NYAIL Budget Summary for New York State 2025

Independent Living

The state budget allocates an additional $750,000 to the current IL network funding of $16 million.

The budget language does not include ILCs in the human services COLA of 2.84%. The budget language continues the limited inclusion of only the “O” agencies, for example Office of Mental Health (OMH), Office of Addiction Service and Supports (OASAS), Office for People with Developmental Disabilities (OPWDD), Office of Temporary and Disability Assistance (OTDA), and State Office for the Aging. We will continue to advocate for (A.8437/S.7793) to add ILCs to the COLA.

The state budget includes $250,000 to fund creation of the Olmstead Plan in 2024.

Health/Medicaid

          Hospitals and Nursing Homes:

New York State is committing to a significant 10% Medicaid rate increase for institutions like hospitals and nursing homes. This is expected to translate to $525 million in Medicaid payment increases to hospitals, while nursing homes and assisted living facilities will receive $300 million. The exact allocation process is currently unknown, whether it will be for certain facilities or across the board increases. The funding source for the increases is a managed care organization tax so the final amount of increased funding is subject to change and will be used to create a “health care stability fund”. This is disappointing and concerning considering the ongoing demand and lack of proportional investment for home and community based services instead of institutional care.

CDPA:

Changes to Fiscal Intermediaries: The state budget language specifies one statewide fiscal intermediary to be selected through a ‘mini bid’ process. The budget language limits eligibility of the statewide FI to one that is currently already serving at least one other state and additional criteria.

The budget language requires the statewide fiscal intermediary to contract with subcontractors, specifically including the 11 Independent Living Centers currently providing fiscal intermediary services and at least one other entity “per rate setting region” with experience providing FI services since 2012 or earlier. While we are happy that the ILC role was preserved, we remain seriously concerned regarding this change and the significant disruption in care it will cause.

Prior budget proposals: The budget no longer includes the Designated Representative changes, wage parity cuts, and the requirement that some consumers use licensed home care agencies instead of CDPA based on hours. The budget language does open the doors for the state to set mandatory training requirements but does not include specifics.

You can watch debates of the health bill and hear the strong opposition expressed by the Legislature to this proposal:

Assembly discussion on the Health Bill, including questions on CDPA changes.

Senate discussion on the Health Bill, including questions on CDPA changes.

ADL eligibility changes passed as part of MRT II: No changes. Implementation is still expected once federal COVID funds are fully spent, possibly as early as this summer.

Prescriber prevails: Remains in effect.

End Medical Debt relief:

The campaign is positive on many changes in the budget that become effective in 6 months. A few of the positive changes include:

Hospital Financial Assistance (HFA) applies to all general hospitals, not just those receiving certain assistance (ICP). No asset test for HFA, Interest rate cut to 2%. No lawsuits against patients with incomes under 400% of FPL. No lawsuit or debt collection activity for first 180 days after first post-service bill issued. HFA payment plans cannot be more than 5% of a patient’s gross family income. New HFA sliding scale: 0-200% FPL = free; 201-300% of FPL = 10% of MA (Underinsured pay 10% of their cost-sharing); 301-400% of FPL = 20% of MA (Underinsured pay 20% of their cost-sharing);

Consent to pay for health care shall not be given prior to patient receiving such services and discussing the treatment costs.

Insulin: The state budget eliminates co-pays for insulin.

Housing

Access To Home:

Access to Home is funded at $4 million – this is an increase of $1 million! We are still working on increasing the administration rate, and that can be accomplished outside of the budget.

Good Cause Eviction:

A version of the Good Cause Eviction bill was included in the budget. Advocates and legislators remain critical and mixed on whether these changes will be enough to protect tenants. The bill sponsor of Good Cause Eviction Senator Salazar recently said, “This is not good-cause eviction as [originally] written, clearly…I think this is nonetheless a historic moment. It’s the very first time that we are seeing new protections against unjust evictions and unreasonable rent increases for unregulated renters in New York City.”

The new law will give tenants the right to dispute rent increases above 10%, or 5% plus the rate of inflation (Defined as the Consumer Price Index, currently 3.48%), whichever is less.

The law automatically applies to New York City, and other localities can opt-in to the program and make certain changes if they wish (This gets around prior court rulings prohibiting local rent protections because of state law preemption).

The new law will also not apply to units renting above 245% of fair-market rent, all rent-stabilized and income-restricted housing, or owner-occupied buildings with 10 units or fewer. New construction will be exempt for 30 years, starting with buildings constructed in 2009.The bill also includes a carveout for landlords who own fewer than 10 units.

Landlords will be required to inform tenants on their leases whether they are eligible for good cause protections. The new law still permits evictions for good cause, including nonpayment of rent, illegal activities, recovery for personal use, and nuisance.

Right to Counsel: Not included in the final budget.

Aging

Long Term Care Ombudsman Program: The program is level funded at $12 million, reversing the proposed cut by the Governor of $2.5 million. Advocates project that $15 million is needed to ensure regular visits to facilities.

Master Plan for Aging: The budget has not included significant investments that support older adults. Budget negotiation included a proposal to clear home care waiting lists at County offices for the aging in the Expanded In-home Services for the Elderly (EISEP) program. The program helps keep people living at home with non-medical in-home services. AARP has projected a $51 million investment would be required to eliminate the waitlist of 11,000 people waiting for an array of services, including home delivered meals and EISEP. The state budget only allocated an additional $700,000 to the state Office for the Aging.

Alliance First Look at Enacted NYS Budget for Fiscal Year 2024-25

By Director of Public Policy Luke Sikinyi and CEO Harvey Rosenthal

The New York State budget for Fiscal Year 2024-2025 that was enacted this past Saturday afternoon provides for $236.8 Billion in funding to address a diversity of needs and, most notably in the areas of housing, education, and health services. While it was a difficult budget year to get new initiatives funded, the Alliance and our colleagues were able to successfully advocate for the inclusion of a number of our members’ priority issues including an increase in the Governor’s proposed 1.5% Cost-of-Living Adjustment (COLA), funding for a Daniel’s Law Pilot program and increases in Commercial Insurance Rates and access to treatment.

Great thanks are due to all of our community members and colleagues for their tireless advocacy in pushing for our shared priorities on behalf of people living with mental health, substance use, and trauma related challenges and the providers who support them across the state. Even though the budget is finalized, The Alliance will continue to work to improve services and strengthen the protection of rights for people with disabilities throughout the year, both at the state level and federally. Here are the highlights of this year’s budget:

Cost-of-Living Adjustment (COLA) for human services agencies and workforce: Thanks to the relentless efforts of our members and colleagues, we were able to advocate with the Governor and Legislature to increase total new funding for community agencies to 2.84%. We are grateful that the legislature and Governor provided an increase larger than the Governor’s proposed 1.5% and with less restrictions than the legislature originally proposed. The final COLA agreement added $31.345 million in funding to increase the Governor’s proposed COLA from 1.5% to 2.84%. Providers will be required to use a portion of this funding to increase non-executive staff’s wages by at least 1.7%.

While the 2.84% COLA is certainly appreciated to meet some needs, the COLA deficit, once again, has increased even further when compared to inflation, now exceeding 34%, over the past 17 years and crushing financial and staffing crises will continue to prevent us from make a significant dent in addressing ever mounting service and staff demands and inflationary pressures.

It will be critical that the state heighten its efforts to ensure that our providers receive these additional funds in a prompt manner.

With a budget that saw significant increases in hospital rates, nursing homes payments, and state worker pensions, the state must now focus on our sector to finally make our agencies and workforce whole. Going forward, we will work tirelessly to secure the resources required to ensure every New Yorker can access high quality care through the state’s public mental hygiene system. New Yorkers deserve nothing less.

Other workforce measures in the final budget which we support include:

• New Recruitment and Retention initiatives that will focus on job marketing, creating a job bank, creation of a Behavioral Health Fellowship Program and new mechanisms to credential mental health paraprofessionals.
• Loan Forgiveness Program specifically for licensed mental health clinicians serving children and families ($4 million)

·       Continuing to increase the minimum wage for home care workers

Up to $1.5 Million Available for a Daniel’s Law Pilot: We are excited to see the legislature and Governor heeded our Coalition’s calls to explore the impact of a mental health/EMT First Responder response to New Yorkers in crisis! The Alliance and the Daniel’s Law coalition are very grateful for the hard work of our legislative champions, Senator Samra Brouk and Assemblymember Harry Bronson in getting these funds into the budget.  We will continue to advocate for the Daniel’s Law Task Force to expedite their work to submit recommendations to the state that can be funded in next year’s budget, as we continue our determined efforts to win full passage of Daniel’s Law.

$2.8 Million for Intensive and Sustained Engagement Team (INSET) programs: We were very pleased to see the ongoing commitment to fund INSET programs to voluntarily engage and support people who would otherwise be subject to coercive Kendra’s Law Outpatient Commitment Orders. The Alliance will continue to advocate for the expansion of this program so that more people from additional areas of the state are receive this highly effective peer led innovation.

Other Major Provisions Included in FY 2024-25 Budget:

Hospitals

We are concerned to see the budget once again focus too much on hospital beds, with another increase in the number of inpatient beds at state-operated psychiatric facilities. As we’ve repeatedly pointed out, far too often more hospitals beds result in far more trauma than more recovery and result in countless failed discharge plans and very high rates of recidivism, homelessness and incarceration. The funding associated with putting up these beds would be far better redirected to promote a systematic expansion of community-based prevention, crisis support and hospital and jail and prison diversion models, including the use of Peer Bridgers, INSET peer led engagement teams, the 988-crisis line, peer crisis stabilization, crisis respite and living room drop-in services.

• The final budget allocates $55 million to open another 200 State-operated inpatient psychiatric beds (including 15 for children and adolescents, 85 for adults, and 25 forensic) and 75 Transition to Home Unit (THU) beds.
• $7 million to support Compliance with New Guidance for Mental Health Admissions & Discharges: We strongly support Governor Hochul’s plan to lower the number of people who fall through the cracks after being discharged from a hospital, with a much greater focus on screening for social determinants of health and the presence of complex conditions. At the same time, we are concerned that the required assessments for violence will press discharge planners to look for violent tendencies that do not exist.
• $800 Million in support for distressed and safety-net hospitals
• $350 million in funding for hospital rate increases

Criminal Justice

The Governor and legislature were able to come to an agreement to support more people with mental health challenges who are involved with the criminal justice system. We strongly support the goal of diverting more people with mental health issues from jails and prisons.

Notably the final budget allocates $8.2 million to provide court based mental health navigators to help people get through the system.

At the same time, we are disappointed the Governor and Legislature did not pass the Treatment not Jail Act, which establishes mental health courts in every county while removing the requirement of a guilty plea to be afforded a critically needed diversionary agreement.

Other justice related initiatives include:

• $33 million to improve engagement with individuals living with mental illness and involved in the criminal justice system
• $7.1 million to reduce recidivism and improve reentry into the workforce by providing more intensive supervision of individuals on parole,
• Expanding transitional housing opportunities and college programming to all state prisons
• $1 million for a Law Enforcement and Mental Health Coordination team within OMH that will work with mental health courts and providers to ensure individuals are connected to the services they need.
• $8 million increase to the Judiciary to support Mental Health Court operations.
• $14.6 million to enhance and expand specialized Forensic Assertive Community Treatment (FACT) teams.
• $1 million for transportation for visitors to and from State Correctional Facilities

Housing

We are pleased to see that the Governor budget builds on last year’s commitment to expand housing investments:

• $43 million to increase stipends for over 17,000 OMH Supported Housing units to keep pace with rising property costs. This will go to Scattered site supported housing and SRO programs.
• $890 million capital investment for 3,500 new housing units over 5 years.
• $60 million of this will be for property preservation, with up to $10 million available for modifications to support aging in place pilot models.

Community Services

$119.5 million for an array of existing and new crisis and respite beds, home and community-based services waiver slots, supported housing, mental health urgent care walk-in centers, mobile engagement teams, first episode psychosis teams, family resource centers, evidence-based family support services, peer-operated recovery centers, suicide prevention services, community forensic and diversion services, tele-psychiatry, transportation services and family concierge services. Details pending. Looking forward, we will be making securing increases in the number of peer crisis respite and bridger services a top priority, along with the expansion of clubhouse programs in upstate New York.

Recovery Through the Lifespan

The budget proposes several provisions to improve mental health outcomes for New Yorkers of all ages. These included increased funding and initiatives for older adults, children and youth, and pregnant and postpartum New Yorkers. We thank Senator Samra Brouk, Senate Mental Health Committee Chair, for championing the new Maternal Mental health initiatives.

Maternal Mental Health

• Improve Maternal Mental Health. The Budget will focus on mental health and substance abuse issues during pregnancy, some of the leading causes of poor birth outcomes, by increasing access to comprehensive mental health screening tools in pregnancy and postpartum.
• $1.5 million annually to expand Project TEACH (Training and Education for the Advancement of Children’s Health)

Youth Mental Health

• $9.6 million to expand Youth Assertive Community Treatment (ACT) teams and other key initiatives
• $20 million available for schools statewide to open individual mental health clinics satellites.
• Make available OMH Social Media Resources for Youth and Caregivers

Invest in New York’s Aging Population.

• Funding programs statewide to support aging in place and to fight financial exploitation, elder abuse, and isolation of the aging.
• $116 million in additional funding for various Aging and Public Health programs, including $10 million dedicated to NY State Office for the Aging (SOFA) to finance additional unmet need services.

Disability Policy

We are extremely pleased to see a commitment to:

• Revise and release a new Olmstead Plan in 2024: $250,000
• Employment: Boost New York’s Employment First policies for people with disabilities.

Addiction and Substance Use Services

$5 million to support existing recovery community centers, which are currently funded by Federal grants that are expiring in October.

Medicaid 1115 Waiver

We are excited to see how the groundbreaking Medicaid 1115 Waiver Amendment, which includes $7.5 billion in funding over the next three years, will enhance our ability to serve New Yorkers with complex conditions. Included here is:

• $42.2 million to increase reimbursement for services provided in DOH-licensed facilities and private practices treating mental health conditions.
• $74 million in Patient-Centered Medical Home enhancements for adults and children.
• $10.4 million to increase reimbursement rates for healthcare providers serving individuals with physical, intellectual, or developmental disabilities.
• $1 million to expand coverage for Adverse Childhood Experiences Screenings to all adults enrolled in Medicaid.

The Alliance will have two comprehensive presentations on the waiver at this week’s Executive Seminar and one on how peer support organizations and community providers can set themselves up for successful relationships with regional Social Care Networks (SCNs). See more program and registration details here.

Increased Commercial Insurance Rate and Response Times

The legislature and Governor included regulations to require State regulated private insurers to reimburse providers licensed by OMH or OASAS at or above the Medicaid rate for outpatient mental health and addiction recovery services and to ensure that those individuals are afforded an appointment within 10 days.

Bottom Line: Community providers will be able to afford to work with significantly more individuals with mental health and addiction related needs and those individuals will be guaranteed swift access to the help they seek!

Other Health provisions

• $148 million to increase rates for primary care delivered through New York’s innovative Patient-Centered Medical Homes model.
• $84 million to increase reimbursement for services provided at certain sites treating mental health conditions.
• Expanded access to quality dental care.
• Continue the State Takeover of Local Medicaid Costs. The state will assume nearly $7.4 billion in costs that would have otherwise been incurred by localities.
• Final budget authorizes the Department of Health to apply for a federal waiver to establish an assessment on Managed Care Organizations (MCO) to leverage funding for capital healthcare projects and Medicaid coverage expansion.
• $90 million in opioid settlement funding
• $2 million for suicide prevention efforts for first responders
• $2 million for shower buses to engage and support unhoused people