On Wednesday, February 5, Associate Executive Director of Policy Alice Bufkin submitted testimony to the Senate Finance Committee and the Assembly Ways and Means Committee for a Joint Hearing on Mental Hygiene in the FY26 Executive Budget. On behalf of CCC, the testimony explains how data procured through a coalition CCC co-leads called the Campaign for Healthy Minds, Healthy Kids (HMHK) shows that 3 out of 4 children who need behavioral health services are not receiving them and that this issue is largely due to long wait times resulting from underinvestment in the workforce. The testimony explains how many additional providers in specific service areas are needed and provides data from clinics on just how long families are waiting. The data is clear: more budget investment is needed to keep our youth healthy and to tackle this ongoing crisis.

Read the testimony with compelling data visuals below.

Testimony of Alice Bufkin
Associate Executive Director of Policy
Citizens’ Committee for Children of New York

To the Senate Finance Committee and the Assembly Ways and Means Committee
Joint Hearing on Mental Hygiene in the FY26 Executive Budget
 February 5, 2024

Since 1944, Citizens’ Committee for Children of New York has served as an independent, multi- issue child advocacy organization dedicated to ensuring every New York child is healthy, housed, educated, and safe. CCC does not accept or receive public resources, provide direct services, or represent a sector or workforce; our priority is improving outcomes for children and families through civic engagement, research, and advocacy. We document the facts, engage and mobilize New Yorkers, and advocate for solutions to ensure the wellbeing of New York’s children, families, and communities.

Thank you Chair Krueger, Chair Pretlow, and members of the Senate and Assembly Committees for holding this Joint Hearing and allowing us the opportunity to respond to Governor Hochul’s FY26 Executive Budget.

CCC helps coordinate the Healthy Minds, Healthy Kids Campaign (HMHK), a statewide coalition committed to ensuring all children in New York have access to the high-quality behavioral health services they need. Through this coalition, we work directly with parents, young people, advocates, and providers throughout the state who all have the same story to tell: New York children, youth and families are facing a crisis in accessing mental health and substance use disorder (SUD) services. They are forced to wait months or even years for this desperately-needed care. As a result, parents are leaving their jobs so they can navigate the mental health system for their children; children are cycling in and out of ERs and hospitals; and young peoples’ needs are becoming more acute, complex, and difficult to address as they grow into adults.

At the center of this crisis is a deeply-underfunded children’s outpatient system, which is preventing children and youth from accessing the preventive services they need. In fact, a recent study by the Healthy Minds, Healthy Kids Campaign found that at most, 1 in 4 New York children covered by Medicaid are accessing the outpatient behavioral health (mental health and/or substance use disorder) services they need.[i]

Unfortunately, chronically low reimbursement rates have led to massive staff turnover and vacancies, and widespread provider shortages. HMHK found that an additional 6,281 providers are needed to address the outpatient workforce shortage. This includes:

These shortages are, in turn, leading to unacceptably long waitlists for services. To understand the depth of the waitlist crisis, HMHK conducted a survey in the Fall of 2024 of outpatient providers across the state.[i] We received a total of 43 responses representing Long Island, New York City, Mid-Hudson, Capital District, Mohawk Valley, Southern Tier, Western New York, Finger Lakes, Central New York, and the North Country (Empire State Development Regions). Provider types included the following children’s outpatient services:

• Article 31 Outpatient Clinics (22 responses)
• Children and Family Treatment and Support Services (CFTSS) Therapeutic Services: Psychosocial Rehabilitation Services (PSR), Other Licensed Professional (OLP), and Community Psychiatric Supports and Treatment (CPST) (27 responses)
• CFTSS Peer Services: Family Peer Support Services (FPSS) and Youth Peer Support (YPS) (18 responses)

These responses indicate striking and widespread waitlists and delays in care. All program types rated barriers such as inadequate reimbursement, staff turnover, and staff vacancy as significant, while CFTSS program types also nearly unanimously identified inadequate reimbursement for travel, care coordination, and documentation barriers as significant.

A majority of OMH Article 31 Clinics report children and families waiting for services:

A majority of OMH CFTSS therapeutic services (Psychosocial Rehabilitation, Other Licensed Practitioner, Community Psychiatric Supports and Treatment) report children and families waiting for services:

A majority of OMH CFTSS Peer Services (Family Peer Support Services, Youth Peer Supports) report children and families waiting for services:

This data could not be more clear: providers do not have the capacity to serve the number of children who need care, and as a result families are sitting on waitlists for weeks, months, and even years to get the care they need. Families can’t afford to wait – New York State must reform outpatient rates to reverse the waitlist crisis.

Recommendations

Highlights from the Executive Budget

We are grateful to have a Governor who has elevated the issue of mental health – including children’s mental health – as a priority. We support a number of investments in the FY26 State Budget that will have a positive impact on children’s behavioral health access, including the following new investments:

• $18 million for the Community Mental Health Repayment Practitioner Loan Repayment Program, including the $4 million carveout for practitioners serving children
• $1 million investment in comprehensive clinical assessment hubs to diagnose and refer youth with complex behavioral health needs to services (without hospitalization)
• $1.5 million increase in funding for Teen Mental Health First Aid
• $10 million to establish additional clubhouses and youth safe spaces
• $1 million to enhance monitoring and compliance with the 2024 Medicaid rate mandate law

We also support a number of policy proposals included in Article VII of the Executive Budget:

• Modify Managed Care Provisions to authorize the Commissioner of Health to impose enhanced penalties on managed care organizations for breach of model contract and failure to meet performance standards (HMH Part E)
• Ensuring runaway and homeless youth who receive services at approved RHY crisis service programs or transitional independent living support programs can consent to their own mental health care and substance use treatment. (HMH Part DD)

Finally, we urge State leaders to build on proposals in the Executive Budget in the following ways:

• Increase the Governor’s 2.1% Targeted Inflationary Increase (TII) for mental health and human services program to 7.8%. We greatly appreciate Governor Hochul continuing to commit to a cost of living increase for this vital workforce. However, the depth of the need is enormous and requires sustained and increased investments. We join advocates from across the state in urging the Governor and elected leaders to support a 7.8% COLA in response to widespread staffing shortages and rising inflation that are driving the waitlist crisis for children and families. (HMH Part FF)
• Invest $195 million from the MCO Tax to fund rate enhancements in the children’s outpatient system to address workforce shortages and the waitlist crisis. The current proposal directs MCO revenue to hospitals, nursing, homes, and primary care physicians, but fails to make investments in critical mental health services for children and families. A portion of this funding should be used to strengthen the array of outpatient children’s behavioral health services, including Article 31 clinics, Article 32 clinics, Children and Family Treatment and Support Services (CFTSS), and Home and Community Based Services (HCBS).

Greater Investments in the Children’s Outpatient System Are Urgently Needed

Despite the investments in the Executive Budget outlined above, it is deeply concerning that the proposed budget fails to make any meaningful investment in capacity of the children’s outpatient system. The data cited above underscores the urgency of strengthening upstream services and addressing the workforce crisis that has put families on waitlists and children in emergency rooms, hospitals, and residential settings every single day.

CCC therefore joins members of the Healthy Minds, Healthy Kids Campaign in urging State leaders to make the following investments to help sustain the children’s behavioral health system and create a long-term pathway for expanded access to high quality services.

1. Invest $195 million in the children’s behavioral health outpatient system to address the severe reimbursement rate challenges that have undermined the ability of children to access timely, high-quality services.

The Campaign for Healthy Minds, Healthy Kids (HMHK) developed a first-of-its-kind study of reforms needed to address rate inadequacy and workforce shortages in programs including Outpatient Clinics (Article 31 and 32s), Child and Family Treatment and Support Services (CFTSS), and Home and Community-based Services (HCBS). These rigorously-developed recommendations include adjusting outpatient rates to keep pace with inflation, enabling the children’s clinic rates to reflect the complexity of serving children and families, increasing pay for providers who coordinate with a growing array of care managers, and increasing funding for CFTSS and HCBS to address the true cost of providing home and community-based care.

Trend rates to keep pace with inflation

Trends maintain, but do not advance, the children’s behavioral health delivery system

• 2% trend for children’s behavioral health clinic services: $10,749,230
• 2% trend for children’s HCBS and CFTSS services: $2,107,748

Establish a care team coordination fee

Providers are responsible for coordinating with a growing array of care managers. They should be compensated for the time it takes to do so.

• $7.50 Per Served Member Per Month (PSMPM) fee for children’s clinics $12,112,200
• $7.50 PSMPM for CFTSS and children’s HCBS $8,324,766

Adjust children’s clinic rates to reflect the extra effort children require

Account for the additional costs of navigating the complex web of service systems children and their families are at the nexus of. Enable providers to expand their capacity to meet the need.

• 35% enhancement for clinic visits provided to children $117,569,701

Adjust CFTSS and children’s HCBS to account for actual volume

Enable providers to expand capacity by acknowledging that the anticipated volume efficiencies have not materialized.

• Increase in CFTSS and children’s HCBS rates to reflect the lack of economies of scale $44,460,329

Total investment in children’s behavioral health              $195,264,778

Without this targeted investment in outpatient behavioral health services, the behavioral health workforce will continue to disappear, the capacity to care for children will continue to shrink, and New York’s children will sit on longer wait lists or go entirely without urgently needed services. If the HMHK proposed reforms are enacted, community behavioral health providers could hire over 1,300 additional clinicians and New York’s outpatient mental health system could serve over 26,000 additional children. Notably, once in place these recommendations would ensure the workforce and service capacity can continue to grow to meet demand.

2. Require commercial health plans to provide the same broad range of services to children, youth and families as those that are currently available with Medicaid insurance.

Last year, New York State took a historic step in requiring commercial insurers to reimburse in-network community-based mental health and SUD provider agencies at rates comparable to those paid by Medicaid for the same services. This was a critical progress towards supporting families with commercial plans who struggle to find providers who will take their insurance, and as a result are not able to secure timely mental health and SUD supports for their children.

However, the new law does not address the disparity between the mental health/SUD services Medicaid is required to provide and the services commercial plans are required to provide. For example, Children and Families Treatment Support Services (CFTSS) and Home and Community Based Services (HCBS) are two important services that offer a flexible array of non-acute care including therapy, rehabilitation services, and family and youth peer support within a child’s home and community. These important services are required to be available to children, youth, and families with Medicaid coverage but not families with commercial insurance.

All new Yorkers deserve access to the same array of life-saving mental health and SUD supports, yet families across the state are denied this care because commercial plans do not cover them. We urge state leaders to support budget language requiring regulated commercial insurance and Child Health Plus to provide coverage for children’s mental health and SUD services consistent with coverage under the NY Medicaid Program.

Thank you for the opportunity to provide testimony today.

[i] The full report and regional breakdowns can be found at: https://healthymindshealthykids.org/bh-gap-analysis/?region=New+York+State

[i] The full results from the provider survey can be found at: https://healthymindshealthykids.org/hmhk-publication/?post_type=data_publications&post_id=20315