JANUARY 13, 2023
ALBANY – Yesterday, Governor Kathy Hochul outlined her administration’s priorities in her second State of the State address. Speaking in the Assembly Chamber in Albany, Governor Hochul proposed a broad legislative and policy agenda. The Governor’s speech is accompanied by her State of the State Book, which contains 147 proposals, including additional plans related to reproductive justice, economic development, healthcare and streamlining government operations.
The Fiscal Year 2024 Executive Budget – which Governor Hochul will present later this month – will provide the necessary details to examine the Governor’s proposals, determine their impacts on our community and inform MHEP’s advocacy strategy.
In her State of the State, Governor Hochul promised to make “essential and long overdue” fixes to the state’s mental health system. “We have underinvested in mental health care for so long and allowed the situation to become so dire that it has also become a public safety crisis as well,” remarked Governor Hochul. She announced a number of plans pertaining to the provision of mental health services. The Governor wants to prohibit insurance companies from denying access to medically necessary, high-need, acute and crisis mental health services for adults and children. Governor Hochul also plans to expand commercial and Medicaid coverage of mental health services. She plans to support legislation that closes gaps in coverage of behavioral health services after an individual leaves a hospital or emergency department.
Governor Hochul also wants to broaden school based mental health services. Her proposal includes ensuring school-based mental health services are more accessible for youth with commercial insurance (provided by a private insurance company) by requiring reimbursement equivalent to Medicaid. She details a plan to increase Medicaid rates for Article 31 school based satellite clinics and increasing Medicaid rates for school-based wraparound services. She also references a plan to invest in annual school-based partnership and capacity grants to provide the startup funding to get these expanded school-based services off the ground quickly.
Additionally, the Governor pledged to increase operational capacity for inpatient psychiatric treatment by 1,000 beds. According to the Governor, the number of inpatient psychiatric hospital beds that are operating in New York have declined by roughly 20 percent since 2014, from 9,320 to 7,471.
Governor Hochul plans to direct Article 28 community hospitals to immediately bring inpatient psychiatric beds online. Concurrently, the Governor will propose legislation to allow the Office of Mental Health (OMH) to fine hospitals or non-compliance with their operating certificate at a rate of up to $2,000 per violation, per day.
Governor Hochul will also open 150 new adult beds in State-run psychiatric hospitals. One hundred of these beds will open in New York City and 50 will open outside of New York City. This will build on the 50 new beds that the Governor announced in November. The Executive Chamber notes that this constitutes the largest expansion of State inpatient capacity in decades.
In her State of the State, Governor Hochul notes a plan to expand a wide range of outpatient services, including comprehensive psychiatric emergency programs providing hospital-level crisis care, with 12 new sites across the state, twenty-two new Assertive Community Treatment teams in New York City and twenty new teams in the rest of the state, and expanding from 13 to 39 the number of Certified Community Behavioral Health Clinics (CCBHCs), which provide walk-in, immediate integrated behavioral health care and both mental health and substance use disorder services.
The Governor mentions a plan to create five new Safe Options Support teams in New York City and three in the rest of the state. Safe Options Support teams conduct outreach and connect homeless people with mental illness and substance use disorder to services. The Governor also wants to increase capacity at 20 Article 31 clinics across the state and hire “dozens of new care managers” to serve people with serious mental illness.
Among the most ambitious of Governor Hochul’s plans is her “New York Housing Compact,” a broad policy strategy to create 800,000 new homes over the next decade. “Many forces led to this state of affairs,” opined Governor Hochul. “But front and center, our local land use policies that are the most restrictive in the nation.” The plan would require all municipalities to achieve targets over the next three years. The Governor noted that the state created 1.2 million jobs over the last decade but only built about 400,000 homes.
Another key theme of Governor Hochul’s State of the State is her ambitious plan to establish and operate 3,500 new residential units for New Yorkers with mental illness. Specifically, the Governor’s plan will create 500 Community Residence-Single Room Occupancy (CR-SRO) units. CR-SRO units provide housing and intensive services to individuals with serious mental illness who are at the highest risk of homelessness. The Governor also wants 900 transitional step down units. Step down units are meant to support individuals transition from various levels of care to community-based living. The Governor is also calling for 600 Licensed Apartment units, which will serve individuals who require an intermediate level of services to be able to live in the community but do not require 24/7 staffing and support. Finally, the Governor intends to create 1,500 supportive housing units, which will serve individuals with a serious mental illness who have less acute needs but still require support to be in the community. Half of these would be scattered-site, rental units which can be opened quickly, while the other half would be new construction of renovated facilities completed over the next five years.
In her State of the State, Governor Hochul notes that she intends to launch Mobile Veterans Service Centers. This is intended to literally meet veterans where they are and bring health care, benefits advocacy and other important services to veterans instead of requiring them to go to a Division of Veterans’ Services office.
EXPAND MEDICAID AND ESSENTIAL PLAN ELIGIBILITY
Medicaid provides health insurance to 7.7 million low income New Yorkers. In her State of the State, Governor Hochul proposes increasing supportive housing funding, expanding Adverse Childhood Experiences screening, expanding coverage for nutritionist services, expanding coverage for therapy, increasing dental care rates, increasing rates for children’s vaccine administration, expanding coverage of spinal muscular atrophy prenatal screening, expanding screening for social determinants of health and expanding coverage for Doula services.
To qualify for Medicaid, people generally have to meet Medicaid eligibility income and asset limits. In her State of the State, plans to submit a waiver to the federal government to expand the Medicaid Buy-In program so more New Yorkers with disabilities can work and still qualify for Medicaid coverage.
Governor Hochul also proposes changes to the Essential Plan. The Essential Plan offers health coverage to New York residents with incomes below 200 percent ($27,000 for a single individual) of the federal poverty level (FPL).
Medical debt can be unpredictable and have serious financial implications, with 53,000 New Yorkers sued by hospitals from 2015 – 2020. It can also have a significant impact on an individual’s ability to find housing, secure employment, access higher education or participate in the financial marketplace. In her State of the State, Governor Hochul plans to amend the Consumer Credit Fairness Act to cover medical debt, launch an industry and consumer education campaign that addresses medical debt and affordability and reform hospital financial assistance applications to require hospitals to use a uniform application form. The Governor plans to reduce cost sharing for patients, ensure access by increasing reimbursement rates for health care providers, expand funding for health plans to broaden coverage for mental health and social services, require health plans to spend more on patient care, establish a prescription drug price transparency program by building on the Pharmacy Benefit Bureau, require drug manufacturers to report in advance changes in drug prices and make that information publicly available to consumers and explore the creation of a new Healthy Guaranty Fund to protect New Yorkers if a health insurer becomes financially impaired or insolvent.
Building on her four-year, $7 billion childcare plan that was approved in last year’s budget, Governor Hochul outlined a series of measures to make childcare more affordable and easier to access.
The Governor proposed raising the income limit to cover families earning up to 85 percent of New York’s median income. This would increase the income limit for a family of three from just under $70,000 to nearly $80,000. Individuals and families who access child care assistance also tend to utilize programs such as the Supplemental Nutrition Assistance Program (SNAP), the Home Energy Assistance Program (HEAP), Medicaid and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). Currently, people applying for child care assistance need to prove they are income eligible. Governor Hochul would eliminate that requirement since individuals have already proved their eligibility for other programs.
The Governor also plans to cap family co-payments at one percent of family income above the poverty level. The Executive Chamber estimates that 10 percent of families would see a reduction in their co-pays, making it easier for families to take part in the program.
In her State of the State, she details a plan to mandate that districts cover 80 absences. She also wants to use unspent federal funds to establish a new Workforce Retention Grant Program to provide payments to existing staff in 17,000 programs statewide. Grants would be used to cover payroll tax assistance and support staff recruitment strategies, including sign on bonuses for new employees and other expenses related to hiring new staff.
Governor Hochul also wants to pilot a New York State Employer Supported Child Care pilot program in certain regions of the state to facilitate splitting the costs of care for eligible employees between the State, employers and employees. Additionally, Governor Hochul wants to have New York adopt a more flexible business income tax credit statewide for two years.
Governor Hochul announced a plan to tie the minimum wage to inflation. “If costs go up, so will wages,” said the Governor. She said an increase in the minimum wage would affect more than 900,000 New Yorkers.
The Governor began with a focus on public safety: “My number one priority has always been and always will be keeping New Yorkers safe.” The Governor then detailed a multi-pronged public safety agenda and addressed bail reform: “I would say we can agree that the bail reform law as written leaves room for improvement and as leaders we cannot ignore that.” The Governor’s proposal would eliminate the requirement that judges set bail based on the “least restrictive means” for any alleged crime that is currently bail eligible. The change is intended to work in conjunction with revisions to bail the Governor advocated for last year, which gave judges more discretion to set bail or hold defendants in jail prior to trial in cases involving gun crimes and repeat offenders accused of various crimes including some felonies and misdemeanors. Governor Hochul outlined plans to increase funding for alternatives to incarceration and to triple investments in services for those leaving the justice system. The Governor also promised the “largest investment ever” in the state Gun Involved Violence Elimination (GIVE) initiative, pledged to hire more state troopers and provide more resources to the State Police and provide funding for District Attorneys to hire more prosecutors.
REPRESENTATION IN STATE GOVERNMENT
MHEP is grateful that the Governor signed legislation creating – and then staffing – the Office of the Chief Disability Officer last February. The Office of the Chief Disability Officer advocates on behalf of people with disabilities and represents the issues that all people with disabilities face. In her State of the State, Governor Hochul pledged to reinvigorate the Interagency Coordinating Council for Services to the Deaf, DeafBlind and Hard of Hearing. The Governor plans to operate this council within the Office of the Chief Disability Officer.
The Mental Health Empowerment Project is a recipient run, not-for-profit corporation organized in 1988 to develop and strengthen self-help and mutual support/recovery activities throughout the United States.