FUSA: Defending Health Care in 2017: What Is at Stake for New York

NYAPRS Note: Noted Medicaid advocacy group Families USA has released a state by states assessment of the impact of changes to Medicaid and Medicarethat have been proposed by Republican leaders, most notably the takedown of the Affordable Care Act (Obamacare).
Here’s the one for New York….you can see all of the others if you go to http://familiesusa.org/product/defending-health-care-2017-what-stake-new-york?platform=hootsuite and look for the ‘states’ button.

Defending Health Care in 2017: What Is at Stake for New York

Families USA Fact Sheet December 2016

With a new president and Congress, the health care gains made throughout the last six years face their greatest threat yet. Congress has voted more than 60 times to roll back the historic progress that has been made to expand health coverage to millions of people in this country and to improve coverage for those who already had it. These proposed changes will put the health—and lives—of countless New Yorkers at risk. Here’s what New York stands to lose if the new president and Congress move forward to upend our health care system:

More than a million New Yorkers stand to lose health coverage
1.1 million New Yorkers stand to lose their health coverage.1

New York stands to lose $57 billion in federal funding for Medicaid, CHIP, and financial assistance for marketplace coverage.2Approximately 124,000 New Yorkers who currently get financial assistance to help pay for their health coverage will lose this help and will no longer have affordable coverage options. In 2016, New Yorkers receiving financial assistance saw their monthly premiums reduced on average $178 thanks to this help.3

The now-historically low rate of uninsured people will spike, with the number of uninsured in New York increasing 75 percent by 2019.4This will reverse the immense progress that has been made to expand coverage. Between 2013 and 2015:

  • The number of uninsured in New York declined 34 percent5
  • Working New Yorkers: The uninsured rate among working New Yorkers saw a 31 percent decline6

Repeal will end New York’s Medicaid expansion and cause ripple effects across the state economy

2.3 million stand to lose health coverage, most of whom are working.7The Medicaid expansion has extended health coverage to lower-income New Yorkers who hold down jobs that are the backbone of the state’s economy—from fast food workers to home care attendants to construction workers to cashiers. Repeal will leave these hard working New Yorkers out in the cold.
New York will lose billions in federal Medicaid funding.Over the course of a year and a half alone, Medicaid expansion brought 9.3 billion in federal dollars into the state economy.8The impact of that lost federal Medicaid funding will have a ripple effect throughout the state economy, affecting hospitals, other health care providers, and businesses.

New Yorkers with private health insurance will be stripped of vital protections against discrimination

Approximately 8.6 million New Yorkers with pre-existing conditions like asthma, diabetes, and cancer could once again be denied affordable, comprehensive coverage that actually covers their health care needs.9

New Yorkers will once again face a world where insurance plans routinely cap the most they will pay for someone’s health care in a year and in their lifetime, effectively cutting off coverage for the sickest individuals when they most need it.

  • Roughly 6.4 million New Yorkers (including 1.6 million children) saw lifetime limits on coverage disappear thanks to the Affordable Care Act’s ban on these practices.10

Millions of New Yorkers will lose guaranteed coverage of free preventive services, like recommended cancer screenings and vaccines

Approximately 8.6 million New Yorkers with private health coverage (including 1.7 million children) and 3.3 million New York seniors on Medicare will lose guaranteed access to free preventive care, like blood pressure screenings, immunizations, and cancer screenings.11,12

Insurance companies will no longer be required to put New Yorkers’ premiums toward care, not profits

Insurers will no longer be held accountable for using people’s premium dollars on care and quality improvement or paying back the difference.

  • New Yorkers have received around $98.4 million in refunds from plans that overcharged for premiums since the ACA took effect.13

Thousands of seniors and people with disabilities will lose comprehensive drug coverage
The Medicare donut hole will re-open. This will leave New York’s seniors and people with disabilities with a gap in prescription drug coverage and forced to pay thousands of dollars more in drug costs.

  • Seniors and people with disabilities in New York have saved approximately $1.6 billion on drug costs thanks to the ACA’s closing the Medicare donut hole.14
  • In 2015 alone, approximately 359,000 seniors and people with disabilities in New York saved on average $1,195 on drug costs.15


1Loss of coverage estimates are based on insurance coverage estimates for 2019 under the Affordable Care Act (ACA) and under partial repeal of the ACA through a January 2017 reconciliation bill. Linda J. Blumberg, Matthew Buettgens, and John Holahan, Implications of Partial Repeal of the ACA through Reconciliation (Washington, DC: Urban Institute, December 2016), available online at http://www.urban.org/research/publication/implications-partial-repeal-aca-through-reconciliation (last accessed Dec. 7, 2016).

2Estimates of lost federal assistance are based on estimates of federal spending on Medicaid/CHIP and Marketplace financial assistance from 2019 through 2028 under the Affordable Care Act (ACA) and under partial repeal of the ACA through a January 2017 reconciliation bill. Linda J. Blumberg, Matthew Buettgens, and John Holahan, Implications of Partial Repeal of the ACA through Reconciliation (Washington, DC: Urban Institute, December 2016), available online at http://www.urban.org/research/publication/implications-partial-repeal-aca-through-reconciliation (last accessed Dec. 7, 2016).

3Centers for Medicare and Medicaid Services, March 31, 2016 Effectuated Enrollment Snapshot, (Baltimore, MD: Centers for Medicare and Medicaid Services, June 2016), available online at https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-06-30.html (last accessed Dec. 6, 2016).

4Linda J. Blumberg, Matthew Buettgens, and John Holahan, Implications of Partial Repeal of the ACA through Reconciliation (Washington, DC: Urban Institute, December 2016), available online at http://www.urban.org/research/publication/implications-partial-repeal-aca-through-reconciliation (last accessed Dec. 7, 2016).

5Jessica C. Barrett, and Maria S. Vornovitsky, Health Insurance Coverage in the United States: 2015, (Washington, DC: U.S. Government Printing Office, September 2016), available online at http://www.census.gov/library/publications/2016/demo/p60-257.html (last accessed Dec. 6, 2016).

6Families USA Analysis of 2014-2016 Census Bureau American Community Survey Data

7Robin Rudowitz, Samantha Artiga and Katherine Young, What Coverage and Financing is at Risk Under a Repeal of the ACA Medicaid Expansion (Washington DC: The Kaiser Family Foundation, December 2016) available online at http://kff.org/report-section/what-coverage-and-financing-is-at-risk-under-a-repeal-of-the-aca-medicaid-expansion-appendix/ (last accessed Dec. 7, 2016).


9White House, State by State Cost of Repeal Reports, (Washington, DC: White House), available online at https://www.whitehouse.gov/sites/default/files/docs/state_by_state_cost_of_repeal_report.pdf (last accessed Dec 6, 2016).

10Tomas D. Musco and Benjamin D. Sommers, Under the Affordable Care Act, 105 Million Americans No Longer Face Lifetime Limits on Health Benefits, (Washington, DC: Office of Assistant Secretary for Planning and Evaluation, March 2012), available online at https://aspe.hhs.gov/basic-report/under-affordable-care-act-105-million-americans-no-longer-face-lifetime-limits-health-benefits (last accessed Dec. 6, 2016).

11ASPE, ASPE Data Point: The Affordable Care Act is Improving Access to Preventive Services for Millions of Americans, (Washington, DC: Department of Health and Human Services, May 2015), available online at https://aspe.hhs.gov/pdf-report/affordable-care-act-improving-access-preventive-services-millions-americans (last accessed Dec. 6, 2016).

12Kaiser Family Foundation, Total Number of Medicare Beneficiaries: 2015, (Washington, DC: Kaiser Family Foundation), available online at http://kff.org/medicare/state-indicator/total-medicare-beneficiaries/ (last accessed Dec. 6, 2016).

13Families USA Analysis of 2012-2015 MLR Rebate Reports by State.

14Centers for Medicare and Medicaid Services, Part D donut hole savings by state YTD 2015, (Baltimore, MD: Centers for Medicare and Medicaid Services, August 2016), available online at https://downloads.cms.gov/files/Part%20D%20dount%20hole%20savings%20by%20state%20YTD%202015.pdf.

15Centers for Medicare and Medicaid Services, Part D donut hole savings by state YTD 2015, (Baltimore, MD: Centers for Medicare and Medicaid Services, August 2016), available online at https://downloads.cms.gov/files/Part%20D%20dount%20hole%20savings%20by%20state%20YTD%202015.pdf.


Resentment Is Like Swallowing Poison and Expecting the Other Person to Die: Carrie Fisher

NYAPRS Note: Some insights into the inspiration that Carrie Fisher offered, from a woman who once joked about “hoping to get the centerfold in Psychology Today” and remarked “resentment is like swallowing poison and expecting the other person to die.”

Fans Tweet About Mental Illness to Honor Carrie Fisher
ByRyanBurleson AndTaraParker-Pope New York Times December 27, 2016

The actress Carrie Fisher, who spoke openly about her struggles with mental illness, once joked that she wanted to start a “Bipolar Pride Day” to help erase the stigma of the disease.

Legions of fans seemed to grant her wish on Tuesday in the hours after her death at age 60. One after another, in words both plain-spoken and deeply personal, admirers paid tribute to Ms. Fisher by “coming out” on Twitter with their own stories of mental illness.

Ana Marie Cox, senior political correspondent for MTV with 1.3 million followers on Twitter, was among the first to tweet.

“I really did think, ‘What would Carrie do?’” Ms. Cox said in a subsequent telephone interview, as she described trying to decide how open to be about her own health.

Choking back tears as she spoke, Ms. Cox continued: “I really did identify her as a feminist icon, a model for being a tough smart girl. But where she really pushed the boundary of what we could talk about in polite company or impolite company was her mental illness and her openness about that.”

Almost immediately after her tweet, some of Ms. Cox’s followers began sharing their own stories about mental illness.

Jeremy Hitchcock, 34, a computer programmer from Manhattan, was seeing the new movie “Rogue One: A Star Wars Story” on Friday when he heard other audience members sharing the news that Ms. Fisher had suffered a heart attack hours earlier. Mr. Hitchcock, who was so devoted to the space saga that he named his son Luke after the character Luke Skywalker, said in an interview that he was devastated by her death. After seeing Ms. Cox’s tweet, he decided to do something he’d never done before, something that terrified him. He announced publicly that he has bipolar disorder.

The Chicago radio personality Julie DiCaro also followed Ms. Cox’s lead, tweeting to her 31,000 followers that she suffers from depression. She also began the hashtag #InHonorOfCarrie.

Within a couple of hours, the hashtag had reached 182,000 unique viewers as people began opening up about their struggles with bipolar disorder, depression, anxiety, suicide — often for the first time in such public fashion.

“I wanted to do something that wasn’t about her being beautiful or a sex symbol,” Ms. DiCaro said of Ms. Fisher, “but about her being a woman who wasn’t afraid to speak out about mental illness. She became a hero to me because of who she was off the screen more than who she was on the screen.”

“People who struggle with these issues often feel like they’re going it alone,” Ms. DiCaro continued. “But it’s comforting that Carrie, or Princess Leia — who’s cooler than Princess Leia? — was comfortable speaking publicly about her struggles. It made me feel comfortable.”

Ms. Fisher has said that she was first given a diagnosis of bipolar disorder at the age of 24, but that it wasn’t until five years later that she actually accepted it. In time, she spoke often about her lifelong struggles with both addiction and bipolar disorder and her desire to erase the stigma of mental illness.

She wrote her 1987 novel “Postcards From the Edge” after a stint in rehab following a near-fatal drug overdose. It was during her autobiographical one-woman stage show, “Wishful Drinking,” that she first posited the idea for “Bipolar Pride Day.”

Dr. Barron Lerner, a medical historian, said that while public outpourings are common after a celebrity’s death, the nature of the tribute to Ms. Fisher is unusual.

“The fact that they are outing their mental illness needs to be acknowledged as it remains far more stigmatized than other diseases,” said Dr. Lerner, an internist at New York University Langone Medical Center and author of the book “When Illness Goes Public.”

“Rather than just saying ‘R.I.P. Carrie,’ it is much more powerful to take a courageous step oneself to honor the memory of someone famous who also struggled with what you have,” he added.

Ms. Cox, who also writes the “Talk” column for The New York Times Magazine, said that while it felt risky to tweet about her bipolar disorder, she received a number of emails and tweets from people close to her who also cope with mental illness. And the overwhelming response on social media has convinced her it was a fitting tribute to Ms. Fisher.

“I think she would be floored,” Ms. Cox said. “I think she would be happy. It’s a powerful thing.”

Ms. Fisher’s efforts to destigmatize mental illness and addiction took new form this year as she started writing the column “Advice From the Dark Side” for The Guardian. Characteristically funny and cleareyed, Ms. Fisher fielded questions from readers on bipolar disorder and dysfunctional marriages, among other topics.

She ended one memorable exchange with a line that was often tweeted on Tuesday:

"Move through those feelings and meet me on the other side. As your bipolar sister, I’ll be watching."


NPR: The Future Of Medicaid May Be Found In Indiana, Where The Poor Pay

The Future of Medicaid May Be Found In Indiana, Where The Poor Pay
December 27, 20164:44 AM ET by Alison NPR.org December 27, 2016

To get a glimpse of where Medicaid may be headed after Donald Trump moves into the White House, it may be wise to look to Indiana.

That's where Seema Verma, Trump's pick to run the Centers for Medicare and Medicaid Services, comes from. And that's where she put her stamp on the state's health care program for the poor.

Verma is a private consultant who was hired by Indiana Gov. and Vice President-elect Mike Pence to design a Republican-friendly expansion of Medicaid under the Affordable Care Act. The state paid her almost $5 million over four years through 2017, according to the contracts.

She sees the federal Medicaid program as a bureaucratic nightmare that hamstrings states and encourages poor people to remain dependent.

"The Medicaid program has not kept pace with the modern health-care market," she testified at a Congressional hearing in 2013. "Its rigid, complex rules designed to protect enrollees have also created an intractable program that does not foster efficiency, quality or personal responsibility."

The plan she came up with for Indiana requires poor Medicaid recipients to make monthly payments for their insurance, or lose benefits.

"Seema was very committed to extending coverage to low-income families in Indiana," says Cindy Mann, who was the CMS official who negotiated the deal with Verma on that state's Medicaid expansion.

She says throughout the negotiations, Verma was "very committed to a particular ideology. That ideology is very much focused on personal responsibility."

Verma did not respond to multiple requests to be interviewed for this story.

Pence was one of the few Republican governors who took the Obama administration up on its offer to pay the lion's share of the costs for states that expanded their Medicaid programs to people whose incomes reach 138 percent of the poverty level, or $16,243.

But rather than simply offer coverage to more people, the state sought a waiver to revamp its program. That's the deal that Verma worked out with Mann.

Indiana's program, which extended Medicaid to about 246,000 people who weren't eligible before, is infused with Verma's ideas of how to make poor people take responsibility for their health care.

It has a complex system of carrots and sticks.

Beneficiaries make monthly payments from $1 to about $27 into individual health savings accounts, and the state also contributes. That money can be used for doctor visits and prescriptions.

If beneficiaries get vaccines and other preventive care, they get a discount on their premiums the following year.

But they can also be penalized. People whose incomes are above the poverty line can be cut off for six months if they miss a payment. Those below the poverty line are knocked down to a plan with fewer benefits.

And if a patient unnecessarily goes to the emergency room, extra money comes out of the health savings account.

"There are many ways to try and effectuate personal responsibility," Mann says. "Some states have moved forward with healthy behavior initiatives, for example. Some states have done some premiums and copays." Indiana's plan requires everyone to contribute to a health savings account. "And so the responsibility was really translated into payment requirements, and with pretty strong consequences if somebody was unable to pay."

She says Verma and Indiana wanted the penalties to be even harsher — a full year with no coverage for people who miss payments. But CMS rejected that idea.

So how does it work in practice? For Amber Thayer, a mom of three who lives in a Volunteers of America family shelter in Indianapolis, it's been a bit of a nightmare.

Thayer is a recovering addict who has been clean for six months with the help of the medication Suboxone. And she's training to be a nursing assistant.

"It's been quite, quite the struggle, but we've gotten there and we're doing great, and we're getting ready to get into our own home," she says.

She pays $1 a month for her Medicaid insurance.

In October, she got a bill for that $1 from a different company than the one she had been dealing with. She assumed the state had switched her.

"It is only a dollar," she says. "I could pay a dollar a month, or I could pay $12 and that will cover me for the year. Unfortunately, at that time, I only had I believe it was like $2.38 on my card."

So she called the company and used her bank card to pay the dollar.

But the company, or perhaps the state, lost track of her dollar, and her insurance was cut off. She had her bank statement and a receipt from the insurer that proved she had paid. But she still spent six weeks, with multiple phone calls and visits to state health offices, trying to get her coverage restored.

All the while, she scraped together enough money to buy Suboxone one dose at a time.

"I'm fearing, you know, the withdraws," Thayer recalls.

But she was also afraid the loss of insurance would interfere with her ability to take her nursing assistant exam, which in turn would threaten the stipend she gets because she is in job training. "If I don't get my stipend, we're not going to have our money to help us get into our home."

It's these types of complications that have some advocates worried.

Adam Mueller, a lawyer for Indiana Legal Services, says he's happy more of his clients have health insurance. But he says the state's notion that people will feel more invested in their care if they pay $1 a month just doesn't play out in the real world.

"They don't feel like they have skin in the game," Mueller says. "One guy told me that it feels like Indiana is trying to take his last $12."

Joe Thompson, CEO of the Arkansas Center for Health Improvement, says it's just hard to be poor.

"The social stresses of low-income individuals probably make most aspects of managing through the day more difficult than if you have more affluence and have more resources available to deploy," he says.

Thompson, who's a former Arkansas surgeon general, helped develop a Medicaid program in his state that had many of the same features as Indiana, including premium payments and health savings accounts.

In the end, Arkansas decided it just wasn't worth it.

"We had about a year and a half of experience there, and candidly the administrative cost and the operating aspects exceeded what the Legislature subsequently perceived the benefit of that program was," Thompson says. So the state scrapped the health savings accounts.

He says the ideas about personal responsibility are politically popular, but implementing them is too complex.

"We lose too many folks along the way, and we may be causing more challenges than we're solving," he says.

Arkansas still charges nominal premiums for some Medicaid recipients, but they pay them directly to insurers. The carrots and sticks and individual accounts are gone.

In Indiana, insurers also collect the premiums and administer the individual health savings accounts.

James Gavin, a spokesman for the Family and Social Services Administration, says those costs are included in what the state pays the insurance companies, and so it's not clear exactly how much Indiana is spending to administer the health savings accounts.

Verma has advised several states, including Iowa, Kentucky and Ohio, that are looking for Medicaid waivers from the federal government. Many of those waiver applications include cost features such as premiums or health savings accounts or incentives for healthy behavior.

"The cost-sharing policy is not to burden the individual," she told lawmakers at the 2013 hearing. "I think it's to incentivize them and empower them to be part of the equation."

When Verma testified in 2013, she urged lawmakers to make the process of getting Medicaid waivers easier.

If she's confirmed as administrator of the Center for Medicare and Medicaid Services, it will be her and her staff who review waiver applications and determine whether they should go forward.


Jan. 5 NYC NYAPRS Legislative Day Forum to Feature Discussion on 'New Choices' in MRT Environment

NYAPRS Note: Please join us next Thursday in NYC for a spirited discussion around the new choices face people with mental health conditions in the ever emerging healthcare reform environment and the agenda for which we’ll all raise our voices at our February 28 Annual Legislative Day in Albany!
Look for information on additional dates and times in Suffolk, Nassau, Westchester counties and the mid–Hudson Valley and possibly more sites, in the coming days.

Feb 1 CMHS National Advisory Council Meeting; On the Matter of DJ Jaffe

NYAPRS Note: While we usually try to avoid dignifying the work of DJ Jaffe, I do want to refer to the article that follows this announcement regarding the next SAMHSA’s Center for Mental Health Services National Advisory Council on February 1.
If you can make it through, Jaffe launches yet another rant spinning his well-worn wildly unsubstantiated claims tying SAMHSA and the recovery movement with every tragic death and encounter with the criminal justice system and homelessness involving a person diagnosed with a serious mental illness. Along the way, he attacks preventive ‘Mental Health First Aid’ programs and peers on teams that enforce outpatient commitment orders and continues his crusade focused solely on more hospitalizations, medication and court mandated care, with never a word about all of the progressive innovations that have been launched over the past few decades.

SAMHSA spends the tiniest amount of its program dollars and education and TA initiatives on bullying initiatives or other preventive measures but you’d never know that from reading Mr. Jaffe. Recovery, rehabilitative and relapse and crisis management programs are apparently anathema to him, or perhaps they’ve escaped his extremely narrow view because they don’t fit his narrative.

It’s too bad that this politicized propaganda gets so much public attention because those approaches have spared millions of what he’d call ‘the sickest’ individuals from disabling chronic disease, death, despair, isolation, suicide, incarceration and homelessness.

Full disclosure, NYAPRS offers technical assistance to state and local groups on peer approaches that engage and serve what he’d call the ‘sickest and most resistant’ individuals via indirect SAMHSA funding to the tune of 3% of our budget, a relatively scant amount I’d give back in a minute to refute Jaffe’s claim that anyone who opposes his miniature world view is motivated via a collusion with the federal agency that has helped save or advance the lives of tens of millions of Americans over the past few decades.

Let’s hope that in 2017 this dark distraction is one of the casualties of draining the swamp of what ails us.

There�I feel better now�.this was just a holiday present to myself. Happy New Year everybody. Harvey Rosenthal

This is a save the date for the next meeting of the SAMHSA/Center for Mental Health Services National Advisory Council on February 1, 2017. More information will be shared closer to the date.


Substance Abuse and Mental Health Services Administration

Notice of Meeting Center for Mental Health Services

Pursuant to Public Law 92–463, notice is hereby given that the Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Mental Health Services (CMHS) National Advisory Council (NAC) on February 1, 2017, from 9:00 a.m. to 5:15 p.m. E.D.T.

The meeting will include discussion of the Center’s policy issues, and current administrative, legislative, and program developments and a conversation with the SAMHSA Principal Deputy Administrator, and the SAMHSA Chief Medical Officer.

The meeting will be held at the SAMHSA building, 5600 Fishers Lane, 5th Floor, Conference Room 5W07, Rockville, MD 20857. Attendance by the public will be limited to space available. Interested persons may present data, information, or views, orally or in writing, on issues pending before the committee. Written submissions should be forwarded to the contact person (below) on or before January 18, 2017. Oral presentations from the public will be scheduled at the conclusion of the meeting. Individuals interested in making oral presentations are encouraged to notify the contact on or before January 18, 2017. Five minutes will be allotted for each presentation.

The meeting can be accessed via telephone. To attend on site, obtain the call-in number and access code, submit written or brief oral comments, or request special accommodations for persons with disabilities, please register at the SAMHSA’s Advisory Committees Web site at http://nac.samhsa.gov/Registration/meetingsRegistration.aspx or contact Pamela Foote (see contact information below).

Substantive meeting information and a roster of Committee members may be obtained either by accessing the SAMHSA Committees’ Web site http://www.samhsa.gov/about-us/advisory-councils/cmhs-national-advisory-council or by contacting Ms. Foote.

Committee Name: Substance Abuse and Mental Health Services Administration, Center for Mental Health Services National Advisory Council.

Dates/Time/Type: Wednesday, February 1, 2017, 9:00 a.m. to 5:15 p.m. EDT: OPEN.

Place: SAMHSA, 5600 Fishers Lane, 5th Floor, Conference Room 5W07, Rockville, Maryland 20857.


Pamela Foote, Acting Designated Federal Official,

SAMHSA CMHS National Advisory Council,

5600 Fishers Lane, Room 14E53C,

Rockville, Maryland 20857,


(240) 276– 1279,


(301) 480–8491,

Email: pamela.foote@samhsa.hhs.gov
Mental health malfeasance

Donald Trump should make sure he drains the swamp at the federal mental health agencies
By D.J. Jaffe Pittsburgh Post-Gazette | December 27, 2016

The 21st Century Cures Act signed by President Barack Obama contains smart, well-designed mental-health provisions. But unless President-elect Donald Trump and Tom Price, his nominee for secretary of health andhuman services, “drain the swamp” at the Substance Abuse and Mental Health Services Administration and the Center for Mental Health Services, many of the new law’s useful provisions could be negated or undone by the permanent bureaucracy.

SAMHSA and CMHS are largely responsible for overseeing and implementing federal mental health policy, and will remain so under the Cures Act. Unfortunately, those agencies are failures, as SAMHSA’s former chief medical officer, Elinore McCance-Katz, revealed in an op-ed, after she left the agency in disgust in 2015.

“SAMHSA does not address the treatment needs of the most vulnerable in our society. There is a perceptible hostility toward psychiatric medicine, a resistance to addressing the treatment needs of those with serious mental illness, and a questioning by some at SAMHSA as to whether mental disorders even exist — for example, is psychosis just a ‘different way of thinking for some experiencing stress?’”

SAMHSA and CMHS virtually ignore skyrocketing rates of homelessness, arrest, incarceration, suicide and hospitalization that occur when the seriously mentally ill are allowed to go untreated. Instead, they wrap the provision of social services in a mental health narrative and divert funds to unrelated or ineffective programs.

These agencies encourage states to spend part of the $500 million that they receive in federal mental health block-grant funding on people who don’t even have mental illness and on “prevention,” though serious mental illnesses, such as schizophrenia and bipolar disorder, can’t be prevented.

Nonprofit groups that depend on SAMHSA funding have lobbied states to close psychiatric hospitals, thereby making treatment more difficult. Recently, SAMHSA-funded groups convinced New York City to divert $8 million of city funds to Mental Health First Aid, a SAMHSA-promoted educational program that trains people to “better recognize the signs, symptoms and risk factors of mental illness and addiction and more effectively provide support.” The program does nothing to help the mentally ill because no treatment is made available, even when symptoms are identified.

SAMHSA and CMHS are failed agencies that have almost no support from anyone other than those whom they fund. Thanks to the leadership of U.S. Rep. Tim Murphy, R-Upper St. Clair, the mental health provisions of the Cures Act attempt to refocus SAMHSA and CMHS on the seriously ill — as opposed to the worried well — and to rely on science rather than pop psychology.

The Cures Act replaces the SAMHSA administrator with an assistant secretary for mental health and substance-use disorders. The person who fills this important job will be responsible for both SAMHSA and CMHS, and for coordinating mental health policy with other federal agencies.

Mr. Trump should appoint a top psychiatrist like Dr. McCance-Katz or others who are committed to focusing on the seriously ill and ending the funding of nonsense. Or he could appoint a judge who is committed to reducing incarceration of the seriously mentally ill.

Mr. Murphy, along with powerful Texas Republican Sen. John Cornyn, included in the bill many provisions that are designed to force SAMHSA and CMHS to focus on the seriously ill. In the past, however, these agencies have ignored congressional direction, especially as it relates to assisted outpatient treatment.

Known as “Kendra’s Law” in New York and “Laura’s Law” in California, AOT is court-ordered out patient treatment of the most seriously ill, who may be so sick that they are unaware of their own symptoms. AOT is reserved for a tiny group of patients who have historically failed to comply with treatment. By keeping such patients out of jails and hospitals, and ensuring that they take prescribed violence-preventing medications, AOT has improved outcomes and reduced the costs of care.

The Cures Act extends and modestly expands federal AOT funding through 2022. The last time Congress funded AOT, however, CMHS bureaucrats hijacked the grant-funding process, giving preference to states whose AOT teams employed a “peer-support worker.” In other words, the agency required state mental health agencies to hire people with mental illness. There is no evidence that this improves outcomes, but it clearly increases costs.

SAMHSA-funded groups succeeded in watering down the final bill. Early iterations of the Cures Act contained provisions that would have allowed parents to access medical information about their seriously mentally ill adult children, as well as provisions to increase the number of hospital beds available to the seriously ill and rein in federally funded anti-treatment lawyers.

But the bill is still a major step forward. It provides funding for mental health courts, which can divert nonviolent, seriously mentally ill offenders to mandated treatment instead of jail. It provides funds to train police on how to de-escalate interventions with the seriously ill. It provides for the collection and dissemination of data on the number and types of crimes committed by mentally ill individuals, the involvement of mental illness in deadly incidents involving law-enforcement officers and the costs of imprisoning the seriously ill.

For too long, we have spent too much on trying to improve “mental wellness” — whatever that is — rather than delivering treatments that can reduce homelessness, arrest, incarceration, suicide and hospitalization among the seriously mentally ill. We’ve sent the least ill to the head of the line and the most-seriously ill into the shadow mental health system of jail and prison. Bullying and stress have been treated; schizophrenia and bipolar have been ignored. This bill attempts to end that insanity.

And if the right person is appointed as assistant secretary, it will likely work.

D.J. Jaffe is executive director of Mental Illness Policy Org. and the author of “Insane Consequences: How the Mental Health Industry Fails the Mentally Ill.” This piece originally was published in the Manhattan Institute’s City Journal.

'The Least Discussed & Most Unknown Public Health Crisis in America' Will Once Again be a NYAPRS Feb. 28 Advocacy Priority

NYAPRS Note: Supporting strategies to address the horror of up to 120,000 Americans, a large number of whom are diagnosed with a mental health condition, living each day in barbaric solitary confinements has long been a NYAPRS policy priority, dating back to our front and center support of the successful passage of New York’s SHU Exclusion Act of 2011 (with ‘Special Housing Unit’ as a euphemism for ‘the box.’
Read more about that law at http://www.correctionalassociation.org/news/isolated-confinement-the-facts.

This is why NYAPRS has continued to play leading roles in securing over $3.4 million for local Crisis Intervention Team diversion initiatives and last year’s approval for the restoration of Medicaid 30 days before prison/jail release for ‘high needs’ groups (awaiting CMS action).

And that’s why NYAPRS will be out front again in the coming state budget/legislative session working closely once more as a member of ‘Mental Health Alternatives to Solitary Confinement’ (MHASC) to seek passage of bills that will either virtually eliminate its use for, at minimum, people diagnosed with extensive mental health conditions.

Look for a flyer to come out shortly advertising our February 28th Annual Legislative Day in Albany!

Solitary Confinement: the Least Discussed & Most Unknown Public Health Crisis in America: A Conversation with Jean Casella (December 19th)

Listen Now http://hwcdn.libsyn.com/p/3/b/c/3bc3dc5d3bf5646a/Casella.mp3?c_id=13646147&expiration=1482868996&hwt=78db24ba026e2e94cc677303fa7d569d

On any given day US prisons and jails hold between 80,000 and 120,000 men, women and children in solitary confinement. A significant percent of these individuals enter solitary with a mental disease and a similar percent of those held in isolation for extended periods of time develop severe psychiatric illnesses that include self amputation and suicidality. (US prisons and jails constitute the largest psychiatric hospitals in the country.)

The UN Special Rapporteur on Torture and Other Cruel, Inhuman or Degrading Treatment and Punishment, Juan E. Mendez, has concluded solitary confinement for more than 15 days constitutes torture. InHell is a Very Small Place, Voices from Solitary Confinement," edited by Jean Casella, James Ridgeway and Sarah Shourd, 16 former and current solitary confinement inmates discuss their experience in solitary and two physicians and three professors (in law, political science and philosophy) discuss its physical and psychological effects and legal justification.

During this 32 minute conversation, Ms Casella provides an overview ofHell Is a Very Small Place. She explains why inmates are placed in solitary confinement, for how long and describes conditions under confinement. She provides an overview of the psychological effects of solitary noted by contributing authors Dr. Stuart Grassian and Dr. Terry Kupers. She addresses whether solitary confinement constitutes torture, explains how inmates attempt to keep their sanity, explains to what extent private sector profit making contributes to the practice and discusses what continued progress, if any, may be made under a new, incoming administration.

Ms. Jean Casella is co-director of Solitary Watch, a web-based watchdog project that investigates, documents, anddisseminated information about solitary confinement in US prisons and jails. Prior to co-founding Solitary Watch in 2009, Ms. Casella managed several mission-driven book and magazine publishers including Thunder's Mouth Press and the Feminist Press. Jean's writing has appeared inThe Nation,Mother Jones,The Guardian,Al Jazerra, and other publications and media outlets. The Hell is a Very Small Placeanthology edited was published by The New Press in February. For her work on solitary confinement, Jean was awarded a Soros Media Fellowship in 2012.

For more information concerningHell Is a Very Small Placego to:http://thenewpress.com/books/hell-very-small-place.

The UN Special Rapporteur's report is at:http://solitaryconfinement.org/uploads/SpecRapTortureAug2011.pdf.

For another physician's review of solitary confinement, see, for example, Dr. Atul Gawande's essay titled,"Hellhole," in the March 30, 2009 issue ofThe New Yorker. At:http://www.newyorker.com/magazine/2009/03/30/hellhole.


Study Examines Causes of Premature Death of Individuals Diagnosed w Schizophrenia

NYAPRS Note: Some powerful findings from a study published a year ago pointing to diabetes, cancer and suicide among the reasons for the extraordinarily high rates of early death among individuals diagnosed with schizophrenia. The authors link the causes with smoking, limited physical activity, obesity, elevated serum glucose level, hypertension, and dyslipidemia as well as economic disadvantage and ‘negative health behaviors.’ One must include the impact of psychiatric medications in some instances.
Please note that “the mortality rate was higher for men than women, increased with age, and was higher for those of white race/ethnicity than for other racial/ethnic groups.”

The study ends with a very strong endorsement of the integration of behavioral and primary care, a linchpin of New York’s DSRIP initiative.

Urgent Care: Schizophrenia Patients Dying Prematurely, But Why?
By Debra Hughes, MS MPR January 22, 2016

Nonelderly adults with schizophrenia are 3.5 times more likely to die than adults in the general population.1,2 Each individual, on average, loses 28.5 years of life.1

Yet, more than 85% of these deaths are from natural causes, primarily cardiovascular disease, cancer, and diabetes mellitus.1

The questions are: “Why?” and “What can be done”?

One reason is that adults with schizophrenia are “less likely than their age-matched peers to receive adequate treatment for major medical conditions,” Mark Olfson, MD, MPH, and colleagues write in JAMA Psychiatry,2 thus compounding the risk of premature mortality.

“Many factors, including economic disadvantage, negative health behaviors, and difficulties accessing and adhering to medical treatments, are thought to contribute to premature mortality,” Dr. Olfson, of the Department of Psychiatry and New York State Psychiatric Institute, College of Physicians and Surgeons, Columbia University, New York, NY, and coauthors state. “Smoking, limited physical activity, obesity, elevated serum glucose level, hypertension, and dyslipidemia are all significantly more common in schizophrenia than in the general population.”

To characterize key sources of excess mortality among adults with schizophrenia, the investigators conducted a national examination of the Medicaid program, “the largest payer of health services for persons with schizophrenia in the United States.”

They identified 1,138,853 individuals in the schizophrenia cohort and 74,003 deaths, 65,553 of which had a known cause.

What they found was “a more comprehensive picture than was previously available of the gap in mortality, highlighting the need for more effective strategies to improve the medical care of this patient population.”

Increased risk of mortality “was particularly elevated for COPD, influenza and pneumonia, diabetes mellitus, cardiovascular disease, and suicide,” they write. “Among all causes of death, suicide was associated with the highest mean years of potential life lost per death,” Olfson et al note.

The mortality rate was higher for men than women, increased with age, and was higher for those of white race/ethnicity than for other racial/ethnic groups.

“In absolute terms, the leading identified causes of death were cardiovascular disease, cancer, and accidents,” they wrote. By age group, unnatural (vs. natural) deaths were highest among those 20 to 34 years of age, which was attributed to accidents and suicide, while natural deaths from cardiovascular disease were highest in those 35 to 54 and 55 to 64 years of age.

These patterns can guide clinicians managing patients with schizophrenia. Olfson et al suggest the following:

In an accompanying editorial in JAMA Psychiatry,1 Shuichi Suetani, MBChB and colleagues note that the Olfson et al research “is a reminder of how we are failing to meet the needs of people with schizophrenia.” They call on governments “to ensure priority is given to physical and mental health care of those with severe mental disorders” to prevent “a further widening of the life expectancy gap between the general population, whose life expectancy continues to rise, and that of people with severe mental disorders.”

Severe mental illness can also elevate risk for type 2 diabetes mellitus. For this reason, “the American Diabetes Association recommends annual diabetes screening for patients treated with antipsychotic medications, and public health administrators have targeted this population for improved health screening,” Christina Mangurian, MD, of the Department of Psychiatry at the University of California, San Francisco, CA, and colleagues note in JAMA.3

However, due to limitations in public health records, “to our knowledge, no studies have examined screening rates in this highest-risk population of adults with severe mental illnesses,” such as schizophrenia and bipolar disorder. To investigate the prevalence of diabetes screening, they used data from a California healthcare system that included publicly insured adults with severe mental illnesses treated with antipsychotic medications; also assessed were characteristics predictive of screening.

They found that of 50,915 study subjects, 15,315, or 30.1%, received diabetes-specific screening, while 15,832 (31.1%) received no form of glucose screening over the course of a year.

“The strongest correlate of diabetes-specific screening was having at least 1 outpatient primary care visit during the period examined,” in addition to mental health services, Mangurian et al report. The adjusted prevalence ratio was 1.80 (95% CI: 1.62–2.00; P<0.001).

“This observation supports the value of burgeoning efforts to integrate behavioral health and primary care,” they write. “Growing evidence supports the value of screening for diabetes mellitus in higher-risk populations….”

They call for studies “to explore barriers to screening in this vulnerable population.”

1. Suetani S, Whiteford HA, McGrath JJ. An urgent call to address the deadly consequences of serious mental disorders. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2015.1981. Published online October 28, 2015.

2. Olfson M, Gerhard T, Huang C, Crystal S, Stroup TS. Premature mortality among adults with schizophrenia in the United States. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2015.1737. Published online October 28, 2015.

3. Mangurian C, Newcomer JW, Vittinghoff E. Diabetes screening among underserved adults with severe mental illness who take antipsychotic medications. JAMA Intern Med. doi:10.1001/jamainternmed.2015.6098. Published online November 9, 2015.


Alert: Urge Gov. Cuomo to Prioritize the Employment of New Yorkers with Disabilities (3)

NYAPRS Note: This petition to Governor Cuomo to elevate attention to prioritize the employment rate for New Yorkers with disabilities and, a priority for NYAPRS, the numbers who are enrolled in our Medicaid Buy In program.
Please be one of the 169 left to take us to 1,000 petitioners today! Thank you.

Urge Governor Cuomo to Prioritize

the Employment of New Yorkers with Disabilities!

Please join us in signing this petition today, urging NY Governor Cuomo to build on efforts to realize the goals of his groundbreaking Employment First policy for New Yorkers with disabilities. The petition urges Governor Cuomo to add resources to advance our efforts in this area, by giving the issue a state of the state level of importance and to appoint an "Employment Czar" whose sole job will be to move us forward in this area.

This petition will be delivered to Governor Cuomo in the coming weeks.

Sign on at https://www.change.org/p/governor-andrew-cuomo-prioritize
Thank you!

Prioritize the Employment of New Yorkers with Disabilities!

In September 2014, Governor Andrew Cuomo created an Employment First policy which provided a direction for competitive, integrated employment for New Yorkers with disabilities.

Two years after he signed Executive Order # 136, the target dates for all the recommendations made by the Employment First Commission in their report have lapsed. Lots of hard work has occurred but the most plan lacked sufficient targets, timelines, responsibility, work priorities.

We call upon Governor Cuomo to take action on behalf of the 1.1 million working-aged New Yorkers with disabilities to:

1. Prioritize the employment of New Yorkers with disabilities in his upcoming state of the State address.

2. Appoint an "Employment Czar" for people with disabilities with full-time staff to advance priorities identified in the Employment First report via the Executive Budget, including:

  • Establish a small business tax credit for New Yorkers with disabilities.
  • Include disability as a minority in the Minority Women Business Enterprise (MWBE) state procurement program.
  • Hire a 55b/c Statewide Coordinator to oversee greater utilization of the program.
  • Increase utilization of the Medicaid Buy-In for Working People With Disabilities Program (MBIWPD).
  • Create a Medicaid service to support benefits advisement.
  • Develop a policy for regional economic councils to target disability employment and business opportunities.

3. Fully support integrated, competitive employment - New Yorkers must earn minimum wage or higher for inclusive opportunities which comport with Home and Community-Based Services (HCBS) rules.

Please click on the following link to sign the petition: https://www.change.org/p/governor-andrew-cuomo-prioritize-the-employment-of-working-aged-new-yorkers-with-disabilities-c3e14a93-cc9c-4d6e-ae5a-694c83664217

Please distribute and post to others. Thanks!

Brad Williams, NYS Independent Living Council

NYAPRS | 518.436.0008 | fax: 518.436.0044 |www.nyaprs.org

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Alert: Tell Gov Cuomo & Legislative Leaders to Sign the Affordable Housing MOU Now!

NYAPRS Note: It appears that NY Governor Andrew Cuomo and state legislative leaders have only one more day to get a shared commitment ( memorandum of understanding or MOU)to invest $1 billion in previously promised affordable housing, most notably supportive housing, one of NYAPRS top budget priorities this past session.
As a result, Community Access' and NYAPRS Immediate Past President Carla Rabinowitz ust released an alert saying:

"We are at a critical stage with the MOU. Itmay bediscussed in Albany tomorrow.The Governor and leaders of State Senate and Assembly can get the MOU signed tomorrow.

Help us to send 20,000 messages to Albany – one for every supportive housing unit promised.

Just click the link below and tell them to SIGN THE MOU!

We are asking allourfriendsto post this link onyour agency Facebook page and linked in page today!


Last year, as part of the campaign, we fought for a historic commitment from the State to fund 20,000 units of supportive housing over the next 15 years.As a result, Governor Cuomo appropriated $2 billion to fund, among other things, the first 6,000 units of supportive housing over the next 5 years.

However, the State has only released funding for the first 1,200 units.In order to release the remaining funding, a memorandum of understanding (MOU) is required to be signed by the Governor, Senate and Assembly.

We ask for you to again click the link above to show Governor Cuomo and the Legislature that we remain vigilant as ever in our quest to release the remaining funds.

Our battle is not over. Every email counts.Please forward this message to anyone you think would be supportive and ask them to participate as well.

Best regards,

Carla Rabinowitz

Community Organizer

Community Access

Note: See below for articles in yesterday's newspapers.


Homeless Advocates Push for MOU, Session or Not

By Rick Karlin, Albany Times Union Capitol Confidentiality December 21, 2016

As the governor and lawmakers continue to wrangle, tussle and generally agonize over whether there will be a special session by the end of the year to develop a legislative pay raise and pass several measures the governor wants, a group of homeless advocates on Wednesday urged signing of a Memorandum of Understanding, or MOU that would free up money for supportive housing. The MOU was part of the budget talks back in April but such an agreement hasn’t yet been signed and that’s needed to free up money to begin work on new projects.

New York on any given night has about 88,000 homeless people across the state, said demonstrators from the Council of Churches and from shelters in Troy and Saratoga Springs.

Here are some more details:

With today marking National Homeless Persons’ Memorial Day, a coalition of faith leaders, advocates and housing providers gathered in front of Governor Andrew Cuomo’s office in midtown Manhattan and at the State Capitol in Albany to demand the Governor keep his promise to fund thousands of units of supportive housing for the homeless in communities across New York State.

Each night, more than 88,000 New Yorkers struggle with homelessness – roughly the population of Schenectady and Glens Falls combined. During his State of the State speech in January, Governor Cuomo pledged to fund 20,000 new units of supportive housing. The State Budget passed in April included capital funds for the first 6,000 of those units, but required a Memorandum of Understanding (MOU) between Governor Cuomo and the leaders of the Senate and the Assembly before the funds can be spent.

During a press conference in the State Capitol building in Albany, Reverend Peter Cook from the New York State Council of Churches, Kevin O’Connor from Joseph’s House and Shelter, and Michael Finocchi, Executive Director of Shelters of Saratoga, called on the Governor to get the MOU signed. Earlier in the morning, dozens of advocates and supportive housing providers attended a National Homeless Persons’ Memorial Day rally in front of the Governor’s office in Manhattan to demand action. This is the 20th rally since advocates and supporters began these weekly rallies in July.

Today’s events were part of a new effort launched last month by the Campaign 4 NY/NY Housing to convince the Governor to honor his commitment. The Campaign 4 NY/NY Housing kicked off a letter-writing campaign that aims to produce 20,000 emails from real New Yorkers – one for every unit of supportive housing promised – by Governor Cuomo’s next State of the State in January.

“Widespread homelessness in the land of plenty is beyond shameful,” said Reverend Peter Cook, Executive Director of the New York State Council of Churches. “With winter upon us, once again non-profit and government agencies will struggle to provide some type of housing for New York State’s homeless men, women and children. Some will escape the winter unharmed. Others may freeze. But it will be one more winter spent scrambling to address a problem of unprecedented proportions.”

“Today is a sad day for those of us who work with homeless people,” said Kevin O’Connor, Executive Director of Joseph’s House and Shelter. “On National Homeless Persons’ Memorial Day we remember all of the homeless people who passed away during the previous year. Let’s pray that – at this time next year – we aren’t marking another National Homeless Persons’ Memorial Day with another long list. Now is the time to sign the MOU so we can get thousands of units of supportive housing built, and make a difference in the lives of thousands of our people in communities across the state.”

“I see first-hand, every day, people who would benefit from the investment that Governor Cuomo promised,” said Michael Finocchi, Executive Director of Shelters of Saratoga. “Supportive housing is the best, most humane, and most cost effective way to provide chronically homeless people the support they need. This isn’t theory. We see it first-hand. Lives can be rebuilt. Families restored. Spirits renewed. Governor Cuomo has shown leadership on the issue in the past. Now we are calling on him to do it again. Finish the job. Get this MOU signed and allow these 6,000 units of supportive housing to be built.”

Studies throughout the country have repeatedly demonstrated that supportive housing pays for itself by reducing medical and psychiatric hospitalizations, detox and rehab programs, shelters and incarceration. In New York, placing homeless individuals in supportive housing has been found to save our government $10,100 per year, per tenant.

During his budget speech last January, Governor Cuomo promised to build 20,000 units of supportive housing over 15 years. When the State budget was passed in April, it pledged to fund the first 6,000 of those units over the next five years, but made the funding contingent on the completion of a MOU between the Governor and the leaders of the State Senate and Assembly.

Near the end of the 2016 legislative session, the Campaign 4 NY/NY Housing organized a letter-writing campaign that generated more than 10,000 emails calling for this MOU to be signed.

Months later, the MOU still has not been signed. Instead, the Governor released $150 million of the $2 billion, which will support a fraction of the units promised both in January (when the Governor promised to build 20,000) and in April (when the budget anticipated the first 6,000 units over five years).

Supportive housing developers, investors and service providers need long-term financing commitments for the future development of safe, permanent housing for the most vulnerable New Yorkers. Without long-term state-committed capital, service financing and operating subsidies, it is impossible to attract private investment for the acquisition of land and predevelopment financing, which can together cost millions of dollars. This will have negative consequences for years to come.

In the past, New York/New York Agreements between New York City and New York State attracted investors because they diminished risk to developers by providing long-term commitments to fund a set number of units. The five-year MOU promised by the Governor is a critical first step to creating the robust pipeline of supportive housing needed to address New York State’s homelessness crisis.

In the months since the legislative session ended, the Campaign 4 NY/NY Housing has kept up the pressure by organizing weekly protests in front of the Governor’s office in Manhattan urging him to get the MOU signed so the long-term funding commitment required to build supportive housing can be locked into place.

Since last year, 159 state legislators — close to 75 percent of the Legislature — have signed letters from their respective chambers demanding the state fund 20,000 units of supportive housing.

For more information, visit the Campaign 4 NY/NY Housing website at http://www.nynycampaign.org/ or contact Damien LaVera at 518-432-9220 or dlavera@plynchassociates.com.


NYAPRS Note: It appears that Governor Cuomo and NYS Legislative leaders have one more day to nail down a share commitment to commit $1 billion for previously promised funding for affordable housing, most notably supportive housing.

Albany Agreement Could Leave $1 Billion in Affordable-Housing Money on the Table

Gov. Cuomo And Legislators May Convene a Special Session to Release Just Half of the Housing Money Allocated In April's Budget
By Joe Anuta Crain's New York Business | December 21, 2016

Advocates criticized Gov. Andrew Cuomo Wednesday for pushing a last-minute housing agreement in Albany that would release only half of the $2 billion in housing money that was promised in April's budget.

The governor and the heads of the state Assembly and Senate are in talks to meet before the end of the year and tie up a number of unfinished legislative items. Among the issues being considered is an agreement to release $1 billion in housing money for supportive housing, which is typically apartments for homeless New Yorkers who need additional services beyond a roof over their heads.

In April's budget, however, the governor allocated $2 billion in housing money. At the time, there was no agreement on exactly what the cash should be used for, so lawmakers said that they would hash out the details later in an agreement called a memorandum of understanding, or MOU. The governor subsequently released $150 million for supportive housing, and then in September signed an MOU that was never ratified by the Senate and Assembly. As a result, a broad agreement has yet to be reached.

"Clearly, the idea of an MOU did not work," said Jolie Milstein, head of a trade group of mostly for-profit affordable-housing builders called the New York State Association for Affordable Housing.

Milstein said that her members were promised that the $2 billion would be dished out for a variety of programs that would fund, for example, new apartments for seniors and middle-income New Yorkers, along with the preservation of existing affordable units and renovations of public-housing projects around the state. Instead, only supportive housing would get $1 billion over five years under the agreement being discussed. The rest of the programs would have to wait for another MOU.

"I just don't understand the rationale of giving a five-year commitment to one piece and ignoring the desperate need across the rest of the program," Milstein said. "That's not what we were promised."

The governor’s office said that the money released earlier has already funded thousands of apartments for homeless New Yorkers.

“The governor's unprecedented plan to combat homelessness and build 6,000 units of supportive housing over 5 years is on track,” a spokeswoman said in a statement. “Its first year is fully funded with $150 million to build the first 1,200 units already out the door.”

It was unclear whether other housing-related items, such as the revival of a controversial tax exemption program called 421-a, would be considered at the special session.