March 2, 2020
New York’s children are facing a life-threatening mental health crisis caused by the governor’s unwillingness to move forward to implement his own 2011 Children’s Medicaid Redesign Plan. Suicides are spiking and are now a leading cause of death for children age 15-19. More than half of children with a diagnosed mental health condition do not receive the treatment they need. The situation is even worse for African-American and Latino children and children living far from the state’s urban centers.
This crisis didn’t appear overnight. The governor has postponed implementation of the plan for nine years, while claiming publicly and to the federal government his intention to improve access and availability for thousands of children, while using the Medicaid cap as justification for doing nothing. Among the more cynical gambits in the state’s history of delay is the governor’s latest effort to hide plans to cut services to children in a new Medicaid Redesign Team planning process.
Last summer and again in January, the state cut reimbursement rates for new Child and Family Treatment and Support Services, designed to increase access to life-saving mental health treatments for children. Services include crisis intervention, family peer supports, community psychiatric supports and substance use treatment. Even prior to these cuts, that help reached fewer than 5% of the 200,000 children who need it.
Meanwhile, Children’s Health Homes, which offer care coordination to children with complex behavioral health needs, reach just 16% of the roughly 170,000 children the state projected to require such care. Additionally, the governor has enacted a 1% across the board cut to Medicaid, including to Children’s Health Homes. This cut will negatively impact care for the 28,000 children already enrolled and delay or deny care for the 142,000 children in need of these services.
It is a well-known fact that New York’s Medicaid fails children needing mental health services. Parents are offered a choice among 18 health insurance plans, all of which are paid monthly and none of which deliver timely treatment or access to the full array of services outlined in their contracts with the state. Each plan carries top-heavy administration, a poorly paid and oversubscribed network of providers and overly complex navigation hazards that keep parents guessing and children waiting for life-saving treatment.
To make matters worse, many plans don’t even provide mental health services directly. They farm out this responsibility to third-party companies, creating another layer of administration and offering unregulated, low-quality services.
Navigating these plans is a full-time job for families. Parents spend endless hours trying to locate in-network services only to find that practices are closed to new patients and will not see their child. That the governor sees this as the moment to go back to the drawing board instead of following through on the promise made to New York families cries out for relief.
Reducing the crisis in children’s mental health to a call for savings in the state’s poorly managed Medicaid program is shocking. Even more so is the governor’s expectation that counties and enrollees will pick up the tab for the state’s lack of oversight and poor fiscal management. Gutting city and county budgets to pay off the state’s deficit means fewer dollars available for other essential services children and families depend on.
There are five things the governor can do to set things right: Implement the 2011 Children’s Medicaid Redesign Plan. Don’t raid local budgets to plug the budget hole. Reduce the number of managed care plans. Consolidate children’s mental health provider networks and set base rates for clinical treatment high enough to stimulate service availability across the state. Use the savings to beef up complex care management for children to make it easier for families to secure the care they need.
New York must act now.