Opinion: New York is leaving its most vulnerable youth in limbo

As we look back on Mental Health Awareness Month, we’re thinking about a group of young people whose suffering gets scant attention: children with complex mental health needs.

These children, nearly 80,000 of whom across our state are on Medicaid, have severe behavioral health diagnoses along with complicating factors like medical challenges, foster care involvement or intellectual/developmental disabilities. Their families should be spending their time with them – instead, many of them are lost in a bureaucratic maze, creating painful delays in care and costing taxpayers hundreds of millions.

But momentum is building behind complex needs legislation that would streamline these young people’s access to care. The bill has advanced out of the Assembly Children and Families Committee and was reported to the Ways and Means Committee. It’s gratifying to see lawmakers mobilize around this smart policy, which empowers a little-known state entity to cut through red tape. 

Statutorily, the Council on Children and Families, or CCF, is already tasked with assigning care for young people with complex needs, convening officials across agencies to determine who should provide services. 

What does that look like in practice? Consider: A child is hospitalized following an acute behavioral health episode. They are in foster care, and also have a chronic medical condition. CCF’s job is to coordinate with the Office of Mental Health, the Office of Children and Family Services, and Department of Health to determine who should lead and pay for service provision upon the child’s discharge.

But merely convening the proper agencies doesn’t get a child the care they need. Too often, complex cases are in holding patterns as state agencies figure out who’s responsible. More than 200 children each year experience unnecessary extended hospital stays (called “boarding”), racking up over 20,000 inpatient days annually. Often, they are also placed with residential care that is not appropriate to meet their needs.

And when agencies determine children don’t fit rigid criteria for certain programs, children are sometimes sent far from home to out-of-state residential placements. In 2024 alone, 321 New York children were placed out of state because the appropriate services were unavailable.

These outcomes are financially disastrous. Hospital boarding is exorbitantly expensive – one survey found these prolonged stays cost New Yorkers $167 million in a single three-month period. Out-of-state placements are no better, resulting in a statewide price tag of roughly $113 million annually. And those are the costs for just a few hundred youth; if we don’t coordinate care more effectively, even more young people may wind up languishing in hospital beds, with taxpayers on the hook.

It goes without saying, but hospital boarding is not treatment. These children have been cleared for reentry into community, but are stuck in purgatory waiting for services. During that time, they miss school and therapy, lose contact with peers and family routines and often experience worsening psychiatric symptoms. 

To connect our siloed systems and ensure children actually get care, we must strengthen the CCF’s ability to make and implement decisions. That means empowering the CCF’s Interagency Resolution Unit, which, as the name implies, resolves disagreements between agencies. Currently, the unit lacks the necessary authority, staffing, infrastructure, and accountability mechanisms necessary to function effectively. Too often, agencies can delay decisions indefinitely while children wait.

This legislation would give the CCF the mandate and the means to act with urgency. It would create a centralized confidential portal of available beds to coordinate services across agencies and providers, establish timelines for evaluations and placements, and strengthen statewide data collection. Crucially, it enhances the CCF’s statutory responsibility, requiring it to intervene directly when disputes or delays threaten a child’s wellbeing.

If enacted, it would create a system where all children are accounted for, where families have clarity about their children’s care.

To be clear, better coordination will not solve these problems overnight. The CCF itself will need more resources in the long term to hire additional staff and cover services during transitional periods. What’s more, New York must still invest in community-based services, expand provider capacity and strengthen the behavioral health workforce. Those preventive services keep children out of the hospital in the first place. Similarly, community-based options must be expanded to ensure resources are available post-discharge.

But coordination matters: when agencies operate in silos, children suffer. Every unnecessary hospital stay, every delayed placement, and every out-of-state transfer represents both a moral failure and an avoidable cost. The state owes children and their families a system that is coordinated, accountable and capable of meeting urgent needs close to home. It’s the least we can do for children who need it the most.