Details Still Fuzzy for Funding of Christie’s Healthcare Priorities

Lilo H. Stainton | March 2, 2017 | Health Care
Governor highlighted anti-addiction efforts and other health priorities in his budget address Tuesday but a full account has yet to emerge

Credit: Governor's Office/Tim Larsen
Chris Christie
Gov. Chris Christie doubled down on his earlier pledge to prioritize anti-addiction efforts in the state budget he announced Tuesday, calling for $430 million to fund programs to combat substance use disorders in the year to come.

But details of what exactly those dollars would fund remained elusive the day after he outlined the nearly $35.5 billion state spending plan for Fiscal Year 2018, which starts in July.

The governor noted federal and state spending on these programs has grown 52 percent since he took office in 2010; at that point New Jersey committed nearly $283 million to various initiatives designed to prevent addiction, treat the disease, and support those who are in recovery. In recent years, Christie has invested greater attention and resources in addressing the problems related to New Jersey’s opiate addiction epidemic.

Christie devoted nearly two-thirds of his final State of the State address, delivered in January, to “the scourge of drug addiction and how it is impacting the lives of every citizen in our State.” Among other things, he outlined plans to expand a successful peer-mentoring treatment program, build upon the state’s work to connect low-level offenders with addiction services instead of prison, and create more housing for those in recovery.

Fighting addiction crisis remains top of his list

“My budget proposal for 2018 includes vital funding for the proposals that we talked about then, in addition to maintaining other critical funding to combat this epidemic,” Christie told a packed crowd in the State House Tuesday. “Fighting the addiction crisis facing New Jersey has been and will continue to be in the next 10 months a top priority in my tenure as Governor.”

Christie’s most prominent proposal], which he signed into law last month, mandates up to six months of commercial insurance coverage for substance use disorder treatment and restricts initial opiate prescriptions to five days for acute pain patients. This effort — which doesn’t involve state spending and for that reason is not reflected in the budget — sparked some concern among some healthcare experts, particularly prescribers, but it has also drawn praise from many in the addiction community.

‘I think he’s trying to do some very positive, very lasting things to help people,” observed Richard Wohl, president of Princeton House Behavioral Health — one of the state’s larger behavioral addiction and mental health services. “Any good idea is going to have a down side, but he’s trying to think it through and make improvements in a state that is really riddled with opiate addiction issues.”

“I give him credit for taking this on,” added Wohl, whose organization is part of the larger Princeton HealthCare System.

Sen. Joseph Vitale (D-Middlesex), the longtime health committee chairman who is working with Christie to improve access to sober living facilities, or recovery housing, said the Legislature will do what it can to continue to work with the governor to address these issues. The governor praised lawmakers for this partnership in his speech Tuesday.

“We are all in this fight together and must continue to work collaboratively to make a real and direct impact on the innocent lives destroyed by this fierce disease,” Vitale said. “I look forward to forging ahead and working with my colleagues to ensure that the health priorities of New Jersey residents are met and represented in the budget so that we can better serve our communities in leading healthier lives.”

State treasurer unable to provide much detail

Proposed state funding for the Department of Health and the Department of Human Services — the two entities that oversee the majority of addiction-related services — would increase significantly and far more than any other departments, under Christie’s plan. The DOH would receive an extra $50 million, a nearly 10 percent jump from last year’s budget; Human Services, which oversees huge programs like FamilyCare, would increase by more than $199 million, or 3.1 percent of its massive budget.

When asked about these boosts — the only increases over 1 percent to any of the 16 state department budgets — Treasurer Ford M. Scudder was unable to provide much detail during a budget briefing Tuesday. The proposed increase to DOH funding primarily reflects $30 million in new money for graduate medical education, he noted, and the jump in the Human Services budget would fund various social service programs, he said.

Governors traditionally have used budget speeches to highlight priorities or new concepts —not drill down in detail on department spending — and Christie’s address Tuesday was no different; he highlighted the $430 million in addiction spending and ticked off a few programs involved, but didn’t offer a full accounting. Despite multiple requests for comment since, Treasury officials have declined to offer any further detail on the breakdown of proposed spending or confirm certain elements that could be included.

A review of the budget materials, posted on the Treasury website, suggest Christie’s calculations could include the following. These items account for $206.3 million in proposals.

Items on Christie’s list

  • $136 million, largely from federal sources, to continue to fund increased Medicaid reimbursement rates for behavioral health services that Christie first announced and included in the current budget. Medicaid is known to pay among the lowest rates and they are rarely increased, so providers appreciate any boost. But many questions remain about whether the new rates are enough to cover their full costs — and the implementation of a payment reform model that has coincided with the rate hike has caused concern for a number of nonprofit mental health agencies. Vitale said increasing these chronically low rates is important. But more money for the doctors doesn’t immediately guarantee patients will be better able to connect with care. “It’s great to have extra dollars, but what does it mean for access,” he asked.
  • $64 million in new funding for drug courts, a program Christie has championed for several years and expanded significantly. The goal is to divert low-level offenders with substance use disorders into treatment, instead of sending them to prison, where they are far less likely to get treatment for their disease. “I think it’s very smart,” said Wohl, of Princeton House. “An effort to address the addiction aspect of people’s involvement (with crime) is smart. A lot of times it’s the drug talking, not the person’s intention to be a criminal.”
  • $2.8 million for the recovery coaches program, which started last year in Ocean and Monmouth counties and has been expanded into central New Jersey since then. The highly successful model pairs former addicts who are long clean and well trained with drug users who are in the immediate aftermath of an overdose and hospitalized as a result. A high number of the encounters lead to the patient getting drug treatment, organizers have said.
  • $2 million to fund operations at Mid-State Correctional Facility, scheduled to reopen soon as a treatment program for prison inmates. Christie outlined the concept in his State of the State address in 2016 as another effort to ensure those in the correctional system, where addiction rates are particularly high, also have access to care.
  • $1.5 million to expand the recovery dorm program, built on a model developed by Rutgers University to ensure students with substance use disorder issues have a place where they can avoid temptation. Wohl said sober housing — on campus or in a traditional community — is an essential part of recovery success. “In addictions, they talk about people, places and things. You have to change the people, places and things if you want to be successful,” he said. “And this is the places part.”