A federal pilot program that has helped to expand and integrate healthcare and support services for tens of thousands of complex and vulnerable patients in eight states, including New Jersey, has received a reprieve in the form of additional funding that will enable it to continue its work for a few more years and expand its reach across the country.
Four Garden State groups will benefit from up to an additional $2 million each, annually, from the federal government to hire additional psychologists, expand the use of proven addiction treatment protocols, build new partnerships with local hospitals and clinics, and take other steps to help fill longstanding gaps in the often patchwork system of community-based care for those with mental health issues and substance use disorders.
A fifth group, not included in the original pilot program, also received $2 million to implement this model — known as Certified Community Behavioral Health Clinics, or CCBHCs — which is designed to better integrate the treatment of substance use disorders with care for other mental health and physical health issues. The work is focused on improving care for vulnerable patients facing multiple behavioral health challenges, in particular those diagnosed with “co-occurring” conditions of both mental illness and addiction disorders — a situation impacting at least half of all behavioral health patients, treatment providers note.
“Comprehensive health care means more than just good physical health; it also requires attention to good mental health,” said U.S. Sen. Robert Menendez (D-NJ), who has advocated for the funding and announced the awards with U.S. Sen. Cory Booker (also D-NJ).
Urban and rural
The community-based providers selected in New Jersey, who work with patients in several urban and rural areas, will divvy up nearly $10 million in grants from the federal Substance Abuse and Mental Health Services Administration, according to the senators. The program is part of a new round of grants SAMHSA offered to qualified provider agencies in more than two dozen states; with funding designed to last through 2020, each group could receive $4 million total.
“It’s vital that we support New Jersey’s community behavioral health clinics because they provide some of our most vulnerable populations critical care when they need it most,” Booker said.
These grants, announced in two rounds starting in mid-September, build on the more than $1 billion SAMHSA provided to organizations in eight states, including New Jersey, to launch the two-year pilot program in July 2017. Seven Garden State organizations received support through the first round of funding — the largest federal commitment to community-based care in generations, advocates have said, and a critically important investment in the existing system.
“CCBHCs provide a comprehensive collection of services that create access, stabilize people in crisis, and provide the needed treatment and recovery support services for those with the most serious and complex mental and substance use disorders,” the SAMHSA website notes in announcing the grant process. The funded organizations directly provide some of these services, like counseling and case management, and craft agreements with local clinics and hospitals which can offer patients medical care, including preventive services.
Appointments, transportation, job training
The original pilot program showed promise, supporters said, in helping to reduce wait times for new appointments, reach new patients, and expand support services, such as transportation and job training. The initiative, which created new flexibility in Medicaid programs to enable providers to collect higher reimbursements for certain services, also helped these groups divert patients in crisis from seeking help in hospital emergency rooms, which are not always well equipped to offer appropriate assistance.
Demand for services is underscored in the tens of thousands of Garden State residents who seek treatment annually and the roughly 3,000 expected to die of drug-related issues this year. Reports suggest the need may even be greater than it appears: Only one in ten Americans with addiction receive the proper treatment and just over four in ten get proper care for a serious mental illness, according to Booker and Menendez.
Former Gov. Chris Christie expanded access to inpatient care significantly, calling for the creation of new beds and ensuring that health insurance covered more of this care. Gov. Phil Murphy has focused new state resources on enhancing and supporting the loose network of community-care providers, scores of nonprofit and for-profit organizations that contract with the state to treat those in need, including patients with Medicaid or lacking insurance altogether.
Multiple state and federal efforts to better coordinate care and standardize protocols are underway, but advocates note there is only so much community-based providers can do without more funding to build a more sustainable infrastructure of programs and services. The first round of CCBHC support was a welcome addition, they said, but providers have hoped the federal government would extend the pilot program, or better yet, make it permanent.
Lance, Booker, Menendez
Booker and Menendez have echoed this call and a bipartisan group of Congress members, led by U.S. Rep. Leonard Lance (R-NJ), introduced legislation to expand the existing pilot, which has yet to advance. In the meantime, SAMHSA announced a new round of funding designed to reach patients in more states; the program is based on the same model as the initial CCBHC pilot, but offers grant dollars in advance, instead of the higher Medicaid rates used as a mechanism for the first round of funding.
For Monmouth County-based CPC Behavioral Healthcare, which received funding in both the first and second rounds, the new money will enable staff to form alliances with colleagues in neighboring Ocean County and, together, help reach an additional 2,000 patients in an area particularly hard-hit by opiate addiction. In particular, CPC will focus on assisting those with substance use disorders and mental health needs, or “co-occurring disorders.”
“We had already (implemented the model at) all our agencies in Monmouth County,” explained CPC president and CEO Vera Sansone. “So now we are expanding into northern Ocean County.”
The new dollars will allow CarePlus NJ, a CCBHC program in Bergen County, to open a new service hub at its Hasbrouck Heights location with the capacity to reach another 750 clients. The fact that the funding is in a grant form, available up front, is particularly helpful for an organization that has seen its state funding shrink significantly in recent years as part of a controversial payment reform, explained Joe Masciandaro, CarePlus president and CEO.
“We’re trying to expand our geographic base,” Masciandaro said. “And this allows us to get ahead of the curve.”
The other organizations to receive the latest funding included the Catholic Charities Diocese of Trenton, Rutgers Biomedical and Health Services, and Ocean Mental Health Services; Ocean Mental Health is the only one that did not also receive money in 2017.