New Jersey Expands Medicaid Coverage for End-of-Life Planning

Changes will help ensure clients’ final wishes are heeded and should save costs on unwanted, unnecessary medical care

end of life
Hundreds of thousands of New Jersey residents could benefit from healthcare that better aligns with their final wishes — and help to curb growing medical costs over time — thanks to changes officials are making to the state’s Medicaid program.

Leaders at the Department of Human Services, which oversees the health insurance program, announced last week that intend to extend Medicaid’s coverage for advanced care planning: discussions led by physicians or other healthcare providers about the patient’s final medical wishes and how they would like these carried out if they are unable to speak for themselves.

The process can involve filling out documents known as advanced directives or POLST (Practitioner Orders for Life Sustaining Treatment) forms, and frequently encompasses family members, loved ones, or surrogates; versions are available on the state Department of Health website. New Jersey officials are also working to develop an electronic system that allows these forms to be stored in a database accessible to hospitals and other providers throughout the state.

Curbing end-of-life costs

Healthcare experts have focused growing attention on improving patient plans for end-of-life care, which is frequently entail the most expensive interventions — a hefty burden in a state like New Jersey, where medical care costs an average of 20 percent more than other states, according to a recent analysis. While most individuals hope to die at home, more than half will pass away in a hospital or other healthcare institution, studies show.

“The department is taking action to ensure that New Jerseyans with Medicaid coverage have access to advance-care planning, so that they are able to make informed health care decisions that are consistent with their wishes and preferences,” DHS Commissioner Carole Johnson told NJ Spotlight. While covering these services can bring down medical expenses over time, the additional reimbursements are expected to cost the state $1.5 million a year, half of which is funded by the federal government.

The DHS has made similar changes to expand Medicaid coverage for other services beyond the scope of traditional medical treatments, including extending benefits to cover diabetes education — efforts to improve diet and exercise — and smoking cessation, which involves both medication, therapy, and other resources.

Medicare, the federal insurance program that covers 1.8 million Garden State seniors, extended benefits to pay for this type of end-of-life planning in 2016. Providers can also get reimbursed for this work through some commercial insurance plans, but advanced-care planning is not one of dozens of mandated insurance benefits required by state statute, according to the Department of Banking and Insurance website.

Prioritizing advanced-care planning

Expanding this coverage through the Medicaid program, which insures some 1.7 million low-income residents, has been a priority for organizations like the New Jersey Health Care Quality Institute, which has advocated for better advanced-care planning statewide. The institute, which has been working on this issue for years with local communities through its “Conversation of Your Life” program, issued a report in June that outlines a number of steps the state can take to boost this practice — including ensuring these discussions are covered by Medicaid.

The “End of Life Care Strategic Plan for New Jersey” recommends several changes to insurance policies related to advanced planning, including higher rates for these consultations and for palliative care services, as well as greater investment in the state’s electronic POLST system. It also suggests more education and awareness in the medical community — and society at large — about the importance of these discussions. Data shows seven in 10 physicians have not been trained in how to have these conversations and less than 15 percent are getting paid for this work.

Expanding end-of-life planning is also a priority for healthcare providers and those paying the bills. These stakeholders have joined forces in New Jersey as the Goals of Care Coalition, a nonprofit that includes hospitals, insurance representatives, patient advocates, and public agencies. Clearly documenting a patient’s healthcare wishes can help the family avoid unwanted medical treatments, reducing the stress on everyone involved and overall cost to the system.

Data from other states suggests the savings could be significant over time. According to a review of New York State Medicaid data from 2004 through 2007, published in the journal Health Affairs in spring 2011, the use of palliative-care planning teams in certain hospitals reduced per-patient costs as much as $7,500. The authors said this could add up to more than $250 million savings annually, if implemented in hospitals throughout the Empire State.