Mental Health Update

Twenty years ago, a coalition led by Tom O’Clair, passed a law known as Timothy’s Law, named after his son who lost his life to suicide completion.

Looking back at the twenty-year legacy of this landmark legislation, much of the environment has changed. What seemed improbable twenty years ago, treating mental health the same way insurers treat health care, has become normalized. From my personal experience, dealing with a loved one with mental health challenges, passage of the law saved us thousands of dollars and opened the doors to better treatment options. Many insurers have complied and champions like Governor Hochul, Attorney General James, Commissioner Sullivan and Congressmember Tonko continue the fight for full behavioral health parity.

Yet for all that has changed, there are still people who are unable to get mental health services and sadly, there are still insurance plans that are not in compliance with the law. A recent example is this press release (immediately below) from Attorney General James continuing her great work from her 2023 seminal report about ‘ghost networks’, and this case finding Emblem Health in violation of the law.

There must be greater accountability from the state agencies charged with enforcing parity law (notably the Department of Financial Services and the Department of Health).  The example of Emblem Health will hopefully lead to greater enforcement measures for all plans that are denying access to those in need of mental health services.

At MHANYS, we have created a series of recommendations that we will work with the Executive and the Legislature to implement. The consequence of this lack of action has real repercussions for our entire community.

(Note the MHANYS recommendations are listed after the press release.)

Attorney General James Secures Sweeping Reforms Improving Access to Mental Health Care for EmblemHealth Members

OAG Investigation Found Widespread “Ghost Networks” That Prevented New Yorkers from Accessing Mental Health Treatment EmblemHealth Will Pay $2.5 Million Plus Restitution to Consumers,
Expand Mental Health Network, and Submit to Independent Monitoring

February 19, 2026

NEW YORK – New York Attorney General Letitia James today secured more than $2.5 million from health insurer EmblemHealth (Emblem) after an Office of the Attorney General (OAG) investigation revealed the company repeatedly failed to ensure New Yorkers could access mental health care services. The investigation found that Emblem maintained inaccurate provider directories, overstated the availability of in-network mental health and substance use disorder providers, and failed to comply with state and federal behavioral health parity laws, leaving many New Yorkers unable to find timely, affordable care when they needed it most. Under today’s settlement, Emblem will pay $2.5 million in penalties and fees, provide restitution to members who were forced to pay out of pocket for mental health care, and implement sweeping reforms to improve access to mental health and substance use disorder treatment.

“As millions of New Yorkers struggle with anxiety, depression, and substance use disorders, ensuring access to quality, affordable mental health care is more essential than ever,” said Attorney General James. “Health insurers cannot mislead consumers with inaccurate provider directories while families are left without care. We are requiring Emblem to make meaningful changes so that New Yorkers can actually access the behavioral health treatment their insurance promises.”

Emblem covers approximately 1.5 million New Yorkers through commercial plans, Medicaid managed care, Child Health Plus, the Essential Plan, and New York City employee health plans. The OAG launched an investigation into Emblem in 2023 and conducted a secret shopper survey of mental health and substance use disorder providers listed in the company’s online directory. The investigation found that Emblem’s directories contained many errors, including listings for providers who were unreachable, no longer practicing, not accepting new patients, or not actually in the plan’s network. As detailed in Attorney General James’ report, Inaccurate and Inadequate: Health Plans’ Mental Health Provider Directories, OAG determined that more than 80 percent of surveyed behavioral health providers Emblem listed as accepting new patients were effectively unavailable – creating “ghost networks” of providers that exist on paper but not in reality. Emblem’s own surveys showed similar results.

As a result of OAG’s investigation, Emblem will pay $2.5 million in penalties, fees, and costs and establish a comprehensive restitution process to repay members who were wrongfully forced to pay out of pocket for mental health care services because they were unable to schedule an appointment with an in-network provider. In addition, Attorney General James is requiring Emblem to overhaul its policies and practices to ensure online provider directories are accurate and up to date. Emblem must:

• Correct listings within two business days of learning that information is incorrect or a provider is no longer accepting new patients;
• Put a link next to each provider listing that allows members and providers to report inaccurate listings directly;
• Require providers to verify directory information every 90 days and remove providers who fail to verify or are no longer available;
• Remove providers who have not submitted claims within the last 90 days from the directory unless they verify their continued participation;
• Implement new systems to track, monitor, and resolve complaints related to directory accuracy and access to care; and
• Conduct regular secret shopper surveys to assess access to care and publicly report the results.

If Emblem provides inaccurate provider directory information that leads a member to receive an unexpected out-of-network bill, the company must ensure the member pays only their usual copay or deductible.

In addition, Attorney General James is requiring Emblem to take steps to ensure members can access mental health and substance use disorder treatment appointments within specified time frames, including 24 hours for urgent care and 10 business days for an initial outpatient appointment. If a member is unable to secure a timely appointment with an in-network provider, Emblem must allow the member to see an out-of-network provider but only pay their in-network copay or deductible. The settlement also requires Emblem to develop and carry out a comprehensive behavioral health provider recruitment and retention plan to expand its network statewide and reduce administrative burdens on providers. An independent monitor will oversee the restitution process and Emblem’s compliance with these reforms.

This action is the latest in Attorney General James’ ongoing effort to protect New Yorkers’ access to mental health care and take on mental health ghost networks. In December 2025, Attorney General James won a lawsuit protecting over $1 billion in mental health grants for students and young people. In August 2025, Attorney General James took action to overhaul MVP Health’s mental health ghost network. In April 2025, Attorney General James secured a landmark settlement with WMCHealth to expand access to inpatient psychiatric care in the Hudson Valley and overhaul how the hospital system treats patients experiencing mental health crises.

This matter was handled by Assistant Attorneys General Michael Reisman and Carol Hunt, with assistance from Assistant Attorney General Gina Bull, under the supervision of Health Care Bureau Chief Darsana Srinivasan. The Health Care Bureau is part of the Division for Social Justice, which is led by Chief Deputy Attorney General Meghan Faux and overseen by First Deputy Attorney General Jennifer Levy.

MHANYS’ Behavioral Health Parity Summary & Recommendations
(February 2026)

Governor Hochul has said the mental health crisis is the “defining issue of our time.”  To address this need we believe that the State must strengthen and enhance implementation and compliance with the federal and state behavioral health parity laws.  These laws require insurers and health plans to cover mental health and substance use disorder care at the same level of access and benefits as physical health services, and not impose financial requirements or treatment limitations that are more stringent than those for physical conditions.  As the Governor has stated, “…the frustration and delays that many New Yorkers experience in trying to access mental health care today indicate that far stronger enforcement is necessary to realize true parity.”

Later this year, New York will celebrate the twenty-year anniversary of the signing of New York’s mental health parity law, Timothy’s Law (Chapter 748 of the Laws of 2006).  Also, it has been eighteen years since the enactment of the 2008 federal parity law (Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act- MHPAEA). Yet, the promise of parity remains unfulfilled. We believe that lack of compliance with parity laws by insurers and health plans, inhibits and delays access to care and treatment amidst an extraordinary mental health crisis, particularly among our youth. Full compliance with behavioral health parity laws will have a positive impact, not only on the health of New York’s residents, but also would reduce the state’s health, Medicaid and other safety net expenditures.

The current system for enforcement and compliance with parity relies largely on individual consumer or provider complaints with minimal public accountability to verify if these are isolated or systemic issues.  Yet consumers face great difficulty in understanding the nuances and complexities of the law as well as their rights. Only the state oversight agencies have the ability to access the internal policies, algorithms, and decisions that insurers and plans use to limit or deny coverage.  We need all of the oversight agencies to work together to provide more vigorous oversight and enforcement, including the New York State Department of Financial Services, Department of Health, Office of Mental Health, and Office of Addiction Services and Supports. To date, we believe this is not happening to the level that is needed.  Moreover, we have actually heard frustration expressed by state officials that there has not been sufficient enforcement of the behavioral health parity laws.

Recommendations: 

1. Strengthening Enforcement: MHANYS urges New York State to strengthen oversight, enforcement, and compliance with federal and state MH/SUD parity laws. MHANYS recommends the establishment of a centralized cross-agency unit working on parity enforcement and compliance, including audits of commercial insurers and Managed Care plans, coordinating enforcement actions and sanctions, reviewing data collected and reported publicly, and issuing guidance to enhance compliance.
2. Close Gaps with Federal Law/Regulations: MHANYS supports legislation that would codify additional protections to ensure insurers and health plans comply with the federal and state parity laws. This includes codifying additional protections into state law from the 2024 federal final regulations that were put on hold. This includes meaningful coverage for mental health and substance use disorders, additional data reporting and testing to ensure equitable treatment, prohibiting use of outdated data or evidence to deny care and bar local governments from opting out of parity compliance. (S8426, Brouk/A8839, Simon).
3. Enhancing New York’s Mental Health & Substance Use Disorder Parity Report Act: MHANYS supports legislation or regulatory action that would require the New York State Department of Financial Services to publish a report providing a summary of the data and analysis performed pursuant to the Mental Health and Substance Use Disorder Parity Report Act (Section 343 of the Insurance Law). Currently, the data is posted as excel spreadsheets for each insurer/health plans with multiple tabs for two-year periods making review by the public challenging and stakeholders challenging. The current format inhibits meaningful transparency and accountability.
4. Network Adequacy: MHANYS urges vigorous enforcement of the New York State Department of Financial Services (DFS) and New York State Department of Health regulations requiring insurers and health plans to maintain network adequacy, which includes ensuring appointments within ten days for outpatient providers or seven days following discharge from a hospital or emergency room. The regulations also provide the ability to go out-of-network if there is not an in-network provider able to meet the wait time standards. The regulations were effective on July 1, 2025, and applied to policies that were renewed or modified after that date. Since most policies renew on January 1st, it’s important these agencies undertake a significant public awareness campaign to educate New Yorkers.
5. Gambling Disorders: MHANYS supports Part R of the Article VII H & MH legislation to ensure coverage for gambling disorders. The provisions update various provisions of Insurance Law to align with the recent changes in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) pertaining to substance-related and addictive disorders. These changes will provide that patients with gambling disorders receive the same coverage and protections as substance use disorders, which is critical for preventing unnecessary delays or denials for treatment. Amidst the proliferation of mobile sports betting and increase in calls to OASAS’ hopeline, this legislation is critical.