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There are four community mental health centers in the county that provide outpatient services to 30,000 people, said Sidrow. Her agency provides such services in Dumont and Englewood.
“We figured out that, collectively, we’d lose around $8 million,” Sidrow said.
Among them, the four agencies serve 6,000 to 7,000 people on medication for depression, anxiety, schizophrenia, and other conditions, she explained.
If the change takes effect on July 1, 2017, she said, these people will lose their services.
“We are all terrified, seriously. Where do these people go?” Sidrow asked. “Do they end up back on the street? In hospitals? In the criminal justice system?
“Also, we can’t take in new people. We can’t, in good conscience, see more people and tell them their meds are good for a month but then we can’t see them after that.”
For four decades, the state of New Jersey has provided the agencies with contracts of varying amounts that have been negotiated. Now it wants to drop the contracts and instead use a fee-for-service funding model.
Mental health center directors throughout the state have said they’ve used contract money to subsidize low Medicaid rates. They’ve also used it to subsidize people who had no insurance or, as is now the case, those who are insured under the Affordable Care Act but cannot afford their deductibles.
“No one payer —Medicaid, Medicare, even private insurance—pays the full cost of care for mental health,” Sidrow said. “We’ve never had parity with the physical health side of medicine.”
Because heads of community agencies have strongly protested the shift in Trenton, the start date for the change has been moved to July 1, 2017. In the meantime, agencies are raising consciousness in their communities about what could happen.
The fee-for-service system means the only revenue agencies will get is what they bill for, Sidrow said. In itself, that’s not a problem.
What is a problem are the proposed rates, she explained: they don’t cover agency costs.
“What happens when we can’t pay psychiatrists’ salaries anymore?” she asked.
There’s more.
A 30 percent no-show rate is typical in the mental health world, Sidrow said, due to the nature of patients’ conditions.
“They’re depressed, can’t get out of bed. They have schizophrenia. They have anxiety,” Sidrow said.
With state grant money, an agency can continue to pay staff when people don’t show. With a fee-for-service method, an agency cannot.
The staff calls such clients and does follow-ups, Sidrow said. Plus, documentation and paperwork abound, whether a client shows or not.
Other community mental health centers serving Bergen are: CarePlus New Jersey, Paramus; West Bergen Mental Healthcare in Ridgewood, Ramsey, and Mahwah; and Comprehensive Behavioral Healthcare in Lyndhurst and Hackensack.
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