New Web Tool Will Link Enrollees to Expanded Medicaid

Andrew Kitchenman | June 13, 2013 | Health Care
State plans webinars and may provide training in how to enroll more than 100,000 newly covered residents

Valerie Harr, director of the state Division of Medical Assistance and Health Services
A new web portal will be a crucial link to helping the state sign up more than 100,000 new Medicaid enrollees starting this fall, according to the state’s top Medicaid official.

Valerie Harr said the state will still rely on the welfare agencies in each county. But local officials will be able to use the portal to determine who is eligible for Medicaid, the health-insurance program for low-income residents that is funded by the federal and state governments.

“The expectation is that eligibility will be determined in a much more rapid pace and that will be a way for us to get many more people enrolled in Medicaid and Family Care,” said Harr, director of the state Division of Medical Assistance and Health Services.

Speaking during a summit held yesterday by the Greater Health Care Coalition at New Jersey Institute of Technology, Harr provided more details about how the state plans to enroll the many residents who will be newly eligible for Medicaid. In February, Gov. Chris Christie announced his support for the expansion, which is largely funded by the 2010 Affordable Care Act.

Any resident will be able to file a new, streamlined Medicaid application through the state Medicaid eligibility portal , using computers at libraries and county welfare agencies, Harr said. The website will match each individual’s information with a federal data hub, including information from the Department of Homeland Security to determine whether the person is a citizen, she said. The increased speed in determining eligibility will also be aided by implementation of simplified income criteria established by the ACA.

The Rutgers Center for State Health Policy has estimated that 104,000 more New Jersey residents will be newly eligible for Medicaid due to the expansion. However, even more adults and children are expected to enroll due to the new federal mandate to have health insurance and the outreach that’s expected over the next year. Including that population, the state’s Medicaid rolls are expected to grow by 234,000.

Those new enrollees will come from the larger pool of residents who are eligible for these programs. Center Director Joel Cantor said that the effect from both the Medicaid expansion and the new federal health insurance exchange or marketplace will be significant.

In Newark alone, there will be 40,700 residents eligible for Medicaid and 28,900 eligible to receive subsidies to purchase insurance through the federal marketplace, according to center estimates.

“I think the eligibility simplification process that Valerie described is the key to hitting those projections – it will be easier to enroll,” Cantor said.

While Cantor noted that the federal government is planning some outreach and assistance in enrolling more residents, “there needs to be more outreach,” he said.

Medicaid eligibility is being expanded from below roughly 26 percent of the poverty line to 138 percent of the poverty level, which currently amounts to incomes between $2,987 and $15,856 for single residents and between $4,033 and $21,430 for couples.

In addition, subsidies to purchase insurance through the federal marketplace will cover residents with incomes between 138 percent and 400 percent of the poverty line, or between $15,856 and $45,960 for single residents and between $21,430 and $62,040 for couples.

The state will provide webinars on how to use the portal and is seeking a grant from the Centers for Medicare & Medicaid Services to train local and nonprofit health officials and providers in how to do use the portal to determine residents’ Medicaid eligibility.

There are 5,000 sites that currently assist residents in enrolling in Family Care, the state’s largest Medicaid-funded insurance program.

“We will try to make sure that you have either in-person training or you have access to recorded training or a webinar,” Harr said.

Harr also described how hospitals will be able to apply a method called “presumptive eligibility” to quickly enroll newly eligible residents in Medicaid. Under this method, hospitals can enroll patients in Medicaid after a brief screening. Then residents will complete the full application process.

“That is one great way that we can get people enrolled in Medicaid,” said Harr, adding that the state will train hospital personnel in the process.

Harr also gave a status update on a new state program to determine whether accountable care organizations can improve the quality and lower the cost of care for Medicaid recipients. In ACOs, insurers attempt to compensate providers for how well they perform and keep costs down, rather than for each service they provide.

The ACO applicants for this program will be coalitions of healthcare providers who have agreed to become accountable for the quality, cost and access to care of Medicaid recipients residing in a designated geographic area.

The state is taking public comment on proposed regulations for the program through July 8, plans to publish regulations in early October and will accept applications through early December. The final determination on which geographic areas will participate in the project will depend on how many ACOs apply, officials said.