Christie drug-care expansion may hinge on Obamacare

In his  next-to-last State of State address on Tuesday, Gov. Chris Christie made a passionate pitch to expand drug treatment. But he left out what many experts say is a key element: fighting to save the Medicaid expansion that has helped so many addicts get clean and is now threatened by the proposed repeal of the Affordable Care Act.

Drug treatment is one of the many real-world issues in the balance as President-elect Donald Trump and lawmakers on both sides of the aisle in Washington debate the politics of Obamacare.

Under Obamacare's Medicaid expansion in 2014, which provides coverage for about 500,000 state residents, New Jersey for the first time funded substance abuse treatment for poor and low-income residents.

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Without the expansion, it will be impossible to enact some of the measures Christie proposed Tuesday, said Raymond Castro, senior policy analyst at New Jersey Policy Perspective, a leading state think tank.

“As one of the first governors to expand the options for substance-use-disorder treatment in the Medicaid expansion, he has a special interest in protecting it," Castro said.

But so far Christie has been quiet on the issue, even as Ohio Gov. John Kasich, Michigan Gov. Rick Snyder and other Republican governors have made their pleas to congressional Republican leaders to maintain the Medicaid expansion as they seek to replace the Affordable Care Act. Friday was the deadline for governors to respond to a request from House Majority Leader Kevin McCarthy for input as Congress moves to start the reform process.

"A letter is being drafted by the administration in response to the invitation for input,'' Christie spokesman Brian Murray said Friday afternoon, declining to comment further.

Trump campaigned on a promise to repeal Obamacare, but he and many congressional Republicans have said they want a replacement plan in place before they repeal the current law. What shape the replacement will take and how the Medicaid expansion will be affected are matters of speculation.

Republicans have talked about replacing the Medicaid expansion with block grants, which would allow states to design and administer Medicaid as they prefer. On Friday, the House voted 227 to 198 to advance a budget resolution, a first step to reform. Democrats in New Jersey and Rep. Tom MacArthur, a Republican who represents Burlington and Ocean counties, voted against the measure.

Drug treatment under the Medicaid expansion was so successful in New Jersey that Christie expanded those options last year with a $127 million initiative that helped centers expand services or in some cases, keep afloat. Eighty-four percent of the funding was from the federal government.

“Unless the Medicaid expansion is maintained, key features of the governor’s proposals will simply not be possible," Castro said.

Christie called for several initiatives Tuesday including: a new law prohibiting insurance companies from denying anyone treatment for the first six months; directing the attorney general to use an emergency rule to limit the number of opioid prescriptions that physicians can write; spending $12 million to open beds for teenagers who need help.

In Ohio, which leads the nation in deaths from opioid overdoses, Kasich credited the Medicaid expansion for helping many previously uninsured people to get treatment.

“Thank God we expanded Medicaid because that Medicaid money is helping to rehab people,'' he said at a bill signing earlier this month strengthening prescription oversights in Ohio.

Kasich says the Medicaid dollars are being used for treatment and programs that help addicts get off drugs. Kasich is hoping the new law that strengthens prescription drug oversight will also help fight addiction.

New Jersey’s rate of heroin-related deaths last year was more than double the national rate – nearly 1,600 or three times the number of deaths as car accidents, the governor said.

At the 133-bed Turning Point Inc. in Paterson, which benefited dramatically from the Medicaid expansion and increases in reimbursements last year, CEO Robert R. Detore fears future clients couldn’t get the help they need if the program is repealed.

“Thousands of New Jersey residents will not have a means to pay for treatment," he said. The facility, which also operates a halfway house in Verona and two sober houses in Hunterdon County, treats about 3,500 patients a year.

“It would severely cripple access to care and the finances of care providers that service this population,'' Detore said.

About half of the 1,100 clients at Eva’s Village in Paterson each year are enrolled in Medicaid, and treatment options would be gravely impacted if the expansion were repealed, said Mike Santillo, director of integrated services at the network of shelters, rehab, outpatient and other services.

“The Medicaid expansion opened the door to access treatment that there just wasn’t funding for," Santillo said. “It used to be if you’re not a drug court client, it’s hard to access care."

“To just lose that would be devastating to the system,’’ he said. The added funds last year – reimbursement changed from $71 to $109 a day for about four hours of outpatient care – has allowed Eva’s to hire more staff to improve patient-to-counselor ratios, which improves care, he said.

Rep. Bill Pascrell Jr., D-Paterson, also called for Christie to lobby Congress to preserve the expansion, saying the governor made the right decision to allow Medicaid expansion in the first place and must now defend it.

With so many residents potentially impacted and the loss of $3 billion per year in federal Medicaid funding at risk, Christie needs to act, Pascrell said Wednesday.

"This is especially critical in light of the governor’s focus on substance abuse, because the Medicaid expansion and the federal funding accompanying it has made many of Governor Christie’s current reforms possible,'' he said.

Maura Collinsgru, health care program director for N.J. Citizen Action, said the organization is urging Christie to respond to McCarthy's request with a call to protect the expansion. Christie's addiction treatment proposals "will just be totally undermined without the ACA,'' she said. The group "would like to think the governor would take the lead from Kasich and some of the other governors,'' she said.

Providers also want the governor to lobby the federal government for more flexibility in how Medicaid funding can be used to treat addicts. For example, an arcane rule prohibits centers with more than 16 beds — which includes all of New Jersey's treatment facilities — from receiving Medicaid dollars for the treatment of inpatient care except for adults age 19 and 20 and over 65, a means of preventing patients with mental health problems from being warehoused.

“If that exclusion were eliminated, then we could treat thousands more people,’’ Detore said.

Staff Writer Lindy Washburn contributed to this article.