New York Enforces Network Adequacy to Improve Behavioral Health Access
New York State has introduced new network adequacy regulations to improve access to mental health and substance use disorder care for millions covered by Medicaid Managed Care, Child Health Plus, Essential Plan, and commercial health insurance plans. The regulations mandate that qualifying plans provide access to an initial outpatient behavioral health appointment within 10 business days of request, aiming to reduce wait times and improve timely care access. Additionally, plans must maintain and publish accurate, up-to-date in-network provider directories on their websites to eliminate misleading or inaccurate information, known as 'ghost networks'.
Effective July 1, these protections apply immediately to Medicaid Managed Care, Child Health Plus, and Essential Plan enrollees; commercial plan enrollees will receive these protections on a rolling basis as their policies renew or change. Insurers are also required to have staff dedicated to assisting members in finding in-network providers and must provide lists of such providers within three business days of a request. These measures aim to address common barriers to care such as long wait times and out-of-network expenses.
The state has allocated $1 million in the FY 2026 budget to enforce these regulations, enhance compliance oversight, educate consumers and providers, and manage complaints. Consumers can file complaints with the Department of Health or the Department of Financial Services depending on their insurance type. The Community Health Access to Addiction & Mental Healthcare Project (CHAMP) serves as a resource for insurance issues related to substance use and mental health care.
New York continues to lead nationally in behavioral health insurance regulation by requiring commercial insurers to reimburse outpatient mental health and substance use disorder services at no less than Medicaid rates through in-network licensed facilities. Plans must cover all medically necessary treatments and adhere to nonprofit clinical guidelines. These regulations complement existing resources such as the 988 Suicide & Crisis Lifeline and the state's HOPEline for addiction support.
Collectively, these measures represent a comprehensive effort to reduce access barriers, increase transparency, and ensure compliance among insurers to better serve New Yorkers seeking behavioral health care. Insurers and providers are expected to align their operations with these new standards to improve consumer experience and regulatory adherence.