Visits to mental health counselors and a host of other types of therapy could be covered by Medicaid in New York state.

A. 648A/S.3421A was approved 133-15 in the state Assembly and 61-1 by the state Senate. It has not yet been signed by Gov. Andrew Cuomo. Similar legislation had been introduced in the 2013-14 and 2015-16 legislative sessions and failed to be approved by the Assembly’s Health Committee. The legislation was approved by the Assembly in 2017-18 but was not approved in the state Senate.

The legislation was sponsored by Assemblyman Harry Bronson, D-Rochester, in the Assembly. It allows licensed mental health practitioners to bill Medicaid directly for the services they provide. He said the current law that excludes mental health practitioners licensed under Article 163 of the state Education Law from the list of recognized providers within the Medicaid program results in undue hardship for individuals, families, and communities, and a lack of transparency in Medicaid billing. He said that the National Institute of Mental Health states 25 percent of American adults suffer from a mental illness.

The legislation states the cost of expanding coverage is to be determined, though Bronson said there would not be an increase in the state’s Medicaid budget by expanding coverage to mental health counselors as well as marriage and family therapists, creative arts therapists and psychoanalysts.

“They’re already providing these services in a clinical setting, but this would allow them to provide the services and to bill Medicaid directly,” Bronson said. “There will not be an increase in the Medicaid system because those who would be receiving these services are already eligible under Medicaid. The difference will be this. Under the current system there’s a waiting list. A waiting list for our young people who are in need of mental health services and for our families who are in need of mental health services. What this bill would do is authorize the other providers to provide those services to reduce that waiting list.”

In his next breath, though, Bronson spoke of the current system’s dichotomy between those who have the money to pay for the services and those who do not, indicating there will be some sort of increase in Medicaid.

“The current arrangemnet essentially creates a two-track health care system in our state: one for those who have the financial means to simply write a check and get the care they need and another for those who cannot,” Bronson said. “So if you are wealthy person in Manhattan, you have access to mental health services. But if you’re one of the many people living in poverty in the city of Rochester, access is essentially denied. This is a gross injustice. Mr. Speaker, I believe that every New Yorker deserves to have access to health care no matter how big or how msall their bank account is. Health care is a human right. And mental health is a vital part of our state’s overall health care delivery.”

Goodell said the state Psychiatric Association opposed the mental health counselor addition to Medicaid because the association said the legislation removes safeguards and oversights required in a hospital or a clinical setting. Bronson refuted the association’s claim, saying anyone who can bill Medicaid for these services would already be licensed by the state and have to adhere to clinical safeguards. Goodell also pointed to the state’s already high Medicaid costs as a reason not to expand the program further, particularly given the legislation’s inability to pinpoint a cost to taxpayers.

“As you know under current Medicaid coverage we cover psychiatric services,” Goodell said. “The Medicaid program was designed to cover medical services and that’s why we cover psychiatric services. This would expand it to include health counselors, marriage and family therapists, creative arts therapists and psychoanalysts. Our Medicaid program currently has the dubious distinction of being the most expensive in the nation. Even though the size of New York state is smaller than California and Florida, the cost of our Medicaid program exceeds theirs combined. So while I appreciate the services that are likely rpovided by mental health counselors, marriage and family therapists, creative arts therapists and psychoanalysts, this is another expensive expansion of our Medicaid program beyond the medical care that we currently provide.”