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US sues NY state officials over immigration enforcement; NM's national monuments face new development threats from Trump; NC community colleges get 'boost' to bring more students to high-demand jobs; Trump's resignation plan for federal workers can move forward; Advocates push for program to decrease wildlife collisions in VA.

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Deregulation raises environmental and public health concerns, national monuments face potential risks, political neutrality in education sparks protests, and Tulsi Gabbard's confirmation fuels controversy.

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Rural America struggles with opioids and homelessness in unexpected ways, Colorado's Lariat Ditch could help spur local recreation, and book deliveries revive rural communities hit by Hurricane Helene.

NYers face insurance barriers to getting mental health care

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Friday, January 24, 2025   

More than 3 million New Yorkers have a diagnosed mental illness but only around one in three can get the care they need to treat it.

The barriers stem from many factors, like so-called "fail first" policies, which require people to try an insurer-preferred medication first, before covering the original prescription.

Matthew Shapiro, senior director of government and cultural affairs for the New York State Chapter of the National Alliance on Mental Illness, said another issue is what are known as "ghost networks."

"In some cases, up to 75% of providers that the insurance company gives to their client don't actually exist," Shapiro pointed out. "They're no longer practicing in the area. We call that 'ghost coverage,' where they're telling you coverage is there and it's not."

A 2023 New York State Attorney General report found 86% of providers listed on health plan networks are not valid listings. The report recommended state regulators crack down on insurers to maintain consistent and accessible levels of care for all. Another barrier is low mental health care reimbursement rates for providers.

As mental health issues rise nationally, insurance coverage needs to meet the moment. Federal laws like the Mental Health Parity and Addiction Equity Act and the Affordable Care Act ensure behavioral health coverage is on par with other health care.

David Lloyd, chief policy officer for the mental health advocacy organization Inseparable, said loopholes in the laws still have to be closed.

"What mental health advocates across the country and in states are pushing for is to make sure when a doctor is recommending treatment, the health plan has to cover those services when they're consistent with what the standards of care are," Lloyd explained.

The biggest challenge to closing loopholes is lawmakers finding the political will to do so. Lloyd added the overall goal is to align providers' and insurers' standards of care, so patients get the treatment they need.

Disclosure: Inseparable contributes to our fund for reporting on Criminal Justice, Health Issues, Mental Health, and Social Justice. If you would like to help support news in the public interest, click here.


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