Lawmakers Bring Need for Parity into the light

Four New Jersey legislators recently focused a health issue affecting thousands of the state’s residents: insurer treatment limits and denials for people with an addiction or mental illness. Senate Legislative Oversight Committee members Robert Gordon, Teresa Ruiz and Barbara Buono spent a good portion of July 18 listening to expert and personal testimony on this long-standing problem. Earlier this summer, Senator Robert Singer and former Congressman Patrick Kennedy held a forum at Stockton College to make the case a final rule on the federal addiction and mental health parity law, needed to help end insurer non-compliance. These four New Jersey lawmakers, along with long-time parity champion Senator Joseph Vitale, deserve the state’s deep appreciation for responding to a problem that has been terribly costly to the state in the lives it has claimed and in the increasing amount of public dollars it has required.

The Senate committee heard testimony from experts and from two panels of patients and their families. These witnesses described what is known as “medical necessity,” a ploy regularly used by insurers to deny treatment. Simply put, health insurers refuse treatment for patients by asserting that a higher level of care such as inpatient treatment is not medically necessary, even if the patient has had assessment indicating a more intensive level is warranted.

 Should the patient or their family try to argue that the patient does indeed need the more extensive care, they will encounter the health insurance bureaucracy. The labyrinth of this process often leaves patients and their families so bewildered and frustrated that they eventually give up trying to have their treatment covered, likely the outcome the insurers were counting on.

 By taking on insurance denials and restrictions, the lawmakers are assisting citizens who need care as well as attending to the  state’s budget. The details of the immense fiscal costs of treatment denials were presented to the Senate panel by New Jersey Association of Mental Health and Addiction Agencies Executive Director Deb Wentz. She said untreated and undertreated addiction cost the state $262 million each year, the largest amounts arising from criminal justice, child welfare, other health problems resulting from addiction, and lost worker productivity. Ms. Wentz said that of the more than 800,000 residents of the state who need treatment for addiction, only 7 percent of them receive it.

This issue is also being confronted at the federal level.  Senator Singer and Patrick Kennedy held a hearing in mid-June on the Paul Wellstone Pete Domenici parity law and urged people to step forward to advocate against insurer non-compliance with the law. Kennedy stressed that too few have lent their voice to the issue in the public arena owing to the stigma surrounding addiction and mental illness.  One witness at the Senate committee hearing, Wayne Debolfsky, captured this fact. People affected by these diseases, he said, “have suffered too long in the dark and in silence. They have suffered in silence, Debolfsky said, because their “illnesses are shame-based.”

Clearly the challenges for advocates of insurance reform are considerable, yet there is reason for some optimism that people in the state (and across the country) with behavioral health problems will not have to battle through the insurance gauntlet to access proper treatment. Nationally, the Obama Administration is insisting that the final rule on the federal addiction and mental health parity law be in place by the year’s end. New Jersey is among the states expanding Medicaid as part of health care reform, enabling more people to access care. And certainly another reason to hold out hope is that a group of New Jersey lawmakers saw fit to spend the better part of a summer’s lifting the issue into the light. 

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Medicaid expansion a boon to addiction care

In the fall, the devastation brought by Sandy saw Governor Christie respond in a way that put New Jerseyeans above politics. With his recent decision to expand Medicaid, which is a key part of the Affordable Care Act (ACA), the governor again showed that his concern for the state’s citizens outweighed political considerations. The Medicaid expansion will mean in the coming years 300,000 more residents of the state will have access to health care. Of these, 44,000 more with an addiction will be able to enter treatment.

The decision the governor came to is not only humane, it is the fiscally responsible one. Advocates for the expansion noted that it will help create jobs in the health care arena. The expansion could also bring an influx of as much as $300,000 million in the coming year.  

More directly, it will benefit the state by getting people the treatment they need before they wind up in the emergency room, for far too long the only place the poor could turn to receive medical attention.

The ACA promotes treatment of addiction, partly through broader screening to detect an alcohol or drug problem. This screening will increase the likelihood of early detection and thereby get patents into treatment sooner, keeping them from suffering any number of the health problems that arise from prolonged drug or alcohol use (kidney or liver failure, hypertension). In addition, the ACA includes addiction as one of 10 categories of care in its Essential Health Benefits package.

It remains to be seen whether the governor will have a backlash from conservatives for his Medicaid decision. Whatever the fallout for his political future, the governor made the proper decision for New Jersey’s population and its economy. 

Daniel J. Meara
NCADD-NJ

Correctional halfway houses in New Jersey are under scrutiny with due cause

Among state correctional halfway houses reports of violence, drug use and escapes are rampant. While the idea of a transitional facility helping inmates to adjust to society may be sound, there appear to be horrible political barriers that impede proper oversight to these systems. In an undoubtedly troubled economy, poorly utilized resources are especially intolerable.

When stories surface such as the one this past summer, where inmate David Goodell from Logan Hall escaped and killed Vivianna Tulli due to poor security and oversight, it opens a proverbial can of worms that is hard to ignore.

 

 This is only one of approximately 5200 escapes since 2005. During hurricane Sandy there were reports of 15 escapes at once in one facility among others. http://www.northjersey.com/news/politics/nj_politics/halfway_houses.html

At Bo Robinson correctional facility in Trenton, a janitor sexually assaulted a female inmate for weeks before she was transferred to another facility in 2009. As the story came out so did many other sad truths about the facility. Gangs and violence forced some employees to quit. The number that hits home for NCADD-NJ and our efforts is that when this correctional halfway house was investigated, 73% of the inmates tested positive for drugs. This is consistent with the high number of substance abuse found among prisons. If quality substance abuse and mental health services were actually being provided in a clinically sound way, the number of inmates would be significantly reduced in both the prisons and step down halfway houses. This alone would save the state money. Instead, operators continue to build additions to accept more prisoners while lining their own pockets, as they are paid by the inmate.

http://www.nytimes.com/2012/06/18/nyregion/at-bo-robinson-a-halfway-house-in-new-jersey-bedlam-reigns.html?pagewanted=all

One can’t help but wonder if these horrifying truths are in large part due to political contracts and egregious mismanagement of funds. A particular company being looked at right now is The Kintock Group, A “non- profit” organization that is the second largest operator of correctional halfway house facilities in NJ. The Kintock Group is given government contracts to operate several of the NJ correctional halfway house facilities each year. When the founder has been paid over $7 million dollars in the past decade, at what point is an organization considered for-profit? The organization has near $40 million in revenue. It seems they simply call themselves non-profit because they provide some “community services”. There is little accountability and clarity as to where these contract dollars are going. Also lacking is oversight as to whether services that are claimed to be provided, such as:

• Community Resource Centers
• Employment education and placement
• Substance abuse and mental health treatment
• Cognitive behavioral therapy
• Adult basic education and GED preparation
• Life skills education
• Community referrals
• Housing placement

 are truly provided to inmates. Not to mention appropriate training and compensation for employees. The extent to which misappropriation of funds is occurring has yet to be determined due to the inability to investigate. Although Democrats in Trenton are not afraid to make waves with the entire issue, it may not be enough to demand that these dysfunctional systemic issues are properly addressed. http://www.nytimes.com/2012/12/30/nyregion/operator-of-new-jersey-halfway-houses-paid-millions-to-founder.html?nl=todaysheadlines&emc=edit_th_20121230&_r=0