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Alliance Alert: Recent actions by ���������� State to remove insurance barriers, enforce mental health parity, and require timely access to behavioral health providers are critical steps toward ensuring people can get the help they need when they need it. These new regulations—such as requiring initial outpatient behavioral health appointments within 10 business days—will help reduce delays, eliminate “ghost networks,” and give consumers real recourse when plans fail to comply.

But these gains come at a time when the federal government is moving to cut essential programs like Medicaid and SNAP, jeopardizing access to services and basic supports for millions. In this challenging environment, our state must push even harder to expand voluntary, community-based mental health and substance use services that meet people where they are, on their own terms. These are the programs that prevent crises, reduce hospitalizations, and keep people connected to their communities.

The Alliance for Rights and Recovery will continue to advocate for expanded access to voluntary services and for holding insurers accountable to state and federal parity laws. At our upcoming annual conference in September, we will host multiple workshops and keynotes focused on expanding services in the face of funding threats—including strategies for improving and innovating service delivery and exploring new funding opportunities to sustain community-based services.

Unbreakable! Harnessing Our Power, Building Our Resilience, Inspiring Hope and Courage
Alliance for Rights and Recovery 43^rd Annual Conference
Villa Roma Resort and Conference Center | September 29-October 1, 2025
Register Today

Now more than ever, it’s essential that we protect and grow the programs that work—because access to timely, voluntary services should be the standard, not the exception. See below to learn more about the state Office of Mental Health’s actions to improve access to services, including an interview with OMH Chief Fiscal Officer Joe Katagiri.

State Takes Steps to Promote Mental Health Care Access
By David Lombardo | The Capitol Pressroom | July 24, 2025

July 24, 2025 – ���������� Health Chief Fiscal Officer Joe Katagiri explains efforts to boost access to mental health and substance abuse treatments for ����������ers, including removing insurance barriers for Medicaid patients and requiring .

Listen to the Podcast episode here:

Access To Care
NYS Office of Mental Health | OMH News | August 2025

Regulations to require insurers cover behavioral health services
A series of new consumer protections announced by Governor Hochul in July are designed to give ���������� state residents better access to mental health and substance abuse services.

The network adequacy regulations require plans to provide access to initial outpatient appointments for behavioral health care within 10 business days of initial requests and to post up-to-date, accurate lists of in network providers on their websites, which will help to eliminate inaccurate or misleading directories.

Health care plans must also have dedicated employees who can help their members find in-network providers and provide a list of available in-network providers within three business days, following a member’s request.

Removing barriers
These protections took effect on July 1, for ����������ers covered by Medicaid Managed Care, Child Health Plus, and the Essential Plan. For ����������ers covered by commercial health insurance plans, these wait-time standards will take effect on a rolling basis as their policies are renewed, modified, or purchased on and after July 1.

“����������ers in need of mental health or substance use disorder treatment should not be forced to wait months for essential care or to cover these costs themselves when their plan doesn’t include any available providers,” Governor Hochul said. “These new regulations will help remove barriers that often force individuals and families to pay out-of-pocket for care or forgo treatment altogether.”

Plans must post an accurate and up-to-date directory of their provider networks, including health care professionals or facilities, providers’ locations, telehealth options, languages spoken, any restrictions concerning the conditions treated or ages served, and facility affiliations, among other information. Accurate directories will help to eliminate so-called ‘ghost networks’ – ones that give the appearance of offering in-network options, but instead list inaccurate information or providers that aren’t taking appointments.

Giving consumers recourse
The new regulations also provide avenues for consumers to file complaints against plans or insurers that are not in compliance. ����������ers covered by Medicaid, Essential Plan, or Child Health Plus can contact the ���������� State Department of Health; those with state-regulated commercial insurance coverage may contact the Department of Financial Services.

For more information about mental health and substance use disorder treatment coverage requirements and protections, visit the DFS webpage. ����������ers who are unsure of their coverage should contact their insurer or employer. Those needing mental health or substance use disorder services should also check their health insurance policies for a list of what is covered.

Mental health parity
Under Governor Hochul’s leadership, ���������� is leading the nation in requiring health insurers to cover behavioral health services and continues to develop tools to ensure these companies are following all applicable laws.

���������� State has been actively taking steps to ensure Medicaid managed care plans are complying with regulations and providing ����������ers with the coverage they are entitled to receive under law.

OMH reviewed six nonquantitative treatment limitations — provisions that are sometimes manipulated by these plans to restrict access to necessary behavioral health care — and found all carriers in compliance. In addition, OMH’s comprehensive and rigorous examination also determined that both the Capital District Physicians’ Health Plan, Inc. and Excellus BlueCross BlueShield were fully compliant with all 19 nonquantitative treatment limitations.

OMH, however, also found that most managed care plans did not fully demonstrate compliance with other provisions with the Mental Health Parity and Addiction Equity Act. Some continually applied a different rate-setting process for behavioral health services and reimbursing providers for less than they would for medical and surgical services.

���������� State has worked to hold managed care plans accountable for these violations. During a similar review of behavioral health claims filed between 2018 to 2020, OMH uncovered high levels of inappropriate denials for specialty services claims, including $39 million between December 2017 and May 2018. ���������� State took enforcement action on all 15 Medicaid managed care plans, issuing a total of 95 citations between 2019 and 2021, resulting in fines to 11 carriers totaling more than $1 million.

OMH continues to monitor managed care organizations on an ongoing basis to ensure they are properly providing behavioral health services to their members. The agency works in partnership with DOH, which has the legal authority to apply fines and enforce compliance in the Medicaid program.