NYHealth Testimony on New York City Veterans’ Health Needs

NYHealth President and CEO David Sandman, Ph.D., provided the following testimony on the health and related needs of New York City veterans to the New York City Council Committee on Finance for its Fiscal Year 2024 Executive Budget Hearing:

Thank you, Chairperson Brannan and members of the Committee for the opportunity to testify today about the health needs of veterans in New York City. I am pleased to provide testimony on behalf of the New York Health Foundation (NYHealth), a private, independent, statewide foundation dedicated to improving the health of all New Yorkers—including the more than 200,000 or so veterans who call New York City their home.

In our work on behalf of veterans, we have used grants, policy analysis, convenings, and advocacy to create universal access to Veterans Treatment Courts, build a robust network of community-based services, and prepare health care providers to understand veteran culture and meet their unique needs.

Our veteran population is becoming increasingly diverse. Racial and ethnic minorities now make up 23% of New York State’s veteran population, with that proportion expected to reach nearly 30% by 2030. The share of women veterans is also growing quickly; women are expected to make up 10% of New York’s veteran population by 2025.[1]

As we all adapt to an evolving veteran population with unique needs, we encourage the Council to prioritize:

  • Improving mental health services and addressing veteran suicide;
  • Producing local data about our veterans;
  • Maximizing veterans’ access to new health benefits; and
  • Supporting a robust Department of Veterans’ Services.

Improving Mental Health and Addressing Veteran Suicide: Mission:VetCheck
While media depictions too often suggest otherwise, I want to dispel the notion that all veterans are violent or struggling. The majority of veterans return from deployments and transition to civilian life relatively smoothly; they’re healthy, ready to work or go to school, and eager to settle into their communities.

But for some, the adjustment isn’t so easy. They may struggle with physical injuries and disabilities, and they may also be dealing with the invisible wounds of war: mental health issues including PTSD, suicidal ideation, and substance use. They may also be challenged by food insecurity, lack of employment, or homelessness.

A top priority must be meeting veterans’ mental health needs and preventing veteran suicide. In 2020, veterans in New York were nearly twice as likely as the State’s general population to die by suicide.[2] Particularly concerning is the increasing rate of suicide among New York’s youngest veterans. My colleague (and Marine veteran) Derek Coy testified before the City Council earlier this year about the need for supportive services for student veterans at the City University of New York—a younger population with an elevated risk of suicide

Also alarming is New York veterans’ increased usage of firearms in suicide attempts in each of the last five years.[3] Tackling this problem requires a multi-faceted approach, including restricting access to guns. Firearms are by far the most lethal method of suicide; they are deadly in 85% of attempts, compared with 5% for all other methods.

Among other suicide prevention programs, we have invested in a successful partnership between New York Cares and the New York City Department of Veterans’ Services (DVS) to operate Mission: VetCheck, an award-winning program that provided “buddy checks,” peer-to-peer support, and referrals to nearly 30,000 veterans across New York City. Using trained volunteers, the program conducts veteran outreach via phone calls to check on their wellbeing and connect them with services and resources. NYHealth expects to provide New York Care with another round of financial support to refine and continue Mission:VetCheck. We encourage the Council to keep a close watch on the program’s reach and impact. After this next phase, public funding will be vital to sustain this lifesaving program’s work.

New Local Data on Veteran Suicide
At present, only State-level data on veteran suicide are available. This information void makes local planning and targeting of services more difficult, including here in New York City. Having local data can help government agencies and community-based organizations identify the veteran populations most affected by suicide in their communities—and target their prevention efforts accordingly. These data will also enable organizations to evaluate effectiveness of their suicide prevention work.

The City’s Bureau of Vital Statistics can make available and leverage local data, where appropriate, to aid government and nonprofit organizations in their service efforts at relatively little cost. New, more precise data will be a beneficial resource to program planning and policy development at the City level.

Maximizing Veterans’ Access to New Health Care Benefits
New York should also take advantage of recent unprecedented expansions of federal benefits and increased access to health care for veterans. The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act expands eligibility for Veterans Administration (VA) health care to any veteran with toxic exposure. A complementary policy allows every veteran, regardless of their previous VA eligibility, to get access to VA or private care for acute suicidal crises. Together, these policies represent the largest benefits expansion in VA history.

But many veterans, health care providers, local government officials, and veterans service organizations are unaware of the expansion and how to get the benefits for which they have newly qualified. There is a need and an opportunity to educate veterans and the organizations that serve them about these new benefits and how to use them. An expanded Mission: VetCheck program will ensure every veteran within the five boroughs is aware of, and has access to, the benefits they have earned.

New York City’s Department of Veterans’ Services
DVS is the linchpin of local efforts to advance veterans’ health and wellbeing. As recently as 2015, the Mayor’s Office of Veterans Affairs had a meager budget and almost no staff. Thanks to the leadership of the City Council, DVS was elevated to a full-fledged agency led by a Commissioner in 2016.

That move immediately increased the Department’s size and expanded its role. Its enhanced portfolio of work includes benefits enrollment, employment and housing assistance, mental health outreach, and referrals to mental health resources and food and nutrition programs. For example, DVS was a key partner, alongside the New York State Division of Veterans’ Services and community-based organizations, to deliver hundreds of thousands of meals to veterans facing food insecurity across the City during the COVID-19 pandemic.

A robustly funded, high-performing DVS is beyond essential. Thanking veterans for their service means nothing if we don’t back up those words with the first-class services and supports they need and deserve.

In conclusion, we respect and share the Council’s commitment to New York City’s veterans. I hope you will look to the New York Health Foundation as a resource for your important work. You can learn about our veterans work and more by visiting our website, www.nyhealthfoundation.org.

Thank you.

 

 

[1] More information on New York State’s veteran population—including statistics on factors affecting veterans’ health such as employment status, income, and food security—is available at https://nyhealthfoundation.org/resource/new-yorks-veterans-an-in-depth-profile-2/.

[2] New York Health Foundation, “Data Snapshot: Veteran Suicide in New York State,” March 2023, https://nyhealthfoundation.org/wp-content/uploads/2023/03/data-snapshot-veteran-suicide-new-york-state-2011%E2%80%932020.pdf.

[3] New York Health Foundation, “Data Snapshot: Veteran Suicide in New York State,” March 2023, https://nyhealthfoundation.org/wp-content/uploads/2023/03/data-snapshot-veteran-suicide-new-york-state-2011%E2%80%932020.pdf.

Keeping New York Covered

The national COVID-19 public health emergency ended last week, on the heels of the World Health Organization declaring the end of the global public health emergency. It’s a relief to enter this new phase — it is an important milestone toward our collective return to a changed but more normal way of life. The last three years were long ones, filled with more suffering, anxiety, and disruption than we could have imagined.

As we move forward, there are also new challenges as government supports related to the pandemic are ending. One of the biggest is the federal rollback of a policy that prohibited states from terminating Medicaid enrollees’ health insurance. Thanks in part to that continuous coverage requirement, insurance coverage rates in New York are now at a record high. The public safety net is a big part of that success; more than 9 million New Yorkers are enrolled in public coverage, including more than 1.4 million who enrolled for the first time during the pandemic.

The expiration of that policy means that states must begin recertifying all Medicaid beneficiaries. New York State has begun reassessing eligibility and renewing coverage for all eligible Medicaid, Essential Plan, and Child Health Plus enrollees, which will continue over the next 14 months. It’s a massive undertaking — the biggest coverage event since the Affordable Care Act was passed.

There are some states that are licking their lips at the prospect of cutting their Medicaid rolls. But New York is pulling out all the stops to preserve our coverage gains. The State has produced an impressive set of tools and supports, including:

The State is also collaborating with private funders and advocates on a campaign called Keep New York Covered (KNYC). The campaign will identify New Yorkers who need to renew their coverage, reach out to them with clear and effective communications, and provide navigation assistance to help people understand their options and successfully enroll in coverage. (My colleague Avital Havusha co-authored a commentary on that initiative — give it a read to learn more. Also check out a recent webinar featuring State officials and other campaign leaders describing their work.)

New York’s Navigator and facilitated enroller networks, which have helped hundreds of thousands of New Yorkers enroll in or renew coverage over the past decade, are also ready to meet the moment. The Community Service Society of New York is mobilizing community-based organizations across the State to conduct marketing and outreach activities. Already, they have reached nearly 2 million New Yorkers and helped nearly 4,000 of them enroll into public coverage. They’re doing the critical but often overlooked work of getting people the information they need, exactly when they need it, in a way that resonates with them. These groups are using tested strategies and messages, including texts, phone calls, door-to-door outreach, presentations, social media posts, videos, and radio and TV announcements.

The pandemic was short on silver linings, but one was that New York’s safety net held. An unexpected outcome was that people gained rather than lost health insurance coverage. We must preserve those gains rather than backslide. There is no other way but to protect New Yorkers’ coverage and make health care available and affordable when they need it.

By David Sandman, President and CEO, New York Health Foundation
Published in Medium on May 15, 2023

NYHealth Comments on Child Nutrition Programs Community Eligibility Provision

NYHealth submitted the following public comments in support of a proposed USDA rule that would expand eligibility for the Community Eligibility Provision, which helps ensure more students have access to nutritious meals in school. The proposed expansion will allow an additional 925 New York schools to participate in the program:

May 8, 2023

School Meals Policy Division
Food and Nutrition Service
U.S. Department of Agriculture
P.O. Box 9233
Reston, VA 20195

Re: Proposed Rule on Child Nutrition Programs: Community Eligibility Provision—Increasing Options for Schools

Dear School Meals Policy Division:

The New York Health Foundation (NYHealth) appreciates the opportunity to respond to USDA’s Proposed Rule on Child Nutrition Programs: Community Eligibility Provision — Increasing Options for Schools. NYHealth is a private foundation that works to improve the health of all New Yorkers, especially people of color and others who have been historically marginalized.

NYHealth has a long-standing commitment to improve both access to and quality of school meals, with a focus on expanding free, healthy school meals for all. We strongly support the proposed rule, which would help make progress toward that goal.  

Expanding access to school meals is of critical importance in New York. Based on a 1,507-person statewide Survey of Food and Health that NYHealth conducted in 2021, we know that approximately half of all food-insecure households with children have children who had gone hungry that calendar year.[1] Three of every four such households cannot afford to feed their children a balanced meal, and more than 80% rely on low-cost foods.

Nationally and in New York, the Community Eligibility Provision (CEP) has helped ensure all students in eligible schools have access to nutritious meals they need to fully develop. CEP expands school meal participation, reduces stigma, lessens administrative burdens, and streamlines food service operations.[2] CEP benefits students, families, and school districts. Moreover, CEP has been demonstrated to reduce household food insecurity and combat childhood hunger.

During the height of the COVID-19 pandemic, all schools saw the value of offering free meals to all students—reducing student hunger, supporting household finances, improving student behavior and academic achievement, and easing administration and operations. Since the elimination of pandemic-era expansions and a return to a tiered-eligibility system, families, students, and schools have struggled; many districts have reported a rise in school meal debt.

USDA’s proposed rule lowering CEP’s eligibility threshold to 25% from 40% Individual Student Percentage (ISP) will benefit schools and communities, giving 9 million more students access to free school meals and expanding operational efficiencies for 20,000 more schools nationally. For a student to qualify for ISP, their family of four can only earn up to $51,000 a year, leaving out families whose incomes are above the federal poverty line but below a livable wage. In New York State, the expanded eligibility will allow an additional 925 schools to participate.

Even with the proposed expansion, CEP participation will remain financially infeasible for eligible schools because the reimbursement rate calculated using the current 1.6 multiplier is inadequate. Districts spend more than they are reimbursed to make school meals.[3] Lowering the ISP threshold is a critical first step in strengthening CEP, but the Department should consider additional measures, including an increased multiplier, to make it more financially viable for schools.

In the past year, states have enacted legislation to ensure all students have access to healthy school meals. California, Maine, Colorado, Minnesota, and New Mexico passed policies to aid schools in offering free meals to all students. New York State’s 2023–2024 budget provides $134.6 million for free school meals, which will cover only 300 additional schools. State funding will help schools with lower ISPs to adopt CEP, but in many cases will not be adequate to fully fund school meals programs. To better assist states that have expanded school meals, USDA should approve waivers from states to run CEP statewide and consider creating statewide CEP demonstration projects to assess the approach.

Lastly, we urge USDA to give states the option to put the 25% threshold into effect even if the new rule is finalized after the June 30th election deadline. Doing so will allow states and schools to benefit from the update in the upcoming school year.

We thank USDA for this opportunity to comment on this proposed rule and for its continued work to increase school participation in CEP, enabling children to have access to healthy school meals. We encourage USDA to explore all options to make CEP financially possible for all eligible schools.

Sincerely,

David Sandman, Ph.D.
President and CEO
New York Health Foundation

[1] New York Health Foundation. Food insecurity in families with children. October 2022. https://nyhealthfoundation.org/wp-content/uploads/2022/10/food-insecurity-in-families-with-children.pdf. Accessed February 2023.

[2] Bylander, A., FitzSimons, C., and O’Connor, G. (2022) Large School District Report Operating School Nutrition Programs During the Pandemic. Food Research and Action Center. https://frac.org/wp-content/uploads/large-school-district-report-2022.pdf.

[3] Fox MK, Gearen E. Mathematica Policy Research (2019). “School Nutrition and Meal Cost Study: Summary of Findings. United States Department of Agriculture Food and Nutrition Service.

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