‘Managed care’ recipients tell lawmakers of inadequate treatment

TRENTON – Advocates testifying before the Senate Legislative Oversight Committee said Thursday that managed care organizations are providing anything but comprehensive care for behavioral health and substance abuse treatment, often not covering as much as patients were led to believe.

The committee, meeting in a packed committee room 1, focused on the issue of health parity, particularly in those two areas. While the Legislature has passed a health parity law, it is apparently falling short in some areas.

For example, Debra Wentz, of the New Jersey Association of Mental Health and Addiction Agencies, said eating disorders, post-traumatic stress disorder and various emotional and behavioral health problems are not being adequately cared for.  She said only biological problems tend to be addressed.

While one in five New Jersey residents suffers from behavioral health problems or mental illness, only about 30 percent of them actually get access to care, the committee was told.

“Parity is essential for achieving the mission (of getting more care to affected individuals),” she said.

Because of inadequate insurance coverage, many patients resort to Charity Care or other public assistance, which winds up costing taxpayers some $262 million each year and some $500 million in lost income, she said.  

“The return on a modest investment is huge,” she said.

Lynn Clemmons, a Middletown school teacher, told the committee about her son, whom she identified as J.C., who suffered from heroin addiction and received generally insufficient care from managed care organizations. She told the panel he was denied rehabilitation. He often had to rely on halfway houses and homeless shelters for survival.

Pat Woods said a managed care organization had reduced the number of sessions she was initially expecting to receive, and she described the treatments as “cookie cutter.” She said there needs to be a better understanding that a “one-size-fits-all” approach cannot be used.

Sen. Teresa Ruiz, (D-27), of Newark, said there’s a need to create “a better blueprint” in order to ensure manage care organizations are providing adequate care.

Sen. Barbara Buono, (D-18), of Metuchen called the lack of sufficient care for substance abuse and behavioral health patients “disturbing,” adding that the perception still seems to exist among some in the community that it’s the patient’s fault for having those illnesses.

“We are still in the dark ages when it comes to attitudes (about substance abuse and mental illness treatment),” she said. “That disparity in treatment reinforces that.”  

  ‘Managed care’ recipients tell lawmakers of inadequate treatment