State Agency Wants Federal Okay to Continue with NJ’s Medicaid Reforms

Lilo H. Stainton | January 10, 2017 | Health Care
Officials say recent ‘patient-centric’ changes to the program are working and provide national models

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New Jersey wants federal permission to build on regulatory reforms that have helped individuals with disabilities remain at home, improved coordination of behavioral health services, and made it easier for vulnerable residents to get and stay covered by Medicaid.

Officials with the state’s Department of Human Services have finished the latest draft of an application for a Medicaid waiver that, if granted, would enable New Jersey to continue with — and expand upon — changes initiated in 2012 that were designed to increase the program’s flexibility, improve quality, and reduce costs. If approved by the federal Centers for Medicare and Medicaid, the new models would be extended from July 2017 through June 2022.

The public has 30 days to comment on the application — scheduled to be posted Tuesday morning to the DHS website — before it is submitted to the CMS for review. It will then be reposted with any changes for an additional month-long public comment period, before the state submits the final version this spring.

The DHS has said the initial five-year waiver, which expires in June, enabled New Jersey to craft a very “patient-centric” Medicaid program and develop models that have received national acclaim. The waiver, and the pending request for its extension, have received widespread support from advocates for those with autism and other disabilities, groups that serve individuals with mental health or substance use issues, and organizations involved with home-based healthcare services.

“The initial waiver and proposed renewal demonstrate the state’s commitment to preserving the (Medicaid) program and ensuring its long-term viability. Now serving nearly 1 of 5 (state) residents, the program is a lifeline to many of New Jersey’s most vulnerable citizens,” wrote Linda Schwimmer, president and CEO of the New Jersey Health Care Quality Institute, in comments submitted to state officials last summer, when the application was still in draft form. The NJHCQI received a grant from the Nicholson Foundation to analyze the state’s reform effort and provide a strategic blueprint for the future, which should be released in the coming months.

That said, some suggest it is too soon to know exactly how well the revised system is working. A 2015 study by the Rutgers Center for State Health Policy suggested that while initial results seemed positive, more analysis is needed to determine the long-term effects. Medicaid covers some 1.7 million New Jersey residents and tens of thousands have been directly impacted by changes under the 2012 waiver.

The centerpiece of the reform was an overhaul in how Medicaid paid for long-term care; instead of paying a fee for each individual in a nursing home or other residential facility, the government began paying a managed-care organization to coordinate all the care around this patient. The change gave seniors and others the possibility of getting treatments at home, or in a community setting, instead of being forced to seek care in a residential institution.

“It is a sea change in philosophy and practice,” DHS spokesperson Nicole Brossoie said at the time.

Those involved with home-based care have welcomed this reform. “We applaud the effort to ensure patients are cared for where they predominately want to remain — in their home and community,” said Chrissy Buteas, president and CEO of the Home Care and Hospice Association of New Jersey.

“We look forward to working with the Department to continue to improve the management of chronic disease and issues that affect older adults by promoting and maintaining beneficiary independence and person-centered, cost effective quality health care while reducing the risk of facility admissions,” she added. But to sustain quality care in the community, Buteas urged providers to work with the state to find ways to improve reimbursement levels for home-care staff and to reduce the payment challenges many agencies face.

In addition to improving access to community-based care, the state also seeks to build on its work to coordinate mental health and substance use disorder treatments through a system of managed care overseen by the Rutgers University Behavioral Health Center. The center also operates a substance-abuse hotline (1-844-276-2777) staffed 24/7 by trained experts — many who are recovering addicts themselves. The call center fielded tens of thousands of calls in the first six months.

The state also plans to use the flexibility of a continued waiver to streamline the eligibility and enrollment process for NJ FamilyCare, New Jersey’s Medicaid program. It also wants to ensure former inmates are signed up and connected with services before they leave prison.

Schwimmer, from the Quality Institute, praised the state’s efforts but urged officials to do more to update their systems and technology to focus on beefing up FamilyCare enrollment and retention, instead of focusing on weeding out the few who aren’t eligible. “The Medicaid eligibility and enrollment system represents the front door to the program and therefor plays a critical role in the overall health of the recipients,” she wrote.

The state is also seeking permission to use Medicaid funding to help keep some of the most vulnerable individuals in safe homes. The “housing first” model, gaining support nationwide, is based on research that shows a stable, secure residence is a critical aspect of any overall health plan.

The DHS’s Brossoie said the latest version of the application includes minor changes based on the CMS’s response to an earlier draft, submitted last fall.