Latest Writings:

"Reforming Care Management for

Adults with Behavioral Health Needs 
in New York Medicaid"

Policy Brief by Adrienne Anderson

January 23, 2025

Introductory Excerpt

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A spate of recent violent and high-profile incidents involving individuals with documented, unmanaged mental illness and substance use disorders has drawn significant public and press attention. In response, Governor Kathy Hochul and Mayor Eric Adams have both emphasized the need to improve policies that support individuals with serious behavioral health needs and address public safety concerns. Although the focus of the most recent debate is about rules for involuntary commitment, behavioral health experts and many policymakers agree that a comprehensive solution involves addressing the entire continuum of care.

Effective care management is widely recognized as essential for individuals with complex needs, as navigating the intricate systems of physical and behavioral health services, managed care plans, social services, housing, and sometimes the criminal justice system is challenging, particularly for individuals with mental illness or substance use disorders. Nevertheless, the subject of “care management” is arcane and generally, not well understood. 

The purpose of this Policy Brief is to provide an in-depth description of the existing care management infrastructure in New York and trace its evolution to its current form. The current care management system is rife with overlapping programs and confusion of roles. Accountability is complicated by limited insight into outcomes and a bureaucratic structure that divides responsibility among multiple governmental agencies, including the New York State Department of Health (DOH), the Office of Mental Health (OMH), and the Office of Addiction Services and Supports (OASAS). 

The issue of care management in behavioral health is also a case study in bureaucratic inertia. In 2012, the fundamental structure of State oversight shifted to replace programs under which OMH contracted directly with care management agencies (CMAs) – the organizations that directly perform care management services – with a system under which new entities called “Health Homes”, regulated by DOH but licensed and reimbursed as Medicaid service providers, would contract with managed care organizations. In this new model, Health Homes contract directly with CMAs, who, as a result, have no direct contractual accountability to the State.

Health homes received 90% of their funding from the federal government for the first eight quarters of the program, compared to 50% from the federal government under the care management programs they replaced, which made adoption of the health home model fiscally attractive. Over the years, many have questioned whether the Health Home model is, in fact, superior to the previous model, but the technical nature of these programs and the force of inertia has prevented a rethinking of fundamental decisions about organizational structure.

The current political focus on issues involving the behavioral health system provides an opportunity to reconsider many of these issues as they relate to care management. Hopefully, this Policy Brief can help inform that discussion.​

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