Op-Ed: And Now for the Good News, Medicaid Expansion Is Right on Schedule

Raymond Castro | October 17, 2013 | Opinion
There's far more to healthcare reform in NJ than computer glitches and interminable delays

raymond castro
Although most press accounts about the rollout of federal healthcare reform in New Jersey have focused on computer glitches related to the online health insurance marketplace, one key component is running smoothly: the state’s online application for Medicaid coverage at njfamilycare.org.

Since most people who are expected to apply for coverage next year under the Affordable Care Act will be eligible for Medicaid, not the premium subsidies that will fuel the marketplace, this is an enormously important story that is not being told.

According to reports from the state, some counties, insurers and the navigators who help people find the insurance plans right for them, New Jersey’s Medicaid application process is working. Most very low-income adults (for example a single person earning less than $15,856 annually) who were not eligible for Medicaid in the past can sign up now for coverage that starts January 1. A single person making more than that but less than $45,960 will be eligible for premium subsidies to help him or her afford private health coverage through the marketplace.

It may make sense for New Jerseyans without health insurance to apply online for Medicaid now if they believe they are eligible. If they are not, the state will transfer their application to the federal marketplace to determine if they are eligible for premium subsidies.

Uninsured New Jerseyans who lack Internet access or need help filling out the application can go to any County Board of Social Services, where they can apply for Medicaid in person. In addition, the state’s NJ FamilyCare website identifies 178 other agencies that can provide personal assistance or information.

Many parents and children may find that they are already eligible for immediate health coverage in Medicaid and other programs, rather than having to wait until January 1 when the expanded Medicaid coverage takes effect.
Not all of the news is great. Many county boards haven’t seen a large increase in Medicaid applications. Part of the reason may be a lack of information: There hasn’t been a state or county media campaign to let New Jerseyans know that they may be eligible. Intensive outreach is needed since the potential beneficiaries include a disproportionate number of difficult-to-reach New Jerseyans, like young adults who are not convinced they need health coverage, non-English speakers, and people with disabilities.

Still, New Jerseyans who need health coverage are fortunate to have the Medicaid option. Only about half of the 50 states have taken the federal government up on this great offer so far. There was a bipartisan consensus in New Jersey to expand Medicaid because it is a no-brainer: It will save the state billions of dollars, reduce charity-care costs at hospitals, stimulate the state’s economy, and provide health coverage to many working New Jerseyans. The entire cost of the expansion will be paid with federal dollars for the next three years, and no less than 90 percent of the cost after that.

Unfortunately, unlike 31 other states, New Jersey chose not to create a state marketplace for private health insurance, a state/federal partnership, or even help with management of health insurance plans offered to New Jersey residents through the marketplace, leaving all non-Medicaid tasks solely to the federal government. The result is that there are now two eligibility systems for New Jerseyans looking for health coverage: one state-run system for Medicaid and another federal-run system for premium subsidies. Had New Jersey opted for a state exchange, it could have created one system for everyone.

The state-run system for the Medicaid expansion is not without its own challenges. Those eligible only for premium subsidies will not get a prompt determination of those subsidies, and there could be staffing challenges at some County Boards of Social Services as enrollment increases leading up to December 15, the cutoff date for those who want their Medicaid eligibility to start January 1. But the good start clearly demonstrates that health insurance reform is already working in New Jersey.