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Interactive Map: Counties With More Low-Income Residents Would Gain Most from Expanded Medicaid

Estimated economic impact

of Medicaid expansion

Less than $25 million

$25 million - $50 million

$50 million - $100 million

More than $100 million

The average amount of federal funds coming into counties annually if New Jersey expands Medicaid eligibility based on the number of uninsured adults in each county with income below 138 percent of the poverty level. To see the economic estimate and number of uninsured for any county, click on that county.

Source: New Jersey Policy Perspective report

All of New Jersey’s counties would see economic benefits if Gov. Chris Christie backs an expansion of Medicaid, according to a report by a state think tank.

Medicaid spending would rise the most in counties with larger low-income populations, with Hudson County topping the list with a $242 million annual benefit, according to the report by New Jersey Policy Perspective, a nonprofit that focuses on low and moderate-income residents. The state would see an average of $1.7 billion in overall additional Medicaid spending over the first nine years of the expansion.

The estimates combined an overall assessment of Medicaid expansion completed by the Urban Institute with county-level data on the number of low-income and uninsured residents.

Christie is mulling the expansion as he prepares his budget proposal for the fiscal year that starts on July 1. The expansion would occur on January 1, 2014.

New Jersey Policy Perspective senior policy analyst Raymond Castro, the report’s author, said the estimates give policymakers and local officials a sense of how their communities would be affected.

“The real number will depend on the outreach in each county and other factors,” Castro said.

Under the Medicaid expansion, the maximum income for a single adult to be eligible for the program in New Jersey would rise from less than $3,000 to 138 percent of the federal poverty line, which currently amounts to $15,415 for a single adult. The federal government has committed to picking up 100 percent of the cost of the expansion from 2014 to 2016, with the federal commitment then dropping gradually, to reaching 90 percent by 2020.

Castro noted that the effort to inform residents that they would be eligible for the expanded program sion would be a challenge. This will likely be done by nonprofit “navigators,” organizations that will attempt to sign up residents for health coverage through health- benefit exchanges, online marketplaces that will provide information on Medicaid eligibility.

“There’s nothing stopping the state from doing their own outreach for Medicaid, but I doubt that’s going to happen,” said Castro, noting that the state is currently not taking advantage of federal matching funds for Medicaid outreach.

He said local officials should also think about where there are concentrations of low-income residents live. Many of those areas are underserved by medical providers.

“The counties should really be doing a lot of planning. Are there providers in those uninsured areas?” Castro saidasked. “Unfortunately, I don’t think there’s a lot of planning going on.”

He cited Newark as an example of a place where local officials, providers and health advocates are discussing targeting resources.

Castro said that officials with the healthcare advocacy umbrella coalition New Jersey for Health Care will be meeting with federal officials next week to talk about how the state can maximize the benefits of the Affordable Care Act, including the potential for Medicaid expansion.

Former state Health and Senior Services Commissioner Dr. Poonam Alaigh said the economic impact of Medicaid expansion should be a major part of the governor’s decision on whether to expand the program.

The report focused on the increased federal spending in the state that would come with expansion, rather than any increased costs to the state. She added that much more analysis on that topic is needed.

“There is an upfront cost to the state,” said Alaigh, a board member of the Common Sense Institute of New Jersey, a think tank focused on "individual liberty, personal responsibility, and economic opportunity."

The state will be seeing higher Medicaid costs regardless of whether it expands eligibility, Alaigh noted. This is the result of more residents who are already eligible for Medicaid signing up due to the Affordable Care Act. The sState will have to cover a portion of those costs.

Christie’s impending decision comes occurs as amid a backdrop of other Republican governors have reached reaching contradictory conclusions over Medicaid expansion. Pennsylvania Gov. Tom Corbett decided against an expansion over the next year, citing a lack of flexibility in from federal requirements. Ohio Gov. John Kasich and Michigan Gov. Rick Snyder, however, both decided to expand the program.

Christie has made few public comments on the issue, although he said on Fox News in July that the state has little room for expansion after previous governors had already added to the Medicaid program.

AARP New Jersey state President Dave Mollen agreed with the report’s conclusions.

“Expanding Medicaid will provide New Jersey residents with more support from the federal government, which is important, since New Jersey is one of the states that sends more taxpayer dollars to the federal government than it receives back,” Mollen said in a statement.

Joel Cantor, director of Rutgers University’s Center for State Health Policy, said it would be was beneficial for local officials to examine Medicaid expansion’s impact.

“Of course all politics are local and having local legislators understand the potential impact of the expansion in their area will certainly help them understand whether they want to support Medicaid expansion,” Cantor said.

This is also true for hospitals, he said.

“The low-income uninsured are not equally distributed across the state,” Cantor said. “For the hospitals that don’t have a good payer mix, their revenues situation tends to be poor. This can help them plan and and look at the potential impact.”

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