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3 The Behavioral Health Budget Must Reflect New Jersey Values and Needs For decades, many advances in policy and practice have contributed to the growth and development of New Jersey’s community-based behavioral healthcare network, and new, creative ideas continue to be introduced that add value to New Jerseyans’ quality of life, as well as the state’s bottom line. Innovation has improved access to care, including meeting individuals where they are, as well as developed services that improve an individual’s chances at success, as defined by each person. Expansion and innovation have included case management, a focus on social determinants of health, peer support and other non-clinical services that have been expanded or implemented. Unfortunately, the severe workforce crisis that continues to challenge the behavioral health field is having significant impacts on access to all services and the ability to realize the full value of innovative programs. Beds are left vacant because appropriate staff are not available to serve the individuals who are in need of them. Programs close or reduce capacity for lack of staff. And the pipeline of workers has slowed. In the following pages, you will find budgetary, legislative and policy recommendations to address not only workforce issues, but also gaps in service and the needs of specific programs for their sustainability. You will find inspiring stories shared by individuals who have successfully accessed the services they needed. The triumphs in their lives reflect the great value of community-based behavioral health care and the hope, support and successes gained by New Jersey’s children, youth, adults and the friends and families who love them. New Jersey’s budget needs to also reflect the value of behavioral health services. After 15 years (FY2008 to FY2023) without cost-of-living increases to rates and contracts, adult behavioral health programs and some children’s programs received 5% increases in both FY2023 and FY2024. These increases, while immensely appreciated and helpful, did not bring reimbursement to levels that fully covered the costs of providing care. Programs and Staff Are Underpaid In the subsequent years, skyrocketing wages, utility and insurance costs, and other inflated costs of doing business have left behavioral health organizations extremely financially vulnerable. This past year, providers have had to absorb additional costs to meet the new demands associated with the carve-in of outpatient services to Medicaid managed care. With significant cuts to Medicaid on the horizon, many programs will be severely negatively impacted. Current budgets do not allow behavioral healthcare providers to pay competitive wages, which leads to higher turnover and vacancy rates, as well as increased hiring and training costs, all further negatively impacting the bottom line. Rates and contracts also do not permit organizations to invest in their infrastructure, whether to support further integrating their services or to simply ensure safe fleets and facilities. The State’s fiscal pressures threaten not only individual businesses, but also statewide programs. Adequate, reliable funding must be provided to strengthen and expand existing services and bring new services online. If New Jersey truly values accessible, timely, appropriate behavioral health services for all its residents, its budget and policies must reflect what is needed. The recommendations in the following pages outline how that can be achieved.