New York City's aging population is increasing, with nearly one in four older adults experiencing a mental health challenge and about 6% living with a serious mental illness that affects their ability to function independently. The city's mental health system is not adequately equipped for these individuals, leaving them at risk in the most visible and expensive systems such as emergency rooms, hospitals, shelters, and the justice system. The lack of coordinated support has led to a costly and destructive mismatch in programming for people with severe mental illness. The authors suggest the city should develop a specialized, age-appropriate behavioral health pilot for older adults, potentially delivered through qualified community-based providers with relevant clinical and aging-services experience. The pilot could be structured through a blended funding approach, supported through Medicare, Medicaid, and commercial insurance, and city support for core Older Adult Center costs.