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Safety net funding for mental health services remains imperative | Opinion

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By Debra L. Wentz

The state Legislature will soon release its budget for fiscal year 2018.  It is imperative that it include safety net funding for community-based providers as their mental health services are transitioned to a fee-for-service reimbursement system.

This funding is critical to ensuring that tens of thousands of New Jerseyans do not lose access to services that will leave them at risk of health complications requiring much more costly treatment in emergency departments and hospital inpatient units.

Keeping providers fiscally viable so they can maintain patient access to care, as well as continuity and quality of care, will not only save thousands of lives, but will also save the state millions of dollars.

Community-based providers of mental health and substance use treatment services in every region of the state have shared detailed projections with the Department of Human Services that show deficits ranging from $125,000 to $2.5 million, all in their outpatient programs, including medication management; partial care and partial hospital programs; and the newly established Community Support Services.

Many aspects of service delivery and billing contribute to these projected deficits.

Several services that are vital to an individual's well-being and ability to remain in the community are not billable under Medicaid. For example, outreach and case management are essential to engage individuals in treatment and support community living.

Without outreach from providers, individuals with serious mental illnesses, who account for a majority of missed appointments, will fall through the cracks. Without supports for ancillary services - such as finding and maintaining housing, and keeping medical and court appointments - many individuals will not be able to overcome the challenges of independent living in the community.

Many individuals with insurances other than Medicaid will also cease to receive services. Providers have historically delivered services to individuals who cannot afford their co-pays and deductibles. Under fee-for-service, no state funds will be available to enable providers to continue that practice.

For the uninsured, non-Medicaid eligible population, state funding will be capped.  When services are delivered to the uninsured, providers will do so with a built-in deficit, since the rates for this population have been set at only 90 percent of the Medicaid rates.

Medicaid regulations will generate additional service delivery costs for providers and further contribute to their projected deficits. For example, group therapy sessions now must be 90 minutes instead of 60; and higher credentialed staff are required for several service components. In many cases, the reimbursement rates have not been sufficiently increased to cover the costs of such requirements.

Providers have been doing more with less for some time now. They have not received a Cost of Living Adjustment since 2008, while costs have continued to increase and they struggle with recruitment and retention problems. They have filled gaps in state funding with local funding, grants and fundraising. There is no way they can possibly continue their current services with less funding, let alone meet new requirements and need.l do so with a built-in deficit, since the rates for this population have been set at only 90 percent of the Medicaid rates.

The community-based behavioral health system of care in New Jersey is facing service capacity reductions that will leave thousands - possibly tens of thousands - of New Jerseyans without access to treatment. Programs that disappear will not be able to be brought back online easily, or at all, in some cases.

Lives are at stake. The state needs to make the wise investment of safety net funding now to prevent the exorbitant financial costs and the unconscionable costs to lives that will occur without it. We urge all New Jerseyans to support this critical funding.

Debra L. Wentz is president and CEO of the New Jersey Association of Mental Health and Addiction Agencies, Inc.

 

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The Supportive Housing Association of New Jersey (SHA) is a statewide, nonprofit organization, founded in 1998, whose mission is to promote and maintain a strong supportive housing industry in New Jersey serving people with special needs.

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Guest Friday, 18 August 2017

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