Increases Medicaid reimbursement rates for certain behavioral health services provided to individuals under the age of twenty-one; directs that funds in the healthcare stability fund can be used for the funding of children's behavioral health outpatient rate increases.
Summary
This bill would increase Medicaid reimbursement for certain children’s behavioral health services, with a focus on outpatient clinic services for individuals under age 21. Beginning April 1, 2026, Medicaid payments for outpatient behavioral health clinic services provided under Articles 31 and 32 of the Mental Hygiene Law would be increased by at least 35 percent. The bill also requires those payments to include, where applicable, a care coordination fee of at least $7.50 per member per month and a 3.2 percent trend factor.
In addition to the outpatient clinic rate changes, the bill directs the Commissioner of Health to submit state plan amendments to the federal Centers for Medicare and Medicaid Services by October 1, 2025, to secure approval for related rate increases. Those amendments would implement at least $45 million in increased funding for home and community-based services and child and family support services, along with the same care coordination fee and trend factor for those services where applicable. The bill also amends the state finance law to allow the healthcare stability fund to be used to support children’s behavioral health outpatient rate increases.
Impact
The bill would amend the Social Services Law by creating a new section establishing minimum Medicaid payment standards for children’s behavioral health outpatient services, and it would amend the State Finance Law to expressly permit use of the healthcare stability fund for these rate increases. It would affect Medicaid providers delivering outpatient behavioral health, home and community-based services, and child and family treatment/support services for people under 21, while also requiring state action to seek federal approval and matching funds where needed.
Sentiment
The available context suggests a generally supportive posture toward the bill, as reflected by its framing around increased reimbursement for children’s behavioral health services and the absence of recorded opposition, votes, or committee objections in the provided materials. The bill’s purpose appears to be to strengthen provider funding and service capacity for youth behavioral health, which is typically presented as a service-expansion and access measure.
Contention
The main policy questions likely concern the fiscal impact and implementation mechanics rather than the underlying goal. The bill sets minimum increases, but several provisions are contingent on approval by the Commissioner of Health, the Director of the Budget, and, for some items, federal financial participation and CMS approval through state plan amendments. Potential points of contention include the cost to the Medicaid program and state budget, the use of the healthcare stability fund, and whether the proposed rate increases are sufficient or targeted appropriately across outpatient, home-based, and family support services.
Same As
Increases Medicaid reimbursement rates for certain behavioral health services provided to individuals under the age of twenty-one; directs that funds in the healthcare stability fund can be used for the funding of children's behavioral health outpatient rate increases.
Increases Medicaid reimbursement rates for certain behavioral health services provided to individuals under the age of twenty-one; directs that funds in the healthcare stability fund can be used for the funding of children's behavioral health outpatient rate increases.
Increases Medicaid reimbursement for in-person partial care and intensive outpatient behavioral health and substance use disorder treatment services, and associated transportation services, for adults.
Increases Medicaid reimbursement for in-person partial care and intensive outpatient behavioral health and substance use disorder treatment services, and associated transportation services, for adults.
Establishes a core state behavioral health crisis services system, to be administered by the director of behavioral healthcare, developmental disabilities and hospitals.