For decades, federally qualified health centers (FQHCs) have played a crucial role in providing care to low-income New Jerseyans.
Now, two trends are combining to make the centers even more essential – the rising number of people covered by Medicaid and other health insurance as a result of the Affordable Care Act and expanded services ranging from pharmacies to dental clinics.
But state regulations represents a major roadblock to effort to integrate healthcare services for patients who may have chronic physical conditions, such as diabetes or hypertension, and behavioral or mental health conditions like depression.
New Jersey has long-standing rules that require facilities like FQHCs to have separate entrances and service areas for patients in need of behavioral health and addiction services. Several grant-funded and pilot programs have been chipping away at this barrier and a newly proposed state bill would remove it entirely, allowing FQHCs and other ambulatory care facilities to directly offer behavioral healthcare.
“It doesn’t make sense and there’s no need to further stigmatize someone with a behavioral health medical condition,” said Sen. Joseph F. Vitale (D-Middlesex), who is sponsoring the bill, S-2375/A-3700, as part of a package intended to reduce drug-overdose deaths. “They shouldn’t be segregated.”
Vitale added that the measure would allow providers to offer healthcare in a “seamless and efficient manner. All of those services should be available at one stop, in one place.”
Centers across the state are expanding their services thanks to recently announced federal funding through the ACA. The 20 FQHCs in New Jersey will receive $15.6 million, allowing them to add 79 staff positions, including dental and eye care providers, as well as behavioral health staff at centers that can already offer those services because they have separate entrances or are operating pilot programs.
U.S. Department of Health and Human Services Regional Director Jackie Cornell-Bechelli said the combination of the ACA and the fact that some people never regained private health insurance after the 2007-2009 recession has made the federally funded centers crucial.
Cornell-Bechelli said it’s “really exciting to get just a whole range of services in one space. It helps for continuity of care – it helps for the patient to have a better experience, because they have a trusted provider that they know will take good care of them and they’ve been seeing for a long time.”
While she didn’t take a position on the state bill, she said she supports the concept of FQHCs breaking down barriers between different types of care.
“I think that what we have found is that when you can combine as many services under one roof … that you have cost savings both to the medical community and to the patient,” she said. “And you just see better services and better care, because doctors are able to come together and talk about an individual and a whole being and all of their needs, as opposed to treating this issue, and then this problem and then this disease.”
It’s a concept shared by several of the programs that have joined in the Good Care Collaborative – a statewide umbrella organization advocating reform of how the state manages Medicaid, with an eye toward including behavioral health in managed care.
Dr. Kemi Alli, chief medical officer at Henry J. Austin Health Center, a Trenton-based FQHC, said her center will add a women’s healthcare provider and a dental hygienist who will provide oral-health screenings to children, as a result of $225,000 in new federal funding.
Alli, who’s worked at the center for 16 years, said the state regulations have long been a challenge.
“It’s interesting — when you speak to our primary-care providers one of the reason they say they get burned out was because they were having to provide some degree of behavioral healthcare services,” she said. They would refer patients to an outside behavioral health provider, “but the wait was four weeks, eight weeks, three months” for an appointment.
The patients would return to the health center before having the appointment, and the primary-care provider would have to help the patient with their behavioral health problems.
“For years and years and years, our providers and our staff struggled with this notion of helping people with hypertension and diabetes and asthma — trying to treat those primary health conditions and patients not getting better overall,” Alli said. Over time, it’s become clear that behavioral health issues were at the center of the problem.
FQHCs in states with less restrictive regulations than New Jersey have had success in dealing with similar patients, she said. For example, patients are better able to take care of themselves when their behavioral health issues are treated.
“What they found is that when you integrated primary care with behavioral healthcare, the primary healthcare outcomes got better,” Alli said. “If you treat the depression for individuals who have diabetes and depression and do nothing else for the diabetes, lo and behold, the diabetes gets better.”
Under a pilot program, the Henry J. Austin Health Center has taken steps to have licensed social workers providing behavioral health support as part of teams coordinating patient care. The Nicholson Foundation has helped fund this approach. Alli said the possibility of permanently eliminating the regulatory barriers is a “very important opportunity.”