On January 14th, Governor Hochul delivered her 2025 ‘State of the State’ address. HCFANY commends the Governor for proposing sweeping protections for consumers and patients across the State. Her proposals feature many HCFANY advocacy goals falling under six categories: (1) mental health, (2) reproductive health, (3) chronic health conditions, (4) prescription drugs, (5) dental health, and (6) improving insurance coverage. Her proposals plan to:

(1) Mental Health

• Implement a teen mental health first aid program to equip youth with the ability to respond and address signs of mental health and substance use distress for themselves and their peers.
• Introduce an initiative that connects youths to critical mental health resources during state-funded after-school programs.
• Allocate new resources to strengthen compliance oversight and investigate more insurance complaints.

In New York, youth struggling with mental health has been on the rise; in 2023, 48 percent of teens experienced depressive symptoms ranging from mild (27 percent) to severe (11 percent) in New York. Through these proposed initiatives, the Governor hopes to provide basic skills for youths to support themselves and their peers and reduce the impacts of bullying and social violence. Additionally, the State aims to partner with the State University of New York to match social work graduate students with state-funded after-school programs to complete their required fieldwork and support vulnerable youths. 

The current law requires insurers to offer an accessible network of providers, pay at least Medicaid rates for in-network services, and reimburse school-based mental health services at Medicaid rates. Through her proposal, the Governor hopes to improve compliance oversight and investigate and find solutions to mental health care access needs and complaints.

We commend the Governor for her continued commitment to protecting youth mental health and proposing reforms to improve coverage for mental health care.  

(2) Reproductive Health

• Expand funding for reproductive health care facilities to enable renovations and equipment upgrades to help providers deliver the full range of comprehensive services.

In New York, reproductive health care facilities often lack the proper infrastructure to provide the full range of comprehensive services needed. The Governor hopes to support these facilities through the Reproductive Freedom and Equity Grant Fund and security grant funding to ensure a broader network of providers can deliver quality reproductive health care throughout the State.

HCFANY is excited to see the Governor’s continued effort to ensure New Yorkers have access to reproductive care. Earlier this year, she announced a first-in-the-nation initiative to provide 20 hours of paid leave for prenatal care for privately employed, pregnant New Yorkers, both full-time and part-time.

(3) Chronic Health Conditions

• Reduce cost barriers for Medicaid patients at high risk of major cardiovascular events, who need access to Glucagon-like petitde-1 (GLP-1) receptor agonists—more popularly known by their brand names, Wegovy or Ozempic.
• Expand eligibility for Essential Plan members to receive air conditioning units to protect themselves during severe heat events. New eligibility will cover those with diabetes, cardiovascular disease, hypertension, or those who are pregnant.

Obesity is a significant concern for New Yorkers; in 2023, around one in three New Yorkers were found to be obese. This chronic condition increases the risk of diabetes, asthma, cardiovascular disease, cancer, and other chronic health conditions. Recently, GLP-1s have transformed obesity treatment, but many face cost barriers to this life-saving treatment. The Governor proposes to provide greater access to GLP-1 drugs for Medicaid members at high risk of cardiovascular events and pressure drug companies to lower prices.

The effects of climate change have increased the severity, duration, and frequency of extreme heat events, also known as heat waves, and these events are deadly for vulnerable populations with chronic health conditions. Heat-related deaths are more likely to occur at home, highlighting the importance of home cooling access. Last year, the Governor implemented an initiative to distribute air conditioners for Essential Plan members whose asthma poses a significant medical risk. Her proposal builds upon this by expanding eligibility to more individuals whose symptoms worsen through these heat events.

HCFANY applauds the Governor’s outstanding support for New Yorkers with chronic health conditions. These initiatives build upon the first-in-the-nation diabetes initiative that HCFANY supported, eliminating co-pays for insulin covered by state-regulated insurance plans, which went into effect this year. As of 2023, 1.8 million New Yorkers have been diagnosed with diabetes, and this initiative is estimated to save eligible New Yorkers up to $1,200 per year totaling around $14 million in 2025.  

(4) Prescription Drugs

• Seek approval through the Food and Drug Administration’s Section 804 Importation Program to import low-cost Canadian drugs.
• Hold pharmacy benefit managers (PBMs) and drug manufacturers for any hidden, unnecessary cost they add to drug prices.

The United States spends more on prescription drugs than any other peer country—like Australia, Canada, and France—with prices around two to four times higher for major brand-name drugs. A nationwide survey finds that 82 percent of Americans believe the cost of drugs is unreasonable, and over half of Americans worry about being able to afford their family’s prescriptions. Last year, a bill aiming to implement prescription drug importation program to lower costs (A7954A/S604) was passed in the Senate but fell short in the Assembly. Luckily, the Governor plans to participate in the Food and Drug Administration’s Section 804 Importation Program, which achieves a similar goal in importing low-cost drugs from Canada.

Additionally, the Governor is seeking to introduce a first-in-nation initiative to improve transparency and hold PBMs and drug manufacturers accountable to uncover any unnecessary costs they add to drug prices.

(5) Dental Health

• Set minimum standards for dental plans available through New York’s insurance marketplace, New York State of Health (NYSOH).
• Expand the scope of practice for dental hygienists.
• Direct health plans to improve the availability of dental care.

It is well documented that dental care is essential to oral health, yet many New Yorkers face substantial barriers to accessing essential oral health services. HCFANY is thrilled to see the Governor’s proposal announcing plans to make minimum standards for dental plans available through New York’s insurance marketplace, New York State of Health (NYSOH)—an initiative that HCFANY has been advocating for.

The Governor also aims to introduce legislation to expand the scope of practice for dental hygienists and direct health plans to improve the availability of dental care.

(6) Insurance Coverage

• Identify and address equity gaps in quality and outcome measurements for those on Medicaid Managed Care plans.
• Create an integrated care system for Medicaid patients.
• Perform a comprehensive review of the State’s network adequacy standards and increase enforcement of plan compliance.

In 1994, New York implemented Quality Assurance Reporting Requirements (QARR), which measure and report on health care quality. Though current Medicaid Managed Care (MMC) plans meet or exceed national benchmarks for quality measures, these measurements from QARR cannot identify health inequities within the population. The Governor has proposed to direct MMC plans to analyze gaps in quality and outcomes within their populations, as well as develop strategies to address gaps, including creating a value-based payment.

New York is one of the three states where Medicaid patients can enroll in a separate MMC plan for long-term care along with their medical care coverage, called a partial capitation plan. Many also have separate Medicare coverage. This fragmentation reduces the ability for effective, person-centered, coordinated care. Through her proposal, the Governor plans to work with MMC plans to increase the availability and adoption of integrated care options and limit non-integrated offerings.

Lastly, in New York, network adequacy requirements have not been updated in decades despite variations in health care access across the state. Network adequacy standards require that health plans meet basic standards for members’ access to in-network providers without unreasonable delay or excessive travel. Currently, consumers are often directed to unavailable or out-of-network providers, which leads to untimely care and an increased risk of incurring medical debt. The Governor’s proposal intends to instruct the Department of Health to perform a comprehensive review on network adequacy standards and increase enforcement of plan compliance. HCFANY supports the Governor’s continued investment in proposing initiatives that help protect consumers from incurring medical debt, an issue that HCFANY continues to advocate for.

HCFANY commends the Governor for introducing these initiatives to protect patients and consumers in New York. HCFANY will review the newly released Executive Budget to determine how these proposals will be implemented.