Secretary Xavier Becerra Visits Harbor Care
If you had a chance to ask the Department of Health and Human Services (HHS) a question, what would it be? Harbor Care staff as well as a number of guests from social service nonprofit agencies around New Hampshire had that delightful dilemma. They were able to pose their most pressing questions to Xavier Becerra, Secretary of HHS when he made a surprise visit with Representative Annie Kuster to Harbor Care Health and Wellness Center on July 15th.
Harbor Care COO Henry Och, HHS Secretary Xavier Becerra, and Harbor Care CEO Peter Kelleher at 45 High Street in Nashua.
Besides staff and board members from Harbor Care, roundtable participants included Jessica Parnell, Executive Director of ReVive Recovery; Cynthia Whitaker, President and CEO of Greater Nashua Mental Health; Kristin Makara, Director of The Doorway of Greater Nashua; Chris Stawasz, Regional Director of American Medical Response; Greg White, CEO of Lamprey Health; Casey Caster, Executive Director of The Nashua Youth Council; John Jurczyk, President of St. Joseph’s Hospital; Hon. Jacalyn A. Colburn, Recovery Court Judge with Hillsborough County South Adult Recovery Court; Daisy Pierce, Executive Director of Navigating Recovery; and Bobbie Bagley, Director of Public Health, City of Nashua. Congressional staff and staff from various federal agencies were also at the event.
Becerra praised New Hampshire nonprofits for their tireless efforts to stem the tide of overdoses and death in the state. Only a few years ago, New Hampshire was leading the nation in per-capita opioid overdose deaths. Now we are one of only two states to have reduced the number of overdoses per year, and opportunities to enter recovery are greater than ever. Unfortunately, other states across the nation are struggling.
Becerra used his home state as an example of what’s going on in the rest of the country. “California is just beginning to experience what New Hampshire was going through several years ago. It’s just devastating to so many families.” Becerra added that there’s a bright spot on the horizon for communities that are awash in opioids: “It looks like we’re finally close to an actual deal with opioid distributors and manufacturers to address what they helped cause.”
Becerra began his political career in Los Angeles. “I represented Skid Row, and North Hollywood, where nightlife means something else than you would see in Hollywood.” He said that many of the residents of his district were young people. They often live on the streets, unsheltered, and many struggle with substance misuse issues. “The thing they need is stability.” Becerra then nodded toward Harbor Care’s CEO, Peter Kelleher, saying: “You at Harbor Care offer stability to families so they can get anchored. When that happens, they can start to deal with some of the issues they have in their life. They strive for stability, and you give it to them.”
Becerra acknowledged the nonprofits represented and opened the floor to questions.
Casey Caster, Director of the Nashua Youth Counsel, asks HHS Secretary about additional support needed in the wake of COVID-19 for the behavioral / mental health needs of her clients.
Casey Caster, Executive Director at The Nashua Youth Council: For youth in our community, the fallout from the years-long opioid crisis has been severe. In the months since COVID-19 restrictions have begun to lessen, demand for our services has skyrocketed. We now see a new population of youth experiencing anxiety and depression, with many turning to self-harm, substance use and other risky behaviors. In the light of this, I was heartened to see your announcement that Health and Human Services is establishing a Behavioral Health Coordinating Council. Will direct funding be made available to community-based organizations that are treating the behavioral health needs of youth and families who have been impacted by the opioid crisis?
Becerra: A new block grant targeting youth behavioral health became available last month, as part of the American Recovery Plan. Suicidal ideation and the other issues you mentioned are on fire in other parts of the country. We're trying to spend money now to try to get ahead of it because we know there’s a tsunami coming. Very rarely do these types of programs have adequate funding, so we’re hoping we can make some progress now to fulfill what’s needed. We know that Post COVID-19 this issue of Behavioral Health will be harder than before. It’s masked behind these really courageous and strong people who are really hiding a lot of pain. We want to get you working. We know you how to do some of these things. We want to help.
Djemi Lazarre, Certified Recovery Support Worker at Harbor Care: I’m in long-term recovery, and was able to get nothing but minimum-wage jobs until I started working at Harbor Care’s Keystone Hall. Keystone Hall changed the trajectory of my life; I was able to gain experience and work on my education. I got certified as a recovery support worker. I would love to continue my education in my field, and am wondering if HHS might at some point offer education opportunities for people like me, who want to continue in the recovery field?
Becerra: That answer will depend on Congress. Education is usually outside scope of funding for substance use disorder within infrastructure, but we can be flexible. If education helps you, HHS can come up with proposals that are pertinent. They can’t come from Washington, D.C, though – they have to be locally grown. Only states can apply for wavers to the current legislation. We need people to come up with ideas. We can seed ideas but we need people come up with them. Obviously, education has helped you become a stronger recovery worker, and we want to support that.
Kuster: We need more stories like yours to bring forward to Congress to show what peer recovery support is and how helpful it is. Currently we have a difficult market for hiring, and we need stories like yours to point to the fact that people like you are our future workforce. We know that there’s a labor shortage right now. It’s to everyone’s benefit if more people can go through recovery from substance misuse, and take on jobs that are going empty right now. We also need to talk to our educational partners to they recognize recovery support is legitimate way to enter into social services. This is how we can fix our labor shortage – getting people into recovery, and into training.
Becerra: The first step was American Recovery Plan; we had to right the ship of state with that funding. It carried 10 million to New Hampshire for recovery support and substance misuse treatment. The next step will be the infrastructure package and the American Family Plan. Keep an eye out for major legislation coming forward called CARA 3.0. This will be a lot of funding for workforce development and will be a pipeline for workers.
Casey Caster of the Nashua Youth Counsel, Cynthia Whitaker, President and CEO of Greater Nashua Mental Health, and Elisabeth Maguire of Harbor Care Health and Wellness Center enjoy a moment.
Elisabeth Maguire, Licensed Clinical Social Worker, Harbor Care: The United States is experiencing healthcare shortages across the country. Currently Medicare reimburses for clinical social workers and psychologists, but not licensed mental health counselors. Here at Harbor Care we employ a number of licensed clinicians, and some are not reimbursable by Medicare and Medicaid under the current Federally Qualified Health Center (FQHC) model. As an FQHC, we serve a large number of patients who have Medicare, but due to these restrictions, not all of our clinicians are able to treat those patients. This decreases the Medicare patients’ access to care. How we can expand the list of eligible providers?
Becerra: Everything we do regarding reimbursement is due to regulations from Congress. If we try to change reimbursements, there will be a turf battle between those who already get reimbursed versus those who don’t yet; we will see battles between ophthalmologists, for instance, and optometrists. It’s viewed as a zero-sum game. You’ll have folks who are already in who are saying, wait a minute, you’re getting in on our turf, and that means less reimbursement for us. That’s the political side of it. On the more technical side, we have to have data evidence that shows that the providers who seek to be reimbursed – those out of both technical college and experiential training -- are equipped to perform their job at an appropriate level. When that happens then then maybe we can get the rule-making authorities moving in Congress. We’ve got to do testing; while we don’t have the regulatory authority that Congress does, we do have authority to create pilot programs. We can test whether a given program will be fruitful. And just to be clear: we’re not going to open reimbursement up for everyone, but if there’s some signal that it really would be good for the health of Americans and a savings for taxpayers, then we can expand the code of reimbursement to others.
Daisy Pierce, Executive Director of Navigating Recovery of the Lakes Region: According to recent CDC information that NH was one of two states to not have overdose rates increase last year as a result of these efforts, what can be done to ensure that NH continues to receive funds, and spends the money in its entirety?
Becerra: Just because NH has done well you should not lose resources. It’s a matter of having the authority, and remember, there is only a finite amount of funding. We are trying to explore ways of not punishing you for being successful. We understand that when you’ve got things going in the right direction is not when to pull the funding out from under you because it would like cause a back-slide or stall in improvements. You’re having successful outcomes, which means you’re doing something that works, and we understand that.
Kuster: We intentionally wrote the funding proposal to reflect this issue, because at that time, New Hampshire wasn’t doing well in terms of overdoses and deaths.
Bobbie Bagley, Director of Public Health for Nashua, asks about support for recovery from substances other than opioids, while Nashua Mayor Jim Donchess and Harbor Care’s Elisabeth Maguire listen intently.
Bobbie Bagley, Director of Public Health, City of Nashua: Will this funding be flexible enough to help those whose drug of choice is not opioids, but alcohol?
Becerra: It should be as long as I’m Secretary I’ll make sure we won't exclude anyone just because their substance for misuse isn’t opioids.
Kuster: When the opioid epidemic hit I thought it was an excellent time to educate my colleagues who thought drugs were not a white middle class problem. So often many distanced themselves or felt separated from the problem itself and from the people experiencing substance abuse disorder. When it started happening in their families, there was finally a recognition across the aisle that this is a medical issue. This is a co-occurring disorder. Now I feel they’re in a space to do it.
Greg White, CEO of Lamprey Health: Regarding teleheath, what progress may be underway in terms of making permanent some of the accommodations made during the pandemic?
Becerra: We are going to need Congress’ help regarding telehealth. We are constrained. We can’t go farther than that (what was in place before COVID-19) until Congress tells us to go ahead. It has to be an experimental program; we can introduce and wait for a vote on it.
Kuster: It’s a top priority for us on our committee -- the Subcommittee on Health. We need your help in terms of how we go about this. If we go all in for telehealth, another Congress in the future will come along and say, ‘we don't need to pay for lights and receptionists...think of the tax savings!’ And then there won’t be funding for the brick-and-mortar health centers. Be careful for what you ask for. Having said that, however, I understand that telehealth is great for those who can't get to an appointment because they don’t have snow tires to get over the mountain, for example, or simply forgot they had an appointment until the nurse called them up.
Becerra: We have to show that we’re getting results. Telehealth is the future, but we have to be careful how we set the ground rules, so we won't find out years later that some bad actors found a loophole and took advantage of the taxpayers. Also, let's not have any communities left out – no one should be left out of telehealth because they don’t have broadband, for instance. We want equal access to all communities.
The Honorable Jacalyn Colburn of Hillsborough County South Adult Recovery Court asks HHS Secretary Becerra about quality assurance for sober homes.
Hon. Jacalyn A. Colburn, Recovery Court Judge with Hillsborough County South Adult Recovery Court: One of the silver linings of the COVID-19 response is that more funding went to recovery support. Because of this, there’s a cottage industry of sober living houses that have sprung up. Anecdotally speaking, I hear some are good, some bad. I’m worried because of the rapid growth, that we might be throwing people into places that may or may not be good. Especially in our current difficult employment environment.
Becerra: Once a program qualifies to reimburse; we have to reimburse. We can’t pick and choose from Washington D.C. which ones are good or bad – we simply can’t tell from that distance. And if we can’t justify our actions, Congress will grill us. The solution to this issue is more of a local issue. At the federal level we don’t get to say which programs get certified, but we do get to determine best practices. I want to create a system so you -- at a local level -- can determine and then tell us who the good players are. You’ll be able to see who in your community is doing the good work, and who isn’t. I would support this kind of oversight.
Chris Stawasz of American Medical Response, asks HHS Secretary Becerra about workforce recruitment and retention.
Chris Stawasz, Northeast Regional Director of Government Affairs, American Medical Response: My colleagues and I are worried about workforce recruitment and retention issues. Specifically, if we are all competing to hire and retain qualified employees on an essentially fixed reimbursement budget what are HHS and/or Congress doing to help us overcome those challenges.
Becerra: We need to boost funding for people who are care workers because they make poverty wages and they’re saving us money. Without them, people end up in emergency rooms of state-run places, hospitals, etc. That costs taxpayers money.
Kuster: We're all trying to figure out why people are not able to get back to work. For some it’s childcare costs / availability that prevents them from working. Some people we lost to COVID-19, or death through overdose, or they may have behavioral health and/or substance misuse issues that prevent them from being reliable workers. You folks are helping us rebuild our workforce. Because of stigma, people are not stepping forwards to get help for addiction. Nashua Safe Stations was a solution to this problem, while we had it. Nashua Safe Stations provided a warm hand off to anyone who showed up, no questions asked. Of the first 100 people through the door, 90 were approved for the new Medicaid expansion – which meant that suddenly those people had funding behind the to get into treatment. Prior to that, they would be ready but there wouldn't be a bed available for three weeks.
At the end of their visit, Secretary Becerra and Representative Kuster thanked everyone for their questions, and for their work in the field of recovery. Afterward shaking hands and posing for group photos, they walked from Harbor Care Health and Wellness Center to ReVive Recovery Center to greet clients of that facility.