In her second State of the State address, Governor Kathy Hochul proposed significant investments in mental health with the goal of “fixing the entire continuum of care that is necessary to keep people safe and happy.” Her proposals range from expanding insurance coverage for mental health services to increased capacity for inpatient psychiatric beds. The plan also includes an expansion of outpatient services, payment parity for telehealth, more wrap around services for people transitioning from one setting to another, and expanded school-based mental health services.
This holistic approach is commendable especially in light of the growing need for mental health services in recent years. A recent survey of psychologists reported increases in patients seeking treatment for anxiety, depression, and substance-related disorders compared with 2020. Caregivers reported an inability to meet the increased demand and that their patients were facing longer waitlists.
Although details for these proposals will likely emerge when the governor reveals her proposed budget in the coming weeks, it was noted that there will be an addition of 1,000 beds and an increase in reimbursement for mental health-related services. Specifically, the State of the State notes an investment of $27.5 million to support increased reimbursement for inpatient psychiatric services. Higher reimbursement will help underwrite the cost of care and therefore make the provision of such services more likely.
But, in addition to the bricks and mortar that create places for people to receive services, a key factor to the success of many of these initiatives will be the staff to provide those services. These types of professionals can include psychiatrists and clinical social workers. The Health Services Research Agency has documented the current workforce challenges that contribute to barriers in access to care.
…in addition to the bricks and mortar that create places for people to receive services, a key factor to the success of many of these initiatives will be the staff to provide those services.
Newer strategies to address staffing shortages are emerging. Not only is telehealth being used more widely since the pandemic but on the same day that the governor proposed these changes, the Kaiser Family Foundation, a DC-based health policy think tank, released a report that examines strategies implemented through state Medicaid programs to address behavioral health workforce shortages.
The report outlines strategies that fall into four key areas: increasing reimbursement rates, reducing administrative burden, extending the workforce, and incentivizing participation. Increasing the reimbursement rates offered by the state incentivizes more provider participation thereby expanding access. Reducing administrative burdens helps lessen the time and effort it takes to process documentation by centralizing or standardizing credentialing and allowing practitioners more time to focus on care delivery. Extending the workforce allows more flexibility in the provision of services and scope of practice so that additional providers can give care without the same requirements for supervisory oversight. And incentivizing participation to attract providers can include prompt pay for services or student loan repayment, for example.
Many states have been using a combination of these strategies or are using similar strategies. For example 28 (including New York) of 44 states that responded to a recent Kaiser Family Foundation survey have implemented some type of rate increases in 2022 and/or 2023. Nearly all states (87% of respondents) indicated they had at least one strategy in place to bolster the workforce during the current fiscal year or planned for the upcoming fiscal year. As New York works to implement the governor’s bold plan to address the mental health needs in the state, policymakers should consider the growing body of research and evidence from other states addressing workforce shortages in this important sector. Utilizing more of the strategies in New York could ensure that the plan to “fix the entire continuum of care” is successful.
ABOUT THE AUTHOR
Courtney Burke is senior fellow for health policy at the Rockefeller Institute of Government