FINANCE

NEW YORK STATE SENATE FINANCE COMMITTEE HEARS MENTAL HYGIENE BUDGET PROPOSAL WITH HISTORIC $1 BILLION MENTAL HEALTH INVESTMENT Albany — The New York State Senate Finance Committee and Assembly Ways and Means Committee held a joint hearing on February 16 to examine Governor Hochul's proposed 2023-2024 budget for mental hygiene agencies, with state officials presenting a sweeping plan to overhaul the mental health and addiction services systems. The centerpiece of the proposal is a historic $1 billion investment in mental health services, according to Dr. Ann Marie Sullivan, commissioner of the Office of Mental Health. The budget would reopen 850 psychiatric beds at community hospitals that were repurposed during the COVID-19 pandemic and open 150 new state-operated beds. It also includes $890 million in capital funding to develop 3,500 new housing units for people with serious mental illness. The mental health budget expands crisis services, including continued funding for the 988 suicide prevention hotline and 50 new Critical Time Intervention teams providing wraparound services for individuals discharged from hospitals. The proposal also funds 26 new Certified Community Behavioral Health Centers, which would serve an additional 200,000 New Yorkers with integrated mental health and substance use treatment. Dr. Chinazo Cunningham, commissioner of the Office of Addiction Services and Supports, reported that $120 million in opioid settlement funds have been made available to date, with $64 million directed to municipalities and $56 million supporting board-identified priorities in harm reduction, treatment, housing, and recovery services. The total OASAS budget is proposed at $1.2 billion. Kerri Neifeld, commissioner of the Office for People With Developmental Disabilities, highlighted workforce challenges as the agency's highest priority. The budget includes back-to-back cost-of-living adjustments totaling more than $700 million — a 5.4 percent increase last year and a proposed 2.5 percent increase — marking the first time in over a decade a governor has provided consecutive COLAs. Sen. Samra G. Brouk, chair of the Senate Committee on Mental Health, raised concerns about the adequacy of the 2.5 percent COLA given inflation rates of 6.4 percent. She advocated for indexing workforce salaries to inflation and questioned whether the proposed increases would be sufficient to retain mental health workers facing rising costs for housing, food, and childcare. She also pressed Commissioner Sullivan on standardizing mental health crisis response teams across counties, noting that response times and staffing vary significantly by region. Commissioner Sullivan acknowledged the workforce challenge but noted that rate increases across the system — including 10 percent increases in clinic rates and 27.9 percent increases in inpatient hospital bed rates — provide additional resources for providers to increase salaries. She also indicated that peer services are embedded throughout OMH programs, though not prominently featured in the budget testimony. The hearing was the ninth of 13 joint fiscal committee hearings on the Governor's proposed budget. Additional testimony from advocacy organizations and service providers is expected in subsequent panels. New York State mental hygiene commissioners faced intense scrutiny from legislators over the 2023-2024 Executive Budget's proposed 2.5 percent cost-of-living adjustment, with multiple lawmakers arguing the increase falls far short of addressing inflation and workforce crises across mental health, addiction, and developmental disability services. Assemblywoman Gunther, chair of the Mental Health Committee, delivered particularly pointed criticism, stating that psychiatric bed closures were driven by "cash and profit" rather than patient need. She highlighted urgent gaps in children's mental health services, noting that Sullivan County parents are sitting with children 24 hours a day without inpatient options and that families lack transportation to access services in distant counties. "This is the United States of America. This is not what we do," Gunther said. Assemblywoman Seawright, chair of the Committee on People with Disabilities, cited specific workforce data showing a 20 percent vacancy rate for direct-support positions statewide, a 42.5 percent increase in vacancies since pre-pandemic levels, and a 30 percent annual turnover rate. She emphasized that the predominantly women-of-color workforce deserves fair compensation and dignity. Multiple legislators called for an 8.5 percent COLA tied to the Consumer Price Index, matching the prior year's inflation metric. OPWDD Commissioner Neifeld defended the 2.5 percent increase as part of a two-year $700 million investment when combined with the prior year's 5.4 percent COLA, but acknowledged the workforce crisis remains acute. OMH Commissioner Sullivan announced a 27.9 percent increase in Medicaid reimbursement rates for inpatient psychiatric beds and described efforts to bring 1,000 beds back online, including 850 psychiatric beds. She also outlined a new Qualified Mental Health Associate credential, modeled on addiction counselors, to expand the mental health workforce—though Sen. Brouk questioned whether the credential would attract new workers or simply relabel existing providers. OASAS Commissioner Cunningham clarified that an apparent $240 million budget decrease reflects reappropriation of funds intended for multi-year spending. She described harm reduction initiatives including naloxone expansion, fentanyl test strips, and drug-checking machines. Sen. Fernandez raised concerns about the tension between scheduling new drugs and encouraging drug testing, indicating intent to propose legislation protecting individuals from criminal penalties for testing drugs. The hearing, held February 16, 2023, revealed deep legislative frustration with budget constraints on mental hygiene services amid what lawmakers characterized as a mental health and addiction crisis. New York's mental hygiene agencies outlined ambitious expansion plans for mental health and addiction services in the 2023-2024 budget during a joint legislative hearing on Thursday, but faced pointed questions about implementation gaps and funding priorities. The Office of Mental Health plans to expand school-based clinics from approximately 1,000 currently operating across the state to several hundred more annually, with a goal of placing one in every school. OMH also announced 3,500 new residential units for individuals with mental illness, with supported apartments expected within 6-9 months and capital construction projects taking 1-2 years. The agency received $25 million in additional funding for the 988 suicide and crisis lifeline to handle increased call volume and establish two new call centers to achieve 100% in-state service. The Office for People with Developmental Disabilities reported a $700 million investment in the not-for-profit system over two years through COLA increases of 5.4% in the current year and 2.5% proposed for the upcoming budget. However, Commissioner Neifeld acknowledged significant challenges: approximately 980 vacancies in the voluntary residential system, 370 in state-operated facilities, and about 1,200 people on the emergency need list for residential placement. Assemblywoman Seawright questioned why available state-operated vacancies were not being filled, and Commissioner Neifeld explained that OPWDD uses a person-centered planning process rather than a placement mandate system. The Office of Addiction Services and Supports reported $123 million in Opioid Settlement Fund appropriations and outlined $1.9 million from medical cannabis and $5.8 million from adult-use cannabis legalization for prevention and treatment programs. However, Sen. Gustavo Rivera directly challenged Commissioner Cunningham over OASAS's refusal to fund overdose prevention centers, repeatedly demanding specific legal citations for the claimed prohibitions. Rivera noted that two OPCs currently operate in New York and have saved over 700 people, creating a logical inconsistency in the agency's position. Sen. Oberacker cited alarming veteran statistics—21 suicides and 30 substance use deaths per day—in strongly supporting the Dwyer program. He also recommended rebranding school-based mental health clinics as "mental wellness" clinics to reduce stigma. Sen. Canzoneri-Fitzpatrick raised concerns about college student mental health, citing a study showing 41% of college students tested positive for depression in 2021, and questioned whether the 4201 schools could access mental health funding in the budget. The hearing revealed tensions between agency priorities and legislative expectations, particularly around overdose prevention centers, rural service delivery, and coordination between OMH and OPWDD for individuals with co-occurring developmental and mental disabilities. New York State mental hygiene commissioners defended the Governor's 2023-2024 budget proposal during a joint legislative hearing on February 16, facing pointed questions from lawmakers about workforce wages, psychiatric bed shortages, and service access in underserved communities. The budget proposes $1.1 billion for the Office of Mental Health, including funding to reopen 850 community psychiatric beds closed during the pandemic and create 150 new state facility beds. However, commissioners acknowledged that none of the 850 community beds have fully reopened yet, though some hospitals have begun the process after receiving a February 10 deadline to submit reopening plans. A central point of contention was the 2.5 percent Cost of Living Adjustment (COLA) for community-based service providers, which several senators argued is inadequate. Sen. O'Mara noted the COLA represents only $138.8 million while minimum wage increases upstate are 7.6 percent, leaving direct care workers earning less than fast food workers. OPWDD Commissioner Neifeld clarified that minimum wage increases are funded separately from the COLA, but declined to specify the amount. Sen. Borrello expressed skepticism about the state's commitment to mental health, noting that Governor Cuomo closed over 1,000 psychiatric beds and questioning whether the state has "the will" to help people in crisis. OMH Commissioner Sullivan responded that the Governor is committed to reopening beds and implementing discharge planning standards. Sen. Hinchey raised concerns about service access in rural communities, citing a constituent with severe traumatic brain injury who had $250,000 allocated but could access only a fraction due to lack of available services. The constituent eventually moved to Long Island and is now seeking services in Oklahoma. OASAS Commissioner Cunningham reported that medication-assisted treatment reduces overdose death risk by 50 percent and discussed exploring contingency management as a tool for stimulant use disorders. She also announced a recent guidance shift toward harm reduction approaches, including reducing barriers like urine drug screens for treatment entry. Sen. Webb asked for timelines on implementing $28 million in critical time intervention teams and mobile crisis services. Commissioner Sullivan said RFPs would be released after the budget and services could begin within a couple of months, with most operational by early to mid-2024. Sen. Rolison described a successful municipal crisis response model in Poughkeepsie called the Echo team, which had 427 contacts with individuals in crisis in 2022, and asked about funding for municipalities to create similar programs. Chairwoman Krueger requested written lists of where the 850 community beds are being reopened, where the 150 new state facility beds will be located, and an inventory of the 6,000 existing community-based inpatient psychiatric beds in the state. NEW YORK STATE SENATE FINANCE COMMITTEE — State mental hygiene officials faced pointed questioning from legislators on February 16 about whether proposed budget initiatives would actually address critical gaps in psychiatric beds, supportive housing, and workforce capacity. Chairwoman Liz Krueger expressed skepticism about the state's ability to reopen 850 community-based psychiatric beds despite a 27 percent Medicaid rate increase, noting that providers have been reluctant to restore capacity. She demanded a detailed list of existing beds and pressed OMH Commissioner Ann Sullivan on what enforcement mechanisms—the "stick" to accompany the rate increase "carrot"—would compel providers to act. Sullivan said she would provide the information in writing. The hearing revealed significant budget commitments: $890 million for 3,500 new supportive housing beds, a 5.4 percent cost-of-living adjustment (COLA) in the current year plus a proposed 2.5 percent COLA yielding over $700 million for the nonprofit disability services sector, and expansion of 12 new CPEP crisis programs statewide. Sen. Brouk raised alarm about maternal mental health, noting it is the third leading cause of pregnancy-related deaths in New York. She said her bill to create a maternal mental health workgroup was vetoed by the Governor and requested written details on OMH's current response. Sullivan described Project TEACH, a statewide consultation line for providers on antidepressant medication safety during pregnancy. On college mental health, Assemblyman Epstein noted that mental health is among the largest reasons students drop out but saw nothing in the budget specifically addressing the crisis. Sullivan responded that OMH is expanding the 988 crisis line and Text5U, a texting service for college students, and working with SUNY and CUNY to connect students with community services. OPWDD Commissioner Scot Neifeld reported 1,200 people on the emergency needs list for residential opportunities and defended the proposed COLA as adequate, though Assemblywoman Seawright challenged whether it would reverse deteriorating conditions in group homes, including inadequate staffing and poor physical plant conditions. OASAS Commissioner Arlene Cunningham discussed expansion of drug-checking machines through 38 community-based providers and defended the adequacy of existing naloxone products, noting that new higher-dose formulations have not shown superior effectiveness. Sen. Fernandez introduced bill S4880 to create a drug-testing machine program, emphasizing the need to protect people who use drugs. Multiple legislators raised concerns about workforce wages and whether COLA increases actually reach direct support professionals. Assemblyman Manktelow reported that frontline workers in group homes are working doubles and triples while waiting for raises to reach their paychecks. Neifeld said the agency would discuss funding streams offline but did not provide specific timelines. NEW YORK — Mental health and addiction service providers testified before a joint legislative committee on Thursday that Governor Hochul's proposed 2023-2024 budget, while containing welcome investments in psychiatric beds and services, falls dangerously short on workforce compensation during a critical staffing crisis. The hearing before the Senate and Assembly Finance committees featured testimony from the New York State Justice Center for the Protection of People with Special Needs and a panel of nonprofit mental health advocates who largely praised the Governor's commitment to mental health as a top priority while sharply criticizing the proposed 2.5 percent cost-of-living adjustment for the mental health and addiction service workforce. Providers requested an 8.5 percent COLA increase, arguing that the 2.5 percent proposal is "grossly inadequate" given 15 years of workforce neglect and rising costs. Glenn Liebman, CEO of the Mental Health Association in New York State, calculated that the system has lost over $600 million relative to inflation and argued that less than $500 million would be needed to increase the COLA from 2.5 to 8.5 percent, noting the state has a $24 billion Rainy Day Fund. John Coppola of the New York Association of Alcoholism and Substance Abuse Providers objected to a proposed $240 million reduction in local assistance funding, calling it unacceptable during an overdose and addiction pandemic. "The number 'minus 240 million' should not be in this budget," he said. On the positive side, Sharon Horton of the National Alliance on Mental Illness praised the Governor's proposal to return 1,000 psychiatric beds, addressing a loss of 1,849 beds since 2014. She also highlighted the need for improved hospital admission and discharge practices, sharing a personal account of her son's traumatic experience involving inadequate discharge planning. Denise Miranda, executive director of the Justice Center, reported that the agency has barred 870 individuals from the service system through its Staff Exclusion List and handles approximately 10,000 to 11,000 abuse and neglect cases annually from its 24/7 call center that receives 90,000 calls per year. She noted that about 65 percent of cases originate from OPWDD, with OCFS accounting for 18 percent and OMH 11 percent. Senators Mannion and Brouk engaged substantively with witnesses, with Mannion explicitly stating agreement that the 8.5 percent COLA increase is necessary. Courtney David of the Conference of Local Mental Hygiene Directors also advocated for the higher COLA and raised concerns about the state's competency restoration process, noting that individuals sometimes languish for years at a cost exceeding $1,100 per day, with counties bearing 100 percent of costs. The hearing underscored a central tension in the budget: while the Governor has proposed significant new investments in mental health services and psychiatric capacity, providers argue the system lacks the workforce to implement these expansions without addressing compensation that has lagged inflation for years. New York State lawmakers heard urgent testimony on Wednesday about critical gaps in the 2023-2024 mental hygiene budget, with providers and advocates calling for substantially higher funding for workforce compensation and expanded services. The joint Senate-Assembly Finance Committee hearing on the Executive Budget revealed deep concerns about the adequacy of proposed investments, particularly regarding cost-of-living adjustments (COLA) for mental health and substance abuse workers. Assemblywoman Gunther called the Governor's proposed 2.5% COLA "absolutely an insult," demanding 8.5% instead, arguing that workers—predominantly women and people of color—deserve living wages and should not have to work multiple jobs. "Mission-driven does not put food on the table," said Mr. Liebman, a provider representative. Provider advocates presented a consensus recommendation of $500 million in additional funding for increased reimbursement rates for substance abuse providers treating co-occurring disorders, citing decades of underfunding in the addiction services system. Mr. Coppola, representing advocacy organizations, also questioned a $240 million decrease in OASAS local assistance, asking whether those funds could be redirected to address current service gaps rather than being reallocated elsewhere. Sen. Fernandez pressed testifiers on whether criminalizing fentanyl would help combat the opioid crisis, with Mr. Coppola responding that addiction should be treated as a public health issue, not a criminal justice matter. He emphasized that African-American men leaving the correctional system face the highest overdose risk and that treatment, harm reduction, and prevention should be prioritized over incarceration. Sen. Oberacker, drawing on his experience as an EMS squad member, raised concerns about fragmented overdose data collection across counties, noting that overdoses are often not counted unless they result in death. He proposed developing legislation to standardize reporting, potentially using Narcan usage in the field as a metric. Testifiers also highlighted specific service gaps. Mr. Rosenthal, a person in long-term recovery, criticized the focus on hospitalization as a solution, noting that people are repeatedly hospitalized 5-15 times per year at a cost of $3,000 per day, indicating failed discharge planning. He advocated for community-based alternatives including peer bridgers, crisis stabilization centers, and housing-first models. Ms. Fagen, a licensed creative arts therapist, testified that her profession was excluded from Part Q of the budget bill, which expands Medicaid reimbursement for other mental health practitioners licensed in 2005. She argued that creative arts therapists have master's degrees and specialized skills effective for populations where talk therapy may not work well. Ms. Cristalli, representing 40 provider organizations serving children and families, reported that her organization alone has several hundred job openings out of 1,800 staff, making it impossible to deliver current services let alone expand them. She called for expanded COLA to include more disciplines, loan forgiveness programs, and support for staff advancement into leadership roles. Chairwoman Krueger expressed surprise at the Governor's veto of a bill requiring non-religious-based substance abuse treatment options for court-ordered treatment plans, noting that while 12-step programs work for some, not everyone is comfortable with religious themes. The hearing underscored a central tension: while lawmakers and the Governor have elevated behavioral health funding to historic levels, providers argue the investments remain insufficient without addressing the workforce crisis that threatens to undermine service expansion. New York State legislators heard urgent testimony on Wednesday about the need for expanded mental health and substance abuse treatment services, with witnesses highlighting stark racial disparities in overdose deaths and calling for significant increases in funding and workforce support. At a joint legislative hearing on the 2023-2024 executive budget for mental hygiene, testifiers painted a picture of a system overwhelmed by demand and underfunded across multiple service areas. Overdose deaths have increased drastically in New York, exceeding the national average, with particularly severe impacts on communities of color: deaths tripled for white New Yorkers, increased fivefold for Black New Yorkers, and quadrupled for Latino New Yorkers, according to Allegra Schorr, president of the Coalition of Medication-Assisted Treatment Providers and Advocates. Ms. Bufkin, testifying on behalf of children and families' services, called for at least half of the Governor's proposed $1 billion in behavioral health funding to be directed to services for children and families, citing a "never-ending cycle" where young people fail to get needed mental health supports and cycle through emergency rooms and hospitals. Multiple witnesses advocated for the Treatment Not Jail Act and expansion of treatment courts, arguing that treatment is more cost-effective than incarceration. Katherine Bajuk, a public defender and crime victim, cited data showing that for every dollar invested in treatment, the state yields $2 in savings, and that 75 percent of crime victims support treatment for people charged with violence. Nadia Chait of the Center for Alternative Sentencing and Alternative Services highlighted the success of the Nathaniel Assertive Community Treatment program, the only OMH-licensed alternative to incarceration in the state, which shows a 70 percent decrease in recidivism, 70 percent decrease in homelessness, and 225 percent increase in employment among participants. She called for at least two additional ACT teams to serve the Bronx and more of Brooklyn. Witnesses also emphasized workforce challenges. Schorr called for an 8.5 percent cost-of-living adjustment and $500 million in reimbursement increases to retain staff and keep programs open. Maria Cristalli of Hillside Children's Center advocated for parity in funding between the 853 schools her organization operates and public schools, noting that rate methodology studies are decades old and that her organization cannot serve all children with complex needs due to resource constraints. Several legislators signaled support for these priorities. Sen. Mannion expressed backing for parity in school funding and introduced questions about his Narcan accessibility bill. Assemblywoman Gunther made passionate remarks about investing in upstream prevention and community-based services rather than emergency responses, calling for safe housing and mental health workers as first responders instead of police. The hearing underscored persistent gaps in mental health and substance abuse treatment access, with witnesses describing insurance network adequacy problems, provider shortages, and inadequate reimbursement rates that prevent people from accessing available services even when they have coverage. NEW YORK STATE SENATE FINANCE COMMITTEE — Disability service providers and advocates testified before the Joint Legislative Committee on Finance on February 16, delivering urgent pleas for increased funding in the 2023-2024 Executive Budget, citing a workforce crisis threatening the state's mental health and intellectual disability services. The hearing focused on two primary demands: an 8.5 percent cost-of-living adjustment (COLA) and a $4,000 wage increase for direct support professionals (DSPs). The Governor's proposed 2.5 percent COLA drew sharp criticism from testifiers who noted it falls far short of the 8.5 percent inflation rate. Mike Alvaro of the New York Disability Advocates coalition, representing 85 percent of disability service providers serving 115,000 people with intellectual and developmental disabilities, quantified the requests: $235 million state share for the 8.5 percent COLA and $126 million for the $4,000 wage increase. He noted that state-employed DSPs earn approximately $24 per hour while nonprofit DSPs earn $16—a 50 percent wage gap for essentially identical work. The workforce crisis emerged as the hearing's dominant theme. Erik Geizer, CEO of The Arc New York, the state's largest I/DD service provider, described 20,000 direct support vacancies and a one-in-three turnover rate costing the field $100 million annually. He illustrated the human impact through case studies: Cole, waiting three years for community transition services; David, unable to develop independence skills due to staffing shortages; and others receiving inconsistent care from substitute staff. Veronica Crawford, a self-advocate with disabilities, testified that staff shortages leave people with disabilities isolated, unable to participate in community programs, and experiencing increased anxiety and behavioral issues. "We need them," she said of DSPs. "One staff in residential homes cannot do that." Sebrina Barrett of the Association for Community Living reported that her members serve over 40,000 New Yorkers with severe mental illness but face a $96 million shortfall and 25 percent staff vacancy rate. She highlighted an emerging crisis: more than 42 percent of residents are age 55 and older with complex medical conditions, yet housing models designed in the 1980s-1990s lack nursing staff and cannot accommodate aging residents. Nursing homes refuse to admit people with mental illness, forcing hospitalizations instead. Jim Karpe, a parent of two young adults with I/DD, testified against extending the managed care investigation, which he said has distracted OPWDD for a decade. He cited Texas studies and a Deloitte report showing managed care increases costs without consistent quality or access improvements, and noted that an OPWDD pilot program achieved only one-third of expected enrollment. Senators signaled support for increased funding. Sen. John Mannion stated he requested 8.5 percent COLA and $4,000 wage increases in his budget priority letter and encouraged colleagues to do the same. Sen. O'Mara expressed frustration with the Executive's proposal, noting that ARCs in his rural district face home closures due to workforce shortages, and questioned whether the budget represents genuine priorities or negotiating strategy. Assemblywoman Gunther shared a personal anecdote about a young woman with disabilities in a group home with limited freedom and community access, emphasizing the need for legislative leadership to prioritize the disability community's needs. The hearing concluded with broad agreement among legislators that the disability and mental health systems face a critical funding crisis, though the extent to which the Legislature will increase funding beyond the Governor's proposal remains uncertain.