Settlement Commits New York State to Providing Kids with Community-Based Mental Health Services

Advocates celebrate “a good day for the thousands of children with serious mental health conditions”

This story was originally published by The Imprint, a national nonprofit news outlet covering child welfare and youth justice. Sign up for The Imprint’s free newsletters here.

New York must now guarantee Medicaid-eligible children access to timely, intensive mental health services in their own homes and communities, under a class-action settlement reached Monday.

The settlement, filed in U.S. District Court with New York’s Department of Health and Office of Mental Health, represents a major step in addressing gaps in care that affect some of the state’s most vulnerable residents. 

Nearly half of the children in New York state — more than 2.5 million — are enrolled in Medicaid. But the lack of accessible mental health care has forced some parents to rely on hospitals and residential facilities for their children. For those with severe psychological and behavioral issues, being separated from families during distressing times causes even more trauma, attorneys said in an announcement Monday. 

“Today is a good day for the thousands of children with serious mental health conditions living in communities across New York State,” Steven Holinstat, one of the attorneys representing the four young plaintiffs who brought the suit, said in a press release. “They have waited long enough. This agreement at long last starts the process necessary to guarantee they get the care they need.”

The 52-page agreement details steps the state must take during the next 18 months. A plan outlining how the agencies will provide intensive care coordination and in-home behavioral health services must be drafted, as well as a crisis response plan that does not rely on police. The settlement requires the state to increase Medicaid reimbursement rates for children’s mental health providers. And an annual quality audit of these services must also be performed.

Justin Mason, a spokesperson for the Office of Mental Health, declined to comment directly on the settlement agreement, but said his office would continue working with the Department of Health to “secure an amicable resolution.”

“Ultimately, our goal is to ensure that our state delivers intensive home and community-based mental health services that serve the needs of all children and youth, including those covered by Medicaid,” Mason said in an email.

The federal class action lawsuit, C.K. v. McDonald, was filed in 2022 by two private law firms and two prominent advocacy groups, Disability Rights New York and Children’s Rights.

The plaintiffs and their families alleged that the state failed to fulfill its requirement to provide intensive mental health and mobile crisis services for children in their homes and communities. Instead, the families said, they spent months stuck on waitlists and were forced to hospitalize their children in restrictive, institutionalized settings for long periods of time.

“The State’s mental health system for Medicaid-eligible children is languishing in a state of dysfunction, providing inadequate, inaccessible, and woefully underfunded mental health services,” the lawsuit stated. 

“Today is a good day for the thousands of children with serious mental health conditions living in communities across New York State. They have waited long enough.”

— Plaintiffs’ attorney Steven Holinstat

One Monroe County parent, identified in the lawsuit by her initials, told The Imprint that she struggled with her child’s mental health issues for nearly a decade, with little help from the state.

P.W. has had custody of the girl, a family member, since she was 11 months old. She grew into an active, creative child who loved arts and crafts, dance and gymnastics. Her behavioral and mental health problems became evident by kindergarten. Over the years, doctors diagnosed the girl with a long list of anxiety disorders, unspecified schizophrenia and other behavioral issues. She was prescribed several kinds of psychotropic medications, according to the court filings.  

But her episodes of aggression and harmful behavior escalated. P.W. tried her best to get local care for her daughter and keep her out of institutions, but she remained on waitlists for the intensive, therapeutic treatment the child should have been eligible for under Medicaid. Instead, P.W. said she spent long hours in emergency psychiatric units whenever her daughter was in crisis.

By age 9, the child’s behavior led to moments that today are terrifying for the Rochester mom to recall. Once, she said, she cowered inside a locked room, while her daughter pounded a knife into the door. 

“As a mother with a Black child, the last thing I want to do is call the police, because often our children are considered criminals, and that’s not the case,” P.W. said. “But knowing she was unsafe, there were times where I didn’t have any other choice.”

The single mother felt helpless watching police officers “manhandle” her daughter, she said. Other times, she felt guilty for refusing to take her home after an emergency room visit because she felt the child had not received any help.Hospital staff would call in Child Protective Services caseworkers to mediate the situation.  

Eventually, P.W. said, she had to turn to residential treatment centers and intensive inpatient psychiatric units for help. In these places, the pre-teen was often isolated, and physically and medically restrained. P.W. remembers only being allowed virtual visits with her daughter for months during the pandemic — even at Christmas. 

Children’s Rights attorney Daniele Gerard, who represented the 57-year-old mother, said the family’s experiences highlight the importance of getting early help for children who need intensive services, to prevent a “huge crisis” later on that might involve traumatic interactions with police. 

“I’m hopeful for families that are able to build resilience and heal appropriately.”

— P.W., Monroe County parent and lawsuit plaintiff

Lawmakers and children’s advocates across the country have also called for increased help for overwhelmed families, some of whom have had to place children in foster care after being unable to meet their behavioral and mental health needs. 

The preliminary settlement in the New York case is awaiting final court approval. 

P.W.’s daughter is now 16 and at home again after three years of living in a residential facility. The mother hopes the settlement will mean a different outcome for families with the same challenges as hers. 

“I’m hopeful for the thousands of children and family members across the state that continue to lack appropriate, intense mental health services and that find themselves going in and out of the traumatizing psychiatric emergency room,” P.W. said. “I’m hopeful for families that are able to build resilience and heal appropriately.”