The federal government has given New Jersey the go-ahead to expand and reform work it has done over the past 45 years to provide community-based services to adults with serious disabilities to help them avoid institutional living.
Disability advocates welcomed the news that federal funding would continue to pay for critical nonmedical services that enable individuals to live independent, productive lives. But they raised concerns about the state’s plan to change the way it pays those who provide these critical services, which they fear could lead to gaps in care.
The state’s Department of Human Services announced Friday that the federal Centers for Medicare and Medicaid Services had signed off on New Jersey’s Community Care Waiver, renewing the program through June 2021. The program covers services for some 11,000 residents with intellectual or developmental disabilities and over age 21 and had been operating on a temporary extension since 2013.
Approval of the CCW program, which dates back to 1982, allows the state to continue spending Medicaid dollars on technology, transportation, and other support services that let disabled individuals with significant needs live at home or in community settings, instead of at an institution. Without the waiver, these funds could only be used to help institutionalized individuals.
Although they address similar goals, this waiver is not tied to the larger Comprehensive Medicaid Waiver that the state will soon submit to the CMS for extension. That request seeks permission to spend Medicaid dollars on long-term care for disabled or elderly individuals, supports a shift to managed behavioral care, and streamlines eligibility for NJ FamilyCare, among other changes.
Joe Young, executive director of Disability Rights New Jersey, said both waivers have been essential to helping those with disabilities live, and thrive, outside of institutional settings. It also underscores the importance of protecting Medicaid, he said, which is being eyed for reform by some Republicans in Washington, D.C. as they seek new ways to repeal and replace the Affordable Care Act.
“It is an example of how Medicaid is so much more than just medical services,” Young said. “Any reduction in the Medicaid program seriously threatens the ability of large numbers of individuals with disabilities to have engaged and productive lives in the community.”
New Jersey officials said the CMS decision on the community care program also enables the state to launch payment reform; starting in July, the Division of Developmental Disabilities will begin to reimburse providers, who are now paid through contracts, on a fee-for-service basis.
This change will also allow the division to use Medicaid to cover a wider range of services for this population, which will bring the CCW benefits in line with those offered under the existing comprehensive waiver, officials said. The new options include behavior support; career planning; occupational and physical therapy; and speech, language, and hearing therapy.
“This approval sets in motion New Jersey’s ability to enhance the CCW’s programming, maximize federal funding for additional services, and provide to participants a broader range of opportunities and options that meet their needs,” DHS Acting Commissioner Elizabeth Connolly said.
Assistant Commissioner Elizabeth Shea, who oversees the division, agreed the CCW waiver was good news for those the division serves. “Clients and their families have been awaiting this waiver renewal eagerly and we all look forward to the benefits they will be able to access.”
Gov. Chris Christie has championed state efforts to shift individuals with disabilities and mental illness from state institutions to community centers, and shuttered several state-run facilities in the process. He has anticipated nearly $550 million in federal Medicaid dollars for the CCW program in fiscal year 2018, which begins in July, some $40 million more than in the current budget and $100 million more than was spent in fiscal 2016.
While a shift from state contracts to fee-for-service payments has caused significant concerns for some behavioral health providers, who are involved in their own reform process, the DHS said providers of services to the disabled community are OK with the change. The state has been working with them to help prepare for this transition.
But DRNJ’s Young said advocates and other stakeholders will be watching this payment reform closely to ensure clients aren’t left short. The transition could make the system more precarious,” he said. “While New Jersey should continue to seek to maximize federal participation in cost reimbursement, we are concerned that there could be significant service gaps without access to state funds when needed.”