After tense and uncertain budget negotiations, New York State will move forward with several pieces of its long-planned expansion of behavioral health services for children on Medicaid.

This week, the Center for New York City Affairs hosted a panel of experts to talk about what’s next for this reform: What the vision for a better system? What are we doing to get there? What are the obstacles in our way?

Watch a video of the event, below. First, here’s background and an update:

The children’s behavioral health reform is part of the State’s larger project to overhaul its $63 billion Medicaid program. The goal is to make it easier for kids and adolescents, up to the age of 21, to access mental health and substance abuse services — ultimately building a system that catches problems early and, when possible, prevents kids from spiraling into crisis. Currently some 220,000 children and adolescents across the state receive Medicaid-covered mental health or substance abuse services.

The reform plan was thrown into calamity when Governor Andrew Cuomo failed to include money for the new services in his spending proposal for the coming fiscal year. However, the final version of the State budget, approved by the Legislature on March 30th, allocates $30 million to pay for expanded services, half of which will come from the State, half from the federal government.

The budget includes an additional $13 million (also split between State and Federal funds) to help behavioral health providers pay for the infrastructural work necessary to build new programs, such as renovating space and hiring staff. Many provider organizations say the drawn-out reform process has exacerbated fiscal problems that stem from chronically low reimbursement rates in the behavioral health world.

The first round of new services will begin rolling out in January 2019, and is intended to give behavioral health providers new flexibility to work with kids and adolescents in their homes, schools, and communities — a model that experts say will let providers reach needier children and serve them better than replicating office visits designed for adults. The rates at which providers will be reimbursed for these services have not yet been determined.

In July 2019, an array of specialized, home-and-community-based services — currently available to a small number of children through capped, limited programs — will become available to a larger number of kids. These include programs designed to keep children stable at home, such as respite care and family support services. A further, larger expansion of these programs is planned for 2022.

Throughout the year, populations of children — including kids in foster care — that currently receive behavioral health services on a fee-for-service basis will be moved under the oversight of managed-care insurance companies.

Many advocates for children with behavioral health needs remain concerned about the limitations of the State’s plan. The budget does not include funding for certain service expansions that were built into the original reform design, such as crisis intervention and peer support programs, which advocates say are vital to helping families access care. Nor does it address the State’s shortage of clinical services for children and adolescents.

Watch a video of our panel discussion, below.

Abigail Kramer is a staff editor at the Center for New York City Affairs. Improving health and human services for children and families is a long-standing priority at the Center. This brief is made possible thanks to the generous support of the Altman Foundation, Child Welfare Fund, and The Sirus Fund. This article was originally published by Center for New York City Affairs.

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