The New Jersey Assembly will consider a resolution on Monday to block Gov. Chris Christie’s proposal to shift mental health and addiction services to a new department — and the Senate may soon follow suit. The two bodies would need to pass a joint resolution before late August to halt the controversial move.
The announcements followed Tuesday’s joint legislative hearing into the reorganization plan, which calls for shifting the Division of Mental Health and Addiction Services — along with its 4,321 employees and $1.16 billion budget — from the Department of Human Services to the Department of Health in an effort to better integrate New Jersey’s behavioral and physical healthcare systems.
While almost all the provider organizations, advocates, and others who testified agreed that treatment designed to benefit the “whole person” offered many advantages, only a few said the governor’s plan made sense right now. And most said such a “radical” reform deserves far more study and stakeholder input to protect care delivery; several also urged the state to wait until a new governor takes office in January, and uncertainty about federal healthcare reform made the timing even more precarious.
A move to block
A few hours after the meeting concluded, a proposal by Assemblywoman Valerie Vainieri Huttle — chair of the Assembly Human Services Committee, which held the session with the Senate Health, Human Services and Senior Services Committee — to block the move was included on the list for a vote during an Assembly session already scheduled for Monday.
“This hearing raised more questions than answers. But one thing we do know is that a restructuring of this magnitude should not be undertaken without those answers,” Vainieri Huttle (D-Bergen), said after, noting that none of the providers involved had been consulted by state officials on the plan.
Sen. Joe Vitale, longtime leader of the Senate panel, said later that he would recommend to Senate President Steve Sweeney (D-Gloucester) that the full Senate oppose the governor’s plan as well. Vitale, who has sought to improve healthcare integration through regulatory changes, said he would also continue to work with both departments on ways to better coordinate care.
Vitale (D-Middlesex) agreed there was “merit to the argument” that patients deserve more coordinated care. “However, I have questions and concerns about how moving the division from one building to another, and from one commissioner to another, will address the challenges that go along with the myriad services it provides,” he said.
Christie, a second-term Republican with less than six months left in office, revealed the plan to the Democratic-led legislature on June 29, the eve of what became a five-day state budget stalemate. Lawmakers have 60 days to pass a joint resolution blocking the reorganization, if they oppose the move; nearly half of that time has elapsed.
Experts agree that better integrated mental health, substance-use disorder, and physical care result in improved health outcomes for patients, more efficient use of healthcare resources, and savings overall. There is a growing effort to improve coordinated treatment, but hurdles remain in how these programs are regulated by state and federal agencies and how the services are funded, particularly when Medicaid is involved.
Seton Hall Professor John Jacobi detailed these roadblocks in a 2016 study — which served as a basis for Christie’s plan — and has since worked with officials in both departments to implement some of the recommendations. One key is consolidating the licensing of mental health, addiction, and medical services in one department; the first two are now handled by DHS while the third is currently overseen by DOH.
“It’s fair to say that creating a single licensing (entity for all three functions) would require some reorganization of the two agencies,” Jacobi testified Tuesday, the lone voice in the room defending the governor’s plan. “Whether this is the right way to do it or not is a question,” he continued, “but the powers of one agency would have to be transferred to the other.”
Health Commissioner Cathleen D. Bennett also submitted written comments in favor of the plan, and quoted several other supporters, but she had a previous commitment out of state and was unable to participate in person. (DHS acting commissioner Elizabeth Connelly was not invited to testify, since the goal was to focus on the “receiving entity,” officials said.)
“Mental and substance-use disorder healthcare should not be treated any differently than chronic diseases like diabetes or heart disease although, at times, the healthcare providers may be different,” Bennett wrote. “Considering one of the main missions of the (health) department is Population Health, it is impossible to meet the needs of all New Jerseyans by focusing only on their physical health.”
But Vitale and Vainieri Huttle wondered aloud why not consolidate the three licensing functions under one roof while preserving the bulk of DMHAS’s duties within Human Services. The division operates four state psychiatric hospitals and community-based mental health and addiction services, among other programs.
Jacobi suggested that approach could be “legally problematic” and “fraught with organizational peril.” Given the momentum around the plan in both departments, he said now was the right time to begin what will be a long process. “I believe there is a window of opportunity here. It would be overstating it to say the stars are aligned,” he continued, “but if I’m right on this I think we can make some progress.”
Providers, however, said that while the goal was admirable, any transition is far from simple. Such a move would cause two to five years of operational disruption, according to Deborah Spitalnik, a pediatrics professor at Robert Wood Johnson Medical School and disabilities expert, who said many of the same benefits could be achieved through better “collaboration and inter-agency planning” without a wholesale reorganization.
“This is a problem that can be solved without doing this kind of major surgery,” agreed Joe Young, director of Disability Rights Now.
Young and others also worried about new ruptures that could emerge between other offices that now work closely with DMHAS — like the Division of Developmental Disabilities and the Medicaid program, which funds much of these treatments — if the agency’s work is moved to the health department. DHS has decades of experience overseeing social-service programs designed to connect clients to housing, transportation, and other supports, while DOH’s expertise is in regulatory oversight, they noted.
“You’re splintering [the system] further if you make that kind of move,” warned Barb Johnston, with the Mental Health Association of New Jersey.
For Johnston and others, the timing is particularly concerning since dozens of community-based mental health providers are now moving to a new system of state reimbursements for Medicaid services. Many providers have warned the new fee-for-service model — in which they are reimbursed for each treatment instead of through a monthly state contract — has created financial shortfalls and forced program cuts.
“It’s a very heavy lift and now is not the time to add additional bricks to the load,” noted Robert Davison, head of the Mental Health Association of Essex County — which will soon absorb its Morris County counterpart as a result of those changes. Davison said that while integration was a “worthy idea” it was “irresponsible at best and reckless at worse” to push through reform in two months or less.