NEWS10 ABC reports that advocates are urging lawmakers to shift most Medicaid mental health and substance use services from private managed care to fee-for-service.
Advocates press for change
According to NEWS10 ABC, healthcare advocates gathered at the Capitol to support a proposed New York bill affecting how most Medicaid mental health and substance use services are managed.
NEWS10 ABC reported that advocates want New York to remove most of those services from private insurance management. They said the current Medicaid managed care model creates delays and barriers for people seeking behavioral health and addiction care.
The bill remains proposed, not enacted. NEWS10 ABC said it is currently stalled in the Health Committees in both the state Senate and Assembly.
How the current model works
NEWS10 ABC reported that Medicaid services are administered through a managed care system in which the state pays private, for-profit insurance companies a flat fee to coordinate and cover healthcare for beneficiaries.
Advocates told NEWS10 ABC that this arrangement creates administrative hurdles for providers and can delay care for New Yorkers who need behavioral health services. They also argued that the model can delay reimbursement for providers serving vulnerable people.
Lauri Cole, executive director of the New York State Council for Community Behavioral Healthcare, told NEWS10 ABC that Medicaid managed care is “drowning providers.” She said private insurers receive hundreds of millions annually to manage care, while providers face what she described as a pattern of delayed or denied care and reimbursement.
Proposed fee-for-service approach
According to NEWS10 ABC, the proposed legislation would move most mental health and substance use services to a fee-for-service model rather than private insurance management.
NEWS10 ABC reported that advocates believe the change could save the state $400 million each year by eliminating administrative fees paid to insurance agencies. The source said any savings from the transition would be reinvested in community-based behavioral health and addiction services.
The proposal concerns most mental health and substance use services, as described by NEWS10 ABC. The source did not report that the bill has advanced out of either Health Committee.
What this means for New York patients
According to NEWS10 ABC, the proposal reflects advocates’ concerns about delays and barriers in Medicaid behavioral health care. For people looking for treatment locally, the directory lists 223 published clinics in New York.
This is general information, not medical advice.
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