proposal to ensure timely access to, and insurance coverage for, life-saving mental health care and substance use disorder. These reforms are a central component of the governor’s plan to address the decades-long crisis in New York’s mental health care system – and eliminating these reforms would hurt the New Yorkers who would most benefit from them.
Simply put, the governor’s proposal will make it more difficult for commercial insurance plans to deny access to medically necessary care for both adults and children. While state and federal behavioral health insurance parity laws have helped improve access, significant barriers remain. Hochul’s mental health plan addresses long-standing gaps in coverage.
Under the proposal, New Yorkers could not be denied medically necessary inpatient services or discharged from a health care facility if their symptoms cannot reasonably be managed through outpatient care. The legislation requires commercial insurance plans to cover life-saving care coordination services, which will further reduce the alarming rate of rehospitalization due to premature discharges and inadequate discharge planning.
Crucially, the governor’s proposal will increase New Yorkers’ ability to access care when they need it. Commercial plans will be required to adopt appointment availability and geographic accessibility standards for behavioral health services. This will also improve access to behavioral health services delivered via telehealth, which remains in high demand after the COVID-19 pandemic.
In addition, Hochul’s plan requires commercial insurance carriers to cover all services provided in school-based mental health clinics, and to pay providers at least the Medicaid reimbursement rate, thereby ensuring children and youth have access to mental health services when and where they need them. These clinics are an essential lifeline for families.
Amid the overdose epidemic, this proposal also plugs crucial gaps in coverage: It clarifies that commercial insurance plans will be required to cover life-saving addiction medication treatments and over-the-counter overdose reversal medications.
The state Assembly did not include these proposed parity changes in its one-house bill. But we are hopeful that continued educational and advocacy efforts will lead to them adding them back in the final budget.
Commercial insurance plans have a critical role to play in Gov. Hochul’s overhaul of the continuum of mental health care. Stripping this proposal from the budget will punch a formidable hole through her landmark plan. Every day we delay implementing these common-sense policy measures is another day that New Yorkers with private insurance will face discrimination and needless risk. We cannot wait any longer.
Glenn Liebman is CEO of the Mental Health Association in New York State. Kayleigh Zaloga is president and CEO of the New York State Coalition for Children’s Behavioral Health. Paul Samuels is director and president of the Legal Action Center. Also contributing to this essay was Sharon Horton, executive director of the National Alliance on Mental Illness – New York State.
