Medicaid Changes on Track to Revamp Long-Term Care

Beth Fitzgerald | December 21, 2011 | Health Care
Policy advisors outline progress in NJ efforts to obtain waiver

New Jersey’s efforts to revamp Medicaid are on track, according to the governor’s policy advisors who spoke Tuesday at a conference presented by the Common Sense Institute of New Jersey, a public policy think tank.

New Jersey is seeking sweeping changes to the $11 billion state and federal Medicaid program, which provides healthcare to about 1.3 million low-income residents.

In its “comprehensive Medicaid waiver” submitted in September, New Jersey seeks to provide more care to the elderly and the developmentally disabled at home and in the community rather than in nursing homes and other residential institutions.

The waiver also envisions coordinating physical and behavioral health services for Medicaid members with mental illness, and innovative primary care programs aimed at reducing non-urgent hospital emergency room visits.

Last week, New Jersey officials responded to the 185 initial questions on the waiver posed by the federal Centers for Medicare and Medicaid Services, according to Lowell Ayre and Bob Schwaneberg, advisors to Gov. Chris Christie.

“Now there will be a continuation of discussions, and CMS will come to us with specific questions, and then hopefully approve the waiver,” Ayre said.

Schwaneberg said the state is still targeting July 1, 2012 as the date when the 28,000 Medicaid members who live in nursing homes will be covered by Medicaid managed care.

Four managed-care companies, including Amerigroup and a division of Horizon Blue Cross Blue Shield of New Jersey, already run the state’s Medicaid program for 98 percent of the Medicaid population, Schwaneberg said. Once nursing home services are part of managed care, the state’s goal will be for the managed-care companies to provide the elderly with an array of home and community-based services that will allow them to avoid or delay moving to a nursing home.

The state has received some feedback from CMS that “July 1, 2012 may be a little ambitious, so we’ll see,” Schwaneberg said. For now though it remains the target date to shift Medicaid’s long-term care patients into managed care, assuming that CMS approves the waiver.

On Oct. 1, the state moved 117,000 “dual eligibles” — the elderly who are eligible for both Medicaid and Medicare –into managed care, which required a separate waiver that the state has already obtained from CMS, Schwaneberg said. The four managed care companies have agreed to provide both Medicaid and Medicare managed care coverage to the dual eligibles, he said.

“The idea behind this is to get the same company responsible for both the Medicaid and the Medicare services, and to spend that dollars so that you minimize the total costs and provide the patient with the best care and the care they really want — which is the care that will keep them in their homes.”

The state spends about $2.5 billion a year on Medicaid long-term care services. In 2007 about 73 percent of that spending went into nursing facilities, which now accounts for about 70 percent, Schwaneberg said. “So we are making progress — this is the direction we want to move, but we would like to get to 50/50. It is a slow process and we would like to speed it up.”