NYHealth Testimony on Resources and Services for New York City Veterans

On November 30, 2023, the New York City Council Committee on Veterans held an oversight hearing on legislation for resources and services available to veterans in New York City. NYHealth Senior Program Officer Derek Coy provided the following testimony:

Thank you, Chairperson Holden 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 veterans who call New York City home.

In more than 15 years of work on behalf of veterans, the Foundation has used many approaches, including grantmaking, policy analysis, convenings, and advocacy to better understand the health needs of military veterans. Through this work, we have identified gaps in services and helped to replicate promising and effective programs; supported a robust network of community-based services; and prepared health care providers to better meet the unique needs of the veteran population.

 My testimony today highlights two key opportunities for New York City to advance veterans’ health: (1) raising awareness about recent, unprecedented veterans’ benefits expansions and (2) prioritizing comprehensive and timely local data collection and dissemination.

1. Maximizing Veterans’ Access to New Health Care Benefits

Most veterans return from deployment and transition to civilian life relatively smoothly. Although media depictions too often suggest otherwise, most returning veterans are healthy, ready to work or go to school, and eager to settle into their communities.

But for some, the adjustment isn’t so easy. Veterans 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—all factors that can increase a veteran’s risk of dying by suicide. Veterans deserve to have high-quality health care and services to meet their unique physical and mental health needs.

 New York City should take advantage of the recent and unprecedented expansions of federal benefits that increase access to health care for veterans. The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act expands eligibility for U.S. Department of Veterans Affairs (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. A similar policy has expanded VA health care to every World War II veteran across the State. Together, these policies represent the largest benefits expansion in VA history.

Yet many veterans, health care providers, local government officials, and veterans service organizations are unaware of this expansion and how to access the newly available benefits. New York has an opportunity and an obligation to educate veterans and the organizations that serve them about these new benefits and how to use them. To support this effort, the Foundation recently invested in expanding the Mission: VetCheck program with the New York City Department of Veterans’ Services (DVS) to ensure every veteran within the five boroughs is aware of, and has access to, the benefits they have earned.[1] The City Council also has the opportunity to fund this outreach—increasing public funding by leveraging federal funds—and further ensure that all New York City veterans have access to these needed resources.

2. Developing New and Timely Local Data on Veteran Suicide, Demographics, and Other Trends

Throughout NYHealth’s work, a common theme, and frustration, has continually emerged: the lack of high-quality, New York-specific data on military veterans. We know the Council shares our concerns about these limitations.

NYHealth has filled some of these gaps by analyzing federal and State data sources and disseminating findings across the State. A few examples include briefs on trends in veteran suicide,[2],[3] a data profile of the State’s veteran population,[4] and a fact sheet on the mental health impact of the COVID-19 pandemic on New York’s veterans.[5] I encourage the Council to dig into the findings and share with others working to improve the health of veterans in New York.

At the same time, data limitations and lack of availability hinder more analyses and understanding of statewide and local issues in three key areas:

 Veteran Suicide

Just two weeks ago, the VA released its national report on veteran suicide for 2021, and the findings are sobering. Nationally, both veteran and civilian suicide rates rose in 2021. However, in New York State, these rates held steady. We even see a potential silver lining in these statewide data: a 13.4% decrease in the use of firearms—the most lethal modality—in veteran suicides.

However, because only State-level data on veteran suicide are available, we can’t understand, analyze, or respond to trends at a local level. This information void makes local planning and targeting of services more difficult, including here in New York City. Having access to local data would enable government agencies and community-based organizations to identify the veteran populations most affected by suicide in their communities and target their prevention efforts accordingly. These data would also enable organizations to evaluate the effectiveness of their suicide prevention work.

 New York City’s Bureau of Vital Statistics should make available local suicide data, where appropriate, to aid government and nonprofit organizations in their service efforts. More recent and more precise data will be a beneficial resource to program planning and policy development at the City level. For instance, we know firearms are an issue both nationally and statewide, but without granular data from the five boroughs, a tailored approach that addresses the specific modalities of veteran suicide is a near-impossible task.

 Veteran Status and Demographics

Our veteran population is becoming increasingly diverse. There is no one-size-fits all solution, especially for suicide prevention. 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.[6] Having more granular data about different demographics within the veteran population can shed light on important trends: for example, younger veterans are at highest risk for suicide, whereas Black and Hispanic veterans are at highest risk for alcohol abuse.

New York City has the opportunity to build on State-level efforts to improve demographic data collection about veteran status in health care settings. Doing so is a critical component of preventing suicide and tailoring services based on veterans’ unique needs. New York State stakeholders participating in the Governor’s Challenge to Prevent Suicide among Service Members, Veterans, and their Families, including NYHealth, have established a core priority to increase access to care through screening for veteran status. New York City agencies should consult with State partners to learn from best practices and recommendations. For example, Governor’s Challenge workgroup members have identified promising data collection models from the New York State Department of Motor Vehicles and school admissions departments.

 Veterans Treatment Courts

Veterans Treatment Courts (VTC) are a type of problem-solving court that provides an alternative to incarceration for justice-involved veterans who have mental health and/or substance use disorders. Although available data largely show positive outcomes of VTCs—including reduced recidivism, lower alcohol and drug use, more stable housing, increased opportunities for employment, stabilized relationships with friends and family, and improved mental health among participants—more robust and longitudinal evaluations are needed. Today, even the most basic data, such as the numbers of New York veterans who have participated in VTCs, are hard to come by.

State court agencies are currently working to make more data available, which is promising. To ensure the effective and equitable implementation of VTCs, ongoing and granular data collection and program assessment are imperative. A firmer grasp on how many veterans have used VTCs in New York City, who they are, and the rate of successful graduations will help legal professionals, researchers, advocates, funders, and policymakers better understand not only how well these courts are performing, but also what prevents success and who is still slipping through the cracks.

New York City court systems have the opportunity to lead the way by working together to improve more granular data collection to contribute to the State’s strategic planning efforts regarding VTCs.

 Looking Ahead: New Veterans’ Health Data From New York Health Foundation

In the coming months, NYHealth plans to release a number of data products that will provide valuable new information for veterans, policymakers, service providers, and others interested in improving veterans’ health in New York. These include data snapshots of veteran suicide in both New York State and New York City, as well as an overview of VTCs across New York State.

We are particularly excited about an upcoming needs assessment of New York State’s veterans, developed by the RAND Corporation with support from NYHealth. RAND is currently fielding the survey, the first statewide veterans’ needs assessment since 2011.[7] The report, which we expect to release in the first quarter of 2024, examines the health, mental health, and social service needs of New York State’s evolving veteran community. It will examine trends over the past decade, explore new issues that have emerged over time, and provide recommendations on how to best meet the needs of New York’s veteran community, with a focus on underserved and minority populations.

We look forward to sharing these new data analyses with the Committee, and we encourage you to look to the Foundation as a resource as you continue your important work to meet the needs of New York’s veterans. You can learn about our veterans work and more by visiting our website, www.nyhealthfoundation.org.

Thank you.

[1] New York Health Foundation, “New York Cares, Inc.: Maximizing Veterans’ Access to New Health Care Benefits”, https://nyhealthfoundation.org/grantee/new-york-cares-inc/, accessed November 2023.
[2] New York Health Foundation, “Veteran Suicide in New York State: The Latest Trends,” https://nyhealthfoundation.org/resource/veteran-suicide-in-new-york-state-the-latest-trends/, accessed November 2023.
[3] New York Health Foundation, “Data Snapshot: Veteran Suicide in New York State (2011–2020),” https://nyhealthfoundation.org/resource/data-snapshot-veteran-suicide-in-new-york-state-2011-2020/, accessed November 2023.
[4] New York Health Foundation, “New York’s Veteran’s: An In-depth Profile,” https://nyhealthfoundation.org/resource/new-yorks-veterans-an-in-depth-profile-2/, accessed November 2023.
[5] New York Health Foundation, “Fact Sheet: The Mental Health Impact of COVID-19 on New York State Veterans,”  https://nyhealthfoundation.org/resource/fact-sheet-the-mental-health-impact-of-covid-19-on-new-york-state-veterans/, accessed November 2023.
[6] New York Health Foundation, “New York’s Veteran’s: An In-depth Profile,” https://nyhealthfoundation.org/resource/new-yorks-veterans-an-in-depth-profile-2/, accessed November 2023.
[7] New York Health Foundation, “The Needs of New York State’s Returning Veterans and Their Families,” https://nyhealthfoundation.org/resource/the-needs-of-new-york-states-returning-veterans-and-their-families/, accessed November 2023.

Giving Thanks in Turbulent Times

The news is depressing to read. Wars in Ukraine and the Middle East. Climate disasters. A dysfunctional Congress.

If you shake off the gloom, there are things to be grateful for. A daily source of joy and comfort has been our rescue pup, Molly, who we adopted almost one year ago. I’m forever grateful to Muddy Paws Rescue for bringing her into our lives. She’s going to enjoy her first family Thanksgiving, without a doubt. The photo above shows Molly and her Thanksgiving turkey (soon to be stuffing).

Beyond my own family, I’m thankful for things that are making New Yorkers healthier:

1. A largely effective Medicaid renewal program: Earlier this year, I wrote about what’s known as the “Medicaid unwinding” — the rollback of a pandemic-era policy that prohibited states from terminating Medicaid enrollees’ health insurance. The expiration of that policy required that all states begin recertifying all Medicaid beneficiaries earlier this year. It is estimated that at least 2 million children across the country have already lost coverage despite remaining eligible, often because of missing paperwork and errors by states.

New York State is doing a lot better in comparison. This state-by-state tracker from KFF shows that, of New York beneficiaries who’ve needed to redetermine their eligibility to date, two-thirds have successfully renewed their coverage. By comparison, in Texas, only one-third of renewals have been successful. New York is also tracking and sharing its own more detailed monthly data; the latest figures show that 77% of those required to recertify in September enrolled successfully in coverage.

Our relatively strong performance isn’t an accident. New York has been putting tremendous energy and resources into this process through the Keep New York Covered campaign, which includes outreach and navigation assistance to help people understand their options and stay covered. I’m thankful to live in a State that is working to be a national leader in preserving its gains.

2. Overdose prevention centers: Record numbers of New Yorkers are dying of overdoses because of a contaminated drug supply. It’s become almost impossible to ignore; I’ve encountered several people actively overdosing in the subways and ATM vestibules and I’ve done my best to intervene.

New York is the only state in the nation with sanctioned overdose prevention centers, or OPCs; we have sites in both East Harlem and Washington Heights operated by a group called OnPoint NYC. I’ve seen firsthand (and written about) the critical work they do. OPCs are clinical, safe, hygienic spaces where people can use drugs under the supervision of trained professionals to prevent deaths. These centers save lives — more than 1,000 and counting. Equally important, they offer dignity and compassion to the people who use their services, which include medical and social services like free meals, counseling services, and showers.

As the opioid crisis persists, cities and states across the country are clamoring to set up similar sites. OnPoint’s executive director, Sam Rivera, was named one of Time’s 100 most influential people of 2023 for his work. The National Institute on Drug Abuse (part of the National Institutes of Health) recently awarded researchers a $5.8 million grant to study the impact of OPCs. An evaluation published just this week found that the OPCs are not associated with increases in crime.

Yet our OPCs are on shaky ground. New York State’s Opioid Settlement Fund Advisory Board has twice recommended devoting a portion of opioid settlement proceeds to OPCs, but Governor Hochul recently rejected the idea. Earlier this summer, the U.S. Attorney for the Southern District of New York vaguely threatened to shut them down.

I’m thankful for the courage and dedication of the OnPoint team and those who are continuing to reduce the harm of the opioid crisis, save lives, and keep thousands of New Yorkers safe.

3. Healthy school meals for kids: Hungry kids can’t learn, grow, and be healthy. New York State’s 2023–24 budget included an additional $135 million to expand and fund free school meals. Food had been the one arena in public schools that segregated children by family income — but now that’s changing. Providing free meals is a proven strategy to reduce food insecurity, improve mental and physical health, boost academic performance, and increase educational and economic equity.

New York has yet to make schools meals universally free for all children, as some states have done. But we’re getting there: Hunger Solutions New York projects that, by January 2024, an additional 1,100 schools serving 300,000 students in New York will have adopted free breakfast and lunch this school year. That means an estimated 83% of students statewide will have the food they need to be healthy and learn well, regardless of their family income and without stigma and shame. And we’re seeing more attention to ensuring that school meals are appealing, nutritious, and culturally relevant, and that school cafeterias are places where students actually want to hang out and eat. Since the Thanksgiving holiday usually revolves around eating, greater access to healthy school meals is a big win.

From my family to yours (including all 4-legged members), I wish you a healthy and happy start to the holiday season.

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