New Jersey to expand Medicaid
Governor Chris Christie announced on February 26 that the state will expand Medicaid, making childless adults eligible for the program. The expansion, part of the Affordable Care Act, means that in the coming years, as many as 300,000 low-income residents could have access to health care, including 44,000 with an addictive disorder. These numbers will depend on how successful the outreach is to the affected population. The federal government will cover 100 percent of the cost for the first three years, after which the state will incrementally assume some of the cost, topping off at 10 percent.
From a fiscal standpoint, the expansion will make available $227 million in the state’s 2014 budget. Over the long haul, estimates are that if all Medicaid eligible people enrolled, the state would see approximately $15 billion in reimbursements over the next nine years. For the state to achieve full enrollment, it will need to undertake an extensive outreach and education effort directed at the affected population.
In response to the announced expansion, Senator Joseph Vitale said, "By participating in the national Medicaid expansion program, we are ensuring the health and well-being of our citizens while allowing the federal government to pick up the tab for the next three years. This is a smart step for the state. Not only will it reduce the costs of the state's charity care program - which compensates hospitals for treating uninsured patients – it will save people's lives by supplying health coverage to many of our uninsured."
The expansion may also allow Substance Abuse Block Grant dollars to be shifted to pay for recovery support services, a much-needed factor in long-term addiction recovery.
Federal Health Care Marketplace for New Jersey
Gov. Chris Christie has decided to leave a key element in health care reform, the health care exchanges or marketplace, to the federal government.
Advocates for having a state voice in the exchange view this decision as a lost opportunity to shape a marketplace tailored to the specific needs of New Jersey.The New Jersey for Health Care Coalition issued a statement saying that while it would have much preferred a New Jersey-run exchange, it believes the federal government will provide an effective health care marketplace for the state. The health care marketplace will be both the entry point for health care consumers who are shopping for health care coverage and the point of access for health care subsidies made available under the Affordable Care Act.
The NJHC Coalition said New Jersey is lagging behind in preparing to launch a program that will need to have the capacity to serve an estimated one million people. The group noted there is much work to be done between now and Oct. 1, when the health care marketplace will begin accepting applications.
New Jersey has received the go-ahead from the Centers on Medicaid and Medicare for a Medicaid waiver to implement managed care for behavioral health care. This means the state will proceed with an RFP to contract with a Behavioral Managed Health Organization (also referred to as an Administrative Services Organization), although because of the time required for CMS' review process, this will be done under a delayed timeline.
Department of Human Services Commissioner Jennifer Velez was delighted when word of the approval reached her. “Today is a great day. This is a lot to celebrate for New Jersey. This approval sets us on a course for long-term, sustainable reform of Medicaid.,” the commissioner said. The three main components of the waiver are:
• Maximizing federally matched funding for services that had been solely funded by the state;
• Reforming the delivery system -- the largest components being the transition of the adult mental healthcare and addiction treatment system to an ASO, and expansion of MLTSS for seniors who have intellectual/developmental disabilities (I/DD); and
• Hospital reform
The overarching goals of the waiver include promoting care integration and introducing a managed care system that will take into account – and ultimately be rewarded for – outcomes. The Administrative Services Organization will begin under a non-risk platform but will shift to a partial shift one, which will reward good outcomes. The timetable for implementation of the waiver has been pushed back. Velez said, “We will work to implement the initiatives under a revised timeline. She added that the estimate of initial savings to result from the waiver implementation would also be adjusted. Furthermore, she indicated that the steering committees for the Administrative Services Organization and Managed Long-Term Services and Supports (MLTSS) will be reconvened to address time frames and, in the case of MLTSS, to make policy decisions that are still needed. Some of the state’s requests in the waiver application were denied. These include:
1) Retroactive Medicaid eligibility (Velez explained that this is a “Maintenance of Effort” issue);
2)Immediate increase of the Federal Medical Assistance Percentage for parents in FamilyCare - CMS indicated that this would require Congressional action;
3)Passive enrollment into Special Needs Plans (this was denied because of its having a Medicare component);
4) Peer decision making - the federal government, however, is allowing flexibility in decision-making; and
5) Retroactive payment of unpaid claims under Medicare Part B.