DHS Explains Plans and Christie-Era Reforms at Budget Hearing

State’s largest department walks lawmakers through how it will put to work its $18 billion proposed spending plan for 2019

Assemblywoman Eliana Pintor-Marin, budget chair
New Jersey officials are eager to improve life for the state’s most vulnerable residents by modernizing health and welfare programs and improving their oversight of the system, while also working to fine-tune reforms already underway and incorporate lawmakers’ priorities in the process.

That was the message that emerged Monday as state Department of Human Services Commissioner Carole Johnson testified before the Assembly Budget Committee regarding the agency’s $18 billion proposed spending plan for the coming year. She explained, however, that while the department has new plans and programs on its agenda, it is still working to implement projects announced and approved by the Legislature during the Christie administration.

Committees in both the Senate and the Assembly are reviewing each department’s plan as part of their assessment of Gov. Phil Murphy’s $37.4 billion fiscal year 2019 budget, which lawmakers must approve by July 1. The state Department of Health, which testified before the Assembly panel late last month, has faced a similar situation and is now working with Murphy’s office to implement an oversight panel that was due to be set up last summer.

Biggest department in state government

The DHS is the largest department in state government — even after the Division of Mental Health and Addiction Services, with its $1 billion budget and 4,000-plus employees, was shifted to the DOH last year. It oversees Medicaid, or NJ FamilyCare, runs programs for developmentally and intellectually disabled individuals and senior citizens, and coordinates food assistance, childcare, welfare, and other social service efforts. The fiscal 2019 proposal calls for nearly $6 billion in state funds and close to $12 billion in federal dollars, for a total of almost $18 billion.

Johnson outlined how new state investments in Medicaid will attract additional federal “match” dollars and allow New Jersey to expand coverage for diabetes prevention programs, hepatitis C treatments, and autism-related services. She also noted that Murphy signed legislation to extend Medicaid coverage for family-planning services to more working-poor women and committed an extra $7.45 million to women’s healthcare services, funding that former Gov. Chris Christie had declined to provide during his
eight years in office.

Underpaid support professionals

But among the issues committee members pushed her to defend is a decision not to include a $20 million one-time payment Christie tucked into the current fiscal budget to provide bonus payments to direct-support professionals, frontline caregivers who serve in a range of healthcare roles. These workers earn, on average, around $10.50 an hour, making it hard for agencies to attract and retain quality staff.

Provider groups and healthcare advocates have lobbied state officials for years to improve pay for these workers, and Assemblyman John Burzichelli (D-Gloucester) said better compensation for these individuals was a sticking point during last summer’s budget debate, which led to a multiday shutdown of state government. The issue was also flagged by Murphy’s social services transition team earlier this year.

“Not having this $20 million in the budget, what is the plan for these people providing these very intimate and valuable services to very vulnerable people?” Burzichelli asked. The question was also raised by Assemblywoman Eliana Pintor Marin (D-Essex), the budget committee chair, and Assemblyman Gordon Johnson (D-Bergen).

Commissioner Johnson praised the role these DSPs play in providing care and said she was eager to work with lawmakers to find a way to improve reimbursement rates for these critical workers over the long term, as opposed to a one-time bonus. She said the need also underscored the importance of Murphy’s campaign for a $15 minimum wage statewide.

The proposal does include some $16.7 million in state funds, Johnson said, which attracts the same in federal dollars, to increase to $16 the hourly wage for personal-care assistants, another group of frontline workers who help elderly and disabled individuals with dressing, cooking and other daily needs so they can remain at home. But there’s not enough money to provide all these workers the $19 an hour wage required by a bipartisan bill lawmakers passed last summer — something the commissioner said would cost $50 million more.

Transportation for Medicaid clients

Lawmakers also pushed Johnson to explain how the DHS would improve the way it monitors work done by contractors that provide non-emergency transportation for some 135,000 Medicaid members, a situation that has raised concerns over the years for state regulators and those who depend on the free service.

In March, the nonpartisan Office of the State Auditor reported that between 2014 and 2017 the DHS had failed to properly address questions of vehicle safety and driver qualifications and lacked the capacity to doublecheck data submitted by the company, which earned more than $180 million for its work in the final year. (The audit focused on the state’s role, not the performance of the broker, LogistiCare, an Atlanta-based company that works in dozens of states and has in the past defended its efforts in New Jersey.)

Johnson agreed that the state, which renewed the vendor’s contract last fall, must do better to make sure it is spending Medicaid dollars wisely — and that patients are getting where they need to go on time. The DHS has committed several staffers to this monitoring and plans to add more, she said. “We are actually increasing our capacity to oversee these services because we need to,” she said.

The commissioner had good news to report to Assemblyman John McKeon (D-Essex), when he asked about the DHS’s progress in implementing Stephen Komninos’ Law, which Christie signed in June 2017 and took effect two weeks ago. Named for a 22-year-old man with intellectual disabilities who choked to death in 2007 at a residential facility under state contract, the law requires the DHS to make at least two unannounced visits to group homes and also to check on day programs. If a resident is injured, staff at the home has an hour to contact family members to report the incident and two days to notify the state.

Johnson said the DHS has launched an incident-reporting system to fill its responsibilities under the law, created training modules for providers, and met regularly with families and advocates who were instrumental in passing the law. “It’s clear that the direct service providers (in these residences) are taking it seriously,” she said, as the number of calls to the department has ticked up since the law went into effect on May 1.