Years After NY Medicaid Overhaul, Kids’ Access to Mental Health Care Still in Crisis: Report
(CITY LIMITS) Jeanmarie Evelly, December 4, 2021
In 2011, former Gov. Andrew Cuomo ordered an overhaul of the state’s Medicaid system, including reforming coverage for the approximately 2 million kids across New York enrolled in Children’s Medicaid.
Core to the Children’s Medicaid Redesign Plan was expanding and streamlining youth behavioral health services—which are used by approximately 10 percent of the state’s children on Medicaid each year—and which were previously provided through a patchwork of waiver programs that advocates and customers said led to fragmented and substandard care.
The redesign, which also included shifting children’s mental health and substance use disorder services into managed care, aimed to offer a wider array of treatment options to more Medicaid enrollees under age 21. The goal, officials said, was to expand the state’s network of “community-based recovery-oriented services and supports” so kids could access care closer to their homes and earlier on, to avoid costly emergency room and inpatient treatment and prevent more complex behavioral health issues later in life.
But nearly a decade after the announcement of the redesign, advocates and experts say access to youth behavioral health services in New York has not substantially improved, and may have gotten worse. While the state has indeed reduced its inpatient capacity—the average number of Medicaid-enrolled youth staying daily in state psychiatric beds and residential treatment facilities both dropped by more than 20 percent between 2012 and 2019—it has failed to adequately invest in the community-based care that was promised to help prevent the need for those more expensive, intensive services, according to a recent report by The New School’s Center for New York City Affairs (CNYCA).
This can mean months-long wait times for young people in need of care, as they struggle to secure a therapist or treatment program spot in a system that advocates say has long suffered from a shortage of providers and decades of under-investment. Lacking adequate outpatient options, some youth in crisis end up cycling through emergency room and hospital visits; In 2019, more than a third of young New Yorkers hospitalized for psychiatric care were back in the ER again within three months, the CNYCA report found—one of the main issues the redesign aimed to prevent.