The Failed Promise of Children’s Medicaid Redesign

Testimony & Public Comments

November 9, 2021

More than a year and a half into the COVID-19 pandemic, it is nearly impossible to overestimate its impact on the mental and emotional wellbeing of children and adolescents. Between March and July of 2020, 4,200 children lost a parent or caregiver to COVID-19, and approximately 325,000 children were thrust into or near poverty. Children have experienced over a year of profound personal loss, economic instability, housing and food insecurity, and educational disruption. According to the CDC’s Household Pulse data, more than half of all youth aged 18 to 24 living in the New York Metropolitan Statistical Area (MSA) report symptoms of anxiety and/or depression, the highest of any other adult age group. Nationally and in New York, suicide is a growing crisis among communities of color, particularly among young people.

In New York and across the country, the pandemic has led to declines in critical mental health screenings and access to services, even as rates of anxiety, depression, substance use, and suicidal ideation have risen. Children are experiencing serious emotional distress, yet have been unable to access adequate primary and preventive services, resulting in stark increases of psychiatric symptomatology and hospitalizations. This has created a perfect storm that is impacting all children, and disproportionately impacting low-income communities and families of color.

Understandably, recent conversations around children’s mental health have revolved around the impact of COVID-19. The long-term repercussions of the pandemic are staggering, and are continuing to unfold as families experience the uncertainty of the Delta variant and deep and ongoing financial strain. But in New York, emerging behavioral health challenges have been built upon a foundation of an under-resourced and over-taxed behavioral health system for children. Suicide remains the second leading cause of death for children age 15-19, and approximately half of children with mental/behavioral health condition did not receive treatment before the pandemic. A history of inadequate reimbursement rates and a lack of parity enforcement have contributed to a deeply inadequate workforce, leaving families struggling to access both preventive and acute services.

Amid this landscape, Children’s Medicaid Redesign promised to increase the number of children receiving behavioral health care, ultimately enhancing services, access and supports in homes and communities, flexibility in tailoring services to individualized needs, and reducing the number of young people requiring services in more restrictive settings. Unfortunately, we have not seen this promise fulfilled. Given the dire behavioral health crisis facing New York’s children, we believe the State must act now to re-evaluate children’s Medicaid redesign and rapidly develop a new plan to meet the behavioral health needs of children and families.

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