FINANCE

NEW YORK STATE LEGISLATURE HEARS MENTAL HYGIENE BUDGET PROPOSALS TOTALING BILLIONS FOR WORKFORCE, YOUTH SERVICES Albany — The New York State Senate Finance Committee and Assembly Ways and Means Committee held a joint hearing Tuesday on Governor Hochul's proposed 2024-2025 budget for mental hygiene agencies, with commissioners detailing billions in investments aimed at addressing workforce shortages, expanding youth mental health services, and accelerating addiction treatment across the state. The Office of Mental Health proposed opening 200 additional state hospital beds focused on individuals with complex needs, building on 150 beds added and nearly 500 restored during the pandemic recovery. OMH Commissioner Dr. Ann Marie Sullivan highlighted $20 million in new resources for youth mental health, including 12 new Youth Assertive Community Treatment teams expected to serve more than 1,000 youth, and $1.6 million for maternal mental health initiatives. The Office of Addiction Services and Supports reported distributing Opioid Settlement funds faster than any other state, with $144 million of a $212 million FY24 allocation already made available. OASAS Commissioner Dr. Chinazo Cunningham reported that over 18 months, the agency distributed 70,000 naloxone kits, 5 million fentanyl test strips, and 4 million xylazine test strips through a free online ordering portal. She noted that all 44 state prisons and all 58 jails are now implementing medication treatment for substance use disorders. The proposed OASAS budget totals approximately $1.2 billion, including $170 million for state operations and $898 million for aid to localities. The Office for People With Developmental Disabilities emphasized workforce development as its highest priority, proposing a 1.5 percent cost-of-living adjustment that, combined with previous years' increases, totals nearly $1 billion in cumulative increases to provider agencies. Commissioner Kerri Neifeld reported that over 1,000 direct support professionals have been certified through a credentialing program and announced a planned $30 million statewide recruitment campaign. The agency also proposed $60 million in new state resources for service expansion, which could reach $120 million with federal matching funds. All three agencies proposed 1.5 percent cost-of-living adjustments representing three consecutive years of increases. Workforce recruitment and retention emerged as a critical theme across all agencies, with commissioners citing ongoing staffing challenges in mental health, addiction services, and developmental disabilities support. Sen. Nathalia Fernandez, chair of the Senate Committee on Alcoholism and Substance Use Disorders, pressed commissioners on co-occurring mental health and substance use disorders, youth services, and whether the state should declare an emergency regarding the opioid crisis. Commissioner Cunningham acknowledged the severity of the overdose epidemic but emphasized the agency's focus on harm reduction and access to proven FDA-approved medications that reduce death by 50 percent. The hearing was the 11th of 13 joint fiscal committee hearings on the Governor's proposed budget. NEW YORK STATE SENATE FINANCE COMMITTEE — Mental health advocates and state officials clashed over funding priorities during a joint legislative hearing on the 2024-2025 Executive Budget on Mental Hygiene, with lawmakers demanding faster crisis response reforms and higher wages for direct support professionals. The hearing, held Feb. 13, featured testimony from commissioners of the Office of Mental Health, Office for People with Developmental Disabilities, and Office of Addiction Services and Supports, who outlined the Governor's mental hygiene proposals. But Assembly and Senate members signaled dissatisfaction with key elements, particularly the proposed 1.5 percent cost-of-living adjustment for direct support professionals and the pace of implementing crisis response reforms. Assemblywoman Gunther, chair of the Assembly Mental Health Committee, criticized the 3.2 percent COLA as insufficient for direct support professionals, who are predominantly women providing care to vulnerable populations. "These are mostly women, and they provide amazing services," Gunther said. "They really should get more than 3 percent... It's only fair. We have a big budget." Senator Mannion, chair of the Disabilities Committee, advocated for his proposed S4127A bill, which would provide a $4,000 wage enhancement to direct support professionals at an estimated cost of $125 million. While OPWDD Commissioner Neifeld expressed interest in exploring workforce support opportunities, she declined to endorse the specific proposal without reviewing details. On crisis response, Senator Brouk, chair of the Mental Health Committee, pressed OMH Commissioner Sullivan to accelerate implementation of Daniel's Law task force recommendations, citing a lawsuit from Oregon involving inappropriate law enforcement response to a 988 mental health crisis call. Sullivan committed to moving faster than the December 2025 deadline, saying the task force has expressed urgency. Sullivan outlined significant mental health investments: approximately 1,200 school-based mental health clinics currently operating, with $20 million in funding to expand by several hundred clinics annually; 125 additional state-operated inpatient psychiatric beds, including 15 for children; and 13 crisis stabilization centers across the state as alternatives to psychiatric emergency departments for youth. However, Assemblywoman Gunther raised concerns about geographic disparities, noting that her rural county has lost psychiatric bed capacity and families are forced to transport children hours away for treatment. She called for mandates requiring hospitals receiving state funding to serve their communities. On opioid settlement funds, Assemblyman Steck pressed OASAS Commissioner Cunningham on whether settlement dollars are displacing existing state funding for ancillary services like transportation and job placement. Cunningham denied displacement but acknowledged that state funding for some job placement functions is being reduced. The OASAS budget dropped from approximately $200 million in settlement funds to $63 million due to declining settlement revenues. Commissioner Sullivan reported that less than 0.3 percent of the nearly 200,000 calls to New York's 988 crisis line are routed to 911, and outlined plans for "who" dispatch models to ensure mental health crises are directed to behavioral health teams rather than law enforcement. The hearing underscored ongoing tensions between state budget constraints and legislative demands for expanded mental health services and higher wages for the workforce delivering them. NEW YORK STATE SENATE FINANCE COMMITTEE HEARING ON 2024-2025 MENTAL HYGIENE BUDGET HIGHLIGHTS WORKFORCE CRISIS AND FUNDING GAPS Albany — A joint legislative hearing on the 2024-2025 Executive Budget for mental hygiene agencies revealed deep concerns about workforce shortages, inadequate funding increases, and service gaps across the state, with lawmakers sharply questioning whether proposed investments will address ongoing crises in mental health, substance abuse treatment, and intellectual and developmental disabilities services. The hearing, held February 13 before the Senate Finance Committee, featured testimony from three state commissioners defending a budget that includes a 1.5 percent cost-of-living adjustment (COLA) for service providers—a figure that drew sustained criticism from multiple legislators who characterized it as insufficient given inflation and a decade of prior funding stagnation. Assemblywoman Rebecca Seawright delivered the most pointed testimony, framing the situation as a crisis of equity and dignity. She cited alarming statistics: 85 percent of people with intellectual and developmental disabilities are served by nonprofit providers facing 30 percent annual workforce turnover and 17 percent agency vacancy rates. Direct support professionals (DSPs) in nonprofit agencies earn $17 per hour in New York City and $16.48 elsewhere—nearly 50 percent less than state-employed DSPs earning $27 and $25 respectively. "Abandoning I/DD New Yorkers and the hardworking professionals who are largely women of color is negligent," Seawright said, advocating for a 3.2 percent COLA and a $4,000 annual wage enhancement for DSPs. OPWDD Commissioner Neifeld defended the budget, citing $1 billion in COLAs over three years and a $350 million rate rebasing initiative updating provider rates from 2017 baselines. She also announced a $30 million media campaign to recruit DSPs and investments in professional credentialing through the National Alliance for Direct Support Professionals. However, she acknowledged the agency does not directly set wages for nonprofit employees, limiting its leverage to address wage disparities. Assemblyman Keith Brown criticized the hearing structure itself, noting that five minutes per legislator was inadequate to discuss a $9 billion budget—4 percent of the state budget—during a mental health and substance abuse emergency. He cited a December 7th Attorney General report documenting serious network adequacy problems, including phantom provider directories and inadequate appointment availability, and referenced a New York State Council of Community Behavioral Healthcare memo documenting a 21 percent annual shortage in waiting lists for services. On mental health expansion, OMH Commissioner Sullivan announced that 13 new Certified Community Behavioral Health Centers were announced in December, with 13 more coming soon. However, Sen. Hinchey expressed frustration that the Mid-Hudson Valley was excluded from the first round, noting that constituents have been forced to leave the region—and even the state—to access services. Sen. Oberacker highlighted Sullivan County's crisis: a 245 percent higher overdose death rate than the state average. He advocated for innovative solutions including rebranding school-based mental health as "wellness centers" to reduce stigma and expanding the "One Box" overdose response project containing Narcan and instructional materials. Commissioner Cunningham committed to working with Oberacker's district and utilizing settlement funds—$64 million in fiscal year 2023 and $46 million more recently—for naloxone, fentanyl test strips, and xylazine test strips. Sen. Weber co-sponsored a DSP wage enhancement bill estimated at $125 million and characterized DSPs as essential workers deserving livable wages, particularly in high-cost areas like Rockland County. She also raised concerns about Fiscal Intermediaries inconsistently denying self-direction budget requests for community classes, pressing Commissioner Neifeld for consistency across the state's 90 Fiscal Intermediaries. The hearing underscored a fundamental tension: while state officials highlighted multi-year investments and new initiatives, legislators argued these measures fall short of addressing systemic underfunding, workforce attrition, and service gaps that have accumulated over years of inadequate funding. The debate over the 1.5 percent COLA versus proposed alternatives of 3.2 percent or higher emerged as a central flashpoint, with multiple lawmakers warning that current proposals risk regression toward institutional care and continued service denials for vulnerable populations. New York State mental hygiene commissioners faced pointed questions about workforce shortages and service gaps during a joint legislative budget hearing on Tuesday, with lawmakers expressing skepticism about whether proposed funding increases will adequately address critical challenges in mental health and developmental disability services. The hearing, held before the Senate Finance Committee and Assembly Mental Health Committee, focused on the 2024-2025 Executive Budget for the Office of Mental Health (OMH), Office for People with Developmental Disabilities (OPWDD), and Office of Addiction Services and Supports (OASAS). Direct support professional (DSP) wages emerged as a central concern. Senator O'Mara presented calculations showing that over three years, COLA increases for DSPs totaled 11.3 percent while minimum wage rose 13.6 percent and inflation reached 12.5 percent—meaning the state is losing ground in making DSP work competitive. Senator Webb cited a provider in her district with a 35 percent DSP vacancy rate, while Senator Scarcella-Spanton highlighted a $8-10 per hour pay gap between OPWDD-employed DSPs ($25-27/hour) and nonprofit DSPs ($17/hour). Assemblyman Bores humorously noted that when he asked if a higher COLA would help recruitment, "everyone smiled"—an implicit acknowledgment from commissioners that it would. OMH Commissioner Sullivan reported progress on school-based mental health clinics, noting 1,200 currently exist with plans to add 200 more this year. Startup funding ranges from $25,000 for well-resourced schools to $45,000 for distressed schools. She also highlighted the Safe Option Support Teams program, which has placed 300 individuals in permanent housing from NYC subways, and reported that 150 state hospital beds opened last year with 200 more proposed, expecting approximately 75 to open this year. OASAS Commissioner Cunningham addressed the overdose crisis, attributing rising deaths to the toxic drug supply, particularly fentanyl and xylazine. He reported shipping over 70,000 naloxone kits, 5 million fentanyl test strips, and 4 million xylazine test strips. He stated that all 58 jails and 44 prisons are now in compliance with medication treatment requirements, though Senator Fernandez questioned whether implementation remains unequal on the ground. Assemblywoman Walsh presented a heartbreaking case study of a mother unable to find services for her 12-year-old son with fetal alcohol syndrome, PTSD, ADHD, and reactive attachment disorder, illustrating how children with co-occurring developmental and mental health disabilities fall through cracks between agencies. Commissioner Neifeld committed to following up on the specific case. Senator Canzoneri-Fitzpatrick raised concerns about social media's impact on youth mental health, particularly teenage girls, and asked about proposed legislation to control addictive algorithms and increase parental controls. She also inquired whether overdose presentations could be treated as mental health crises requiring hospitalization rather than criminal justice responses. The hearing revealed ongoing tensions between agency officials defending their efforts within existing resources and legislators demanding more aggressive action on workforce compensation, service coordination, and overdose prevention. NEW YORK — State mental hygiene officials defended their 2024-2025 budget proposals during a joint legislative hearing Tuesday, facing pointed questions from lawmakers about workforce shortages, housing gaps, and funding mechanisms for addiction and mental health services. The hearing before the Senate Finance Committee examined spending plans for the Office of Mental Health, Office of Addiction Services and Supports, and Office for People with Developmental Disabilities. A central theme emerged: agencies have funding but lack staff to deploy it. OPWDD Commissioner Neifeld acknowledged that the agency has temporarily suspended approximately 150 group homes and residential facilities due to staffing shortages, not permanent closures. He noted that certified residential opportunities have declined 8 percent and day opportunities 16 percent in recent years, even as the population served has grown. The agency serves nearly 30,000 New Yorkers through its self-direction program, with approximately 5,500 on waiting lists for certified group home placements. "A vacancy within a home is not really valuable unless there are the staff there to support the individuals who need those services," Neifeld said, emphasizing workforce development as the priority over capital expansion. Assemblyman Palmesano, a former direct support professional, criticized the proposed 1.5 percent wage increase for DSPs as "woefully inadequate," noting the profession faces competition from fast-food chains. He called for the 3.2 percent COLA increase being discussed and questioned state priorities given spending on film tax credits and migrant services. On addiction services, OASAS Commissioner Cunningham cited a State Department of Health study released last week finding that 4-milligram naloxone doses are equivalent to 8-milligram doses but produce fewer withdrawal side effects. He defended the state's focus on FDA-approved opioid medications, which reduce overdose deaths by 50 percent, while noting legal barriers prevent overdose prevention centers. Assemblywoman Gallagher pressed Cunningham on why Drug User Health Hubs have not received adequate funding from $256.7 million in available opioid settlement and stewardship funds, asking whether OASAS could allocate money directly rather than through the Department of Health. Cunningham said OASAS works through partner agencies that oversee the hubs. OMH Commissioner Sullivan reported that new crisis stabilization centers will feature dedicated youth services with separate entrances and staff, and that the state expects to create over 6,000 home-based crisis intervention slots for youth within a few years. He confirmed the Dwyer program for veterans faces no cuts and is receiving additional funding through the CARES UP peer-to-peer expansion. Sen. Brouk asked whether the state would consider dedicated youth stabilization centers modeled on University of Rochester Medical Center's approach, and inquired about a $195 million proposal for children's outpatient services. Sullivan said new stabilization centers already include segregated youth services. The hearing revealed tension between legislative demands for expanded services and agency arguments that infrastructure and workforce constraints limit deployment of existing funds. Multiple lawmakers requested written follow-up on specific data, including waitlists, closed facilities, and rural service distribution. NEW YORK STATE SENATE FINANCE COMMITTEE EXAMINES MENTAL HYGIENE BUDGET AMID WORKFORCE CRISIS Albany — State lawmakers heard testimony Tuesday on Governor Hochul's 2024-2025 mental hygiene budget proposal, with agency officials and advocates highlighting a critical workforce shortage threatening the state's mental health and disability services systems. The most contentious issue centered on cost-of-living adjustments for direct care workers. Assemblywoman Kelles presented data showing that direct care providers have effectively received wage cuts for a decade, with COLA increases consistently lagging inflation. She noted that while inflation averaged 3.2 percent this year, the proposed COLA increase is only 1.5 percent. Assemblyman Maher and other lawmakers on both sides of the aisle called for a minimum 3.2 percent COLA, arguing the current proposal is insufficient to address massive vacancy rates across mental health, substance abuse, and disability services. "We are seeing across the board a decrease in providers," Kelles said. "I'm seeing a huge vacancy rate in every single area." OMH Commissioner Sullivan reported that the state's $1 billion mental health investment includes $890 million for residential beds in the community, with requests for proposals to be released by end of March. However, only 330 total beds are expected by year's end, far short of the 1,300-bed goal. The Justice Center for the Protection of People with Special Needs, marking its 10-year anniversary, reported substantiating tens of thousands of abuse and neglect cases and barring nearly 1,000 offenders from working with vulnerable populations. The agency receives 85,000 to 90,000 calls annually, with approximately 12,000 abuse and neglect cases per year. Executive Director Denise Miranda said the proposed budget allocation of $1.3 million would fund 18 additional full-time positions, primarily for investigators, to reduce case cycle times. Sen. Mannion raised concerns about whether declining staffing rates have increased reportable incidents, while Assemblywoman Seawright questioned whether the Justice Center is adequately investigating cases involving nonverbal individuals. Miranda assured lawmakers that the Justice Center specializes in such cases and investigates hundreds annually. A separate panel addressed the state's competency restoration process, which requires individuals charged with crimes but deemed incompetent to stand trial to undergo treatment. Courtney David of the Conference of Local Mental Hygiene Directors testified that between 25 and 67 percent of defendants cycle through the system multiple times on the same charge, with some held for 3 to 10 years. Daily forensic placement costs range from $1,300 to $1,500, with Oneida County alone paying $3.9 million in 2023 and facing a projected increase to $4.4 million in 2024. David urged lawmakers to enact statutory reforms to provide defendants a pathway to appropriate mental health treatment and redirect millions in county dollars back to community services. The hearing underscored persistent tensions between budget constraints and service demands as the state grapples with mental health and addiction crises. Mental health advocates testified before the New York State Legislature on February 13 that while Governor Hochul's 2024-2025 budget represents progress on mental health funding, the state must do significantly more to prevent workforce collapse in community-based services and ensure adequate psychiatric capacity. Matthew Shapiro of NAMI New York State and Glenn Liebman of the Mental Health Association of New York State both emphasized that the proposed 1.5% cost-of-living adjustment (COLA) for mental health workers is insufficient. Liebman urged lawmakers to add an additional 1.7% to reach 3.2%, matching the Consumer Price Index. He noted that the behavioral health field has lost over $600 million in funding over years without COLA increases, and that the nonprofit sector faces 25-30% annual vacancy rates as workers leave for better-paying jobs. "If you don't have the crew to run that ship, how are you going to succeed?" Liebman said, using a metaphor for the state's mental health system. Shapiro highlighted the need for psychiatric beds and improved discharge planning. He testified that his family required three psychiatric hospitalizations for his mother, and that patients are being moved across the state to access beds, separating them from family support during recovery. He called for admission and discharge standards to prevent patients from cycling repeatedly through the system. Ms. David, representing county interests, testified that state funding for opioid use disorder treatment in jails is inadequate. Counties initially requested $12.7 million for clinical support services but received only $3.75 million, forcing them to supplement with Opioid Settlement dollars and divert resources from other programs. Sen. Brouk expressed strong support for mental health funding and promoted her bill to create a statutory annual COLA, arguing that workers need assurance that increases will happen every year. She also highlighted her work on maternal mental health services and workforce diversification. Liebman also advocated for a pension system study for the 800,000 nonprofit sector workers who currently have no retirement benefits, and for a "qualified mental health associate" title to create a career pipeline for paraprofessionals—a proposal that faced opposition from professional associations concerned about scope of practice. The hearing underscored a central tension: while lawmakers and the Governor have embraced mental health as a priority, advocates argue the proposed funding increases are insufficient to address workforce shortages, psychiatric bed capacity, and the cycling of patients through emergency rooms and jails rather than community-based treatment. NEW YORK — Advocates for children's mental health, disability services, and substance use disorder treatment testified before a joint legislative committee on Tuesday that the state's 2024-2025 executive budget falls short of addressing critical workforce shortages and service gaps, urging lawmakers to reject proposed cuts and increase funding for behavioral health services. The hearing before the Senate Finance Committee and Assembly Health Committee featured testimony from representatives of disability service providers, child welfare agencies, mental health coalitions, and drug policy advocates, who presented a unified message: the proposed 1.5 percent cost-of-living adjustment (COLA) for providers is insufficient, and the state must invest in workforce development to address a behavioral health crisis affecting children and families across New York. Mike Alvaro, president of New York Disability Advocates, testified that the coalition's 350+ member providers face a workforce crisis with current direct support professional (DSP) vacancy rates around 17 percent, historically as high as 30 percent. He cited wage disparities between voluntary and state-operated facilities, noting that downstate voluntary sector DSPs earn $17 per hour ($34,000 annually) compared to $55,000 for state-operated workers doing identical work. Alvaro called for the full 3.2 percent COLA plus a $4,000 wage enhancement, arguing that recent wage increases have helped reduce vacancies but the field remains in crisis. Jennifer March, executive director of Citizens' Committee for Children of New York, presented findings from a Medicaid rate study showing that current reimbursement rates for behavioral health services are inadequate. She called for $195 million in rate adjustments—including a care team coordination fee ($20 million), a 35 percent enhancement for children's clinic visits ($117 million), and increases to community-based services ($44 million)—which she argued would add 1,300 clinicians and serve 26,000 more children. Ronald Richter, CEO of JCCA, highlighted critical silos between the Office of Children and Family Services and the Office of Mental Health, and raised concerns about proposed cuts to health homes. He noted that JCCA provides services to approximately 25 young adults aged 22-23 without Medicaid reimbursement, costing the agency over $1 million annually. Maria Cristalli, board chair of the New York State Coalition for Children's Behavioral Health, presented data showing that health homes serving 30,000 children and families have increased primary care visits by 68 percent and decreased emergency room visits by 12 percent. She opposed the proposed cut to health homes and called for sustained investment in the behavioral health system. On substance use disorder treatment, Allegra Schorr, president of the Coalition of Medication-Assisted Treatment Providers and Advocates, opposed the proposed 13.4 percent decrease to the OASAS budget, citing a 73 percent increase in overdose deaths from 2018 to 2022 and a 127 percent increase in deaths connected to illicit fentanyl. She called for increased access to treatment, insurance reforms, and workforce investment rather than expansion of new program sites during a staffing crisis. Toni Smith, New York State director of the Drug Policy Alliance, testified against Part U of the executive budget's proposed substance scheduling, arguing that criminalization does not reduce overdose deaths and citing a 2023 study showing drug busts were associated with a 24 percent increase in opioid overdose deaths. She urged the Legislature to expand overdose prevention centers instead. Senators expressed concern about waitlists for behavioral health services. Sen. Brouk asked panelists to describe wait times, with testimony indicating delays ranging from several weeks to several months for service approvals and placement. Panelists described families with children spending months in emergency departments awaiting appropriate placements—a situation one advocate noted creates financial hardship for parents unable to work. The hearing underscored tensions between the executive budget's proposed cuts and advocates' calls for increased investment in a system they described as fragmented, underfunded, and unable to meet rising demand for services. NEW YORK STATE LEGISLATURE HEARS TESTIMONY ON MENTAL HYGIENE BUDGET CRISIS, WORKFORCE SHORTAGES Albany — A joint legislative hearing on the 2024-2025 Executive Budget for mental hygiene services revealed a system in crisis, with testimony focusing on severe workforce shortages, inadequate compensation for direct service providers, and the need for community-based alternatives to institutional care. The most striking testimony came from Erik Geizer, CEO of The Arc New York, who documented the dramatic devaluation of direct service provider (DSP) wages over 15 years. DSPs, who provide intimate care to people with developmental disabilities, now start at $16.48 per hour—only 10 percent above minimum wage—compared to nearly double the minimum wage 15 years ago. Geizer cited a Miami University of Ohio study showing that 50 percent of New York's DSPs experience food insecurity and 50 percent experience housing insecurity. Despite 85 percent job satisfaction, one in three DSPs leave the field annually, creating 20,000 vacancies statewide. "These are trained professionals with a high level of responsibility for the well-being of vulnerable New Yorkers, and providers have been forced to set up food pantries for staff," Geizer said. "Would you do all that for $16 an hour? My teenager can make that at a cash register." Sebrina Barrett, executive director of the Association for Community Living, reported that her members house 42,000 people with severe mental illness but face more than one in five vacant positions. She requested a full 3.2 percent cost-of-living adjustment (COLA) and identified $230 million in needed investments to modernize 30-40 year old housing programs that were not designed for today's residents, who take 15 or more daily medications and have multiple co-occurring conditions. Multiple testifiers emphasized that the crisis is not simply about adding more beds or facilities, but about investing in workforce and community-based alternatives. Mr. Seereiter noted that individuals with developmental disabilities stay in hospitals 2.5 times longer than the general Medicaid population, often for months or years, because reimbursement structures don't allow providers to support increased needs during community reintegration. Tom Harris, president of Times Square Alliance, presented data showing the effectiveness of mental health professional-led crisis interventions. When mental health professionals conduct removals (958 removals), 75 percent of individuals connect with services. When police conduct removals (941 removals), 75 percent return to the street. Harris's Community First initiative reduced street homelessness in Times Square from 31 to 10 individuals, though he acknowledged a 292 percent increase in 311 calls related to unhoused individuals, suggesting that current policies fail to adequately support the most vulnerable. Jim Karpe, representing the Coalition for Self-Direction Families, advocated for innovation and flexibility in how families can use services. He criticized what he called "shadow policies" implemented by the Office for People with Developmental Disabilities in November 2022 that restrict community classes, arguing that New York is overly restrictive compared to neighboring states like New Jersey and Kansas. Service providers unanimously requested a 3.2 percent COLA, noting that the Governor's proposed 1.5 percent falls short of inflation. Assemblywoman Kelles emphasized the false economy of underfunding: "Right now, because they're not paid, we have a shortage of 25 percent in some categories. Because they're not paid enough, they're on social services. We also pay because there's not enough, we end up with more people who end up homeless. Because they're homeless, they're more likely to be engaged with the criminal justice system. Again, we pay again." The hearing underscored a consensus among legislators and advocates that investing in workforce compensation and community-based services is more cost-effective than relying on emergency rooms, hospitals, and the criminal justice system. The New York State Senate Finance Committee held a joint legislative hearing on the 2024-2025 mental hygiene budget on Tuesday, with panelists testifying about critical workforce and service delivery challenges in developmental disability and mental health systems. Self-direction advocate Jim Karpe testified that fiscal intermediaries are imposing arbitrary restrictions on services—including policies limiting care to two hours or less—and that the current reimbursement-based system creates financial barriers for families. Karpe called for representation of self-direction interests at the Office for People with Developmental Disabilities (OPWDD) leadership level and cited New Jersey's CMS-approved pre-approval policy for community classes as a model New York could adopt. Sen. John Weber of Rockland County expressed strong support for a $4,000 wage enhancement and COLA increase for direct support professionals, noting that DSP providers in his district reported employees sleeping in cars and struggling to afford rent and utilities. Weber suggested the proposed 3.2 percent COLA increase should be higher, potentially 6.4 percent, and requested details on administrative changes that could improve the system. Sebrina Barrett of the Office of Mental Health described a $230 million modernization investment focused on the aging population in OMH housing, where 40 percent of residents are age 55 or older and a third are 65 or older. She noted that current staffing is inadequate for medical needs including dementia, COPD, and mobility issues, resulting in residents cycling between residences and emergency care rather than aging in place. Mr. Harris presented data showing a 75 percent success rate for voluntary mental health engagement and cited the INSET program's 83 percent success rate, prompting Sen. Brouk to question whether expansion of involuntary treatment was necessary given the effectiveness of voluntary approaches. Assemblyman Burdick pressed Karpe for documentation of New Jersey's CMS-approved community class policies to use in discussions with OPWDD, noting the agency's historical compliance issues with federal regulators.