June 18, 2025  – Governor Hochul has announced that Medicaid managed care plans across New York are showing significant improvements in compliance with behavioral health access regulations. This development comes as federal enforcement under the current presidential administration declines, raising concerns among mental health advocates nationwide.

On June 10, Governor Hochul reported that all Medicaid managed care plans reviewed by the New York State Office of Mental Health (OMH) are meeting the state’s requirements for equitable access to mental health and substance use disorder services. Two insurers, Capital District Physicians’ Health Plan, Inc. and Excellus BlueCross BlueShield, were found to be fully compliant with all reviewed behavioral health access standards.

“While the Trump Administration sleeps on regulations aimed at ensuring access to critical behavioral health services, New York State has achieved landmark reforms and is holding insurance companies accountable,” said Governor Hochul. “The gains in compliance we’re seeing today reflect our steadfast commitment to ensuring these carriers cover critical mental health services and don’t restrict access to care.”

The federal shift away from enforcement became public last month when the Administration stated in a court filing that it does not plan to uphold certain mental health parity regulations. These rules are designed to prevent insurance companies from creating more barriers to behavioral health care than to physical health services, such as stricter prior authorization rules or limited provider networks.

In contrast, New York has taken a proactive approach. The state’s Office of Mental Health conducted a detailed review of six nonquantitative treatment limitations often used by insurers to restrict behavioral health access. All managed care plans evaluated were found to be in compliance with these key areas.

Further investigation revealed that Capital District Physicians’ Health Plan and Excellus BlueCross BlueShield also met all 19 reviewed nonquantitative standards. However, most plans fell short in fully complying with other provisions of the Mental Health Parity and Addiction Equity Act. Some were found to use different payment methods for behavioral health services, reimbursing at lower rates than for comparable medical or surgical care.

State officials have not been passive in addressing such disparities. A previous OMH review of behavioral health claims from 2018 to 2020 uncovered significant issues, including $39 million in inappropriate service denials during a six-month period. In response, the state issued 95 citations to 15 Medicaid managed care plans from 2019 through 2021, ultimately levying over $1 million in fines across 11 carriers.

The collected penalties have since been used to fund the Community Health Access to Addiction and Mental Healthcare Project (CHAMP). This initiative functions as New York’s independent ombudsman program, helping residents navigate insurance barriers and secure access to mental health and addiction treatment services.

With behavioral health needs continuing to rise, New York’s actions underscore a stark contrast to the direction taken at the federal level. The state’s approach—grounded in enforcement, accountability, and consumer support—offers a model for protecting access to behavioral health care in the face of national policy uncertainty.