State officials have taken proactive steps to support New Jersey’s nearly 1.9 million Medicaid members during the pandemic, including a recent push to expand COVID-19 immunization that involves phone calls to almost 260,000 individuals most at risk for infection.
Much of the work — which also involved mailings in English and Spanish, ongoing case management and partnerships with medical and social service providers to ensure members have proper care, plus food and other necessities — is being done by a handful of health insurance companies that provide Medicaid coverage under contracts with the state Department of Human Services.
While demand for COVID-19 vaccines outpaced supply for months — sparking widespread public frustration over a lack of access to shots — that has shifted recently and daily immunization numbers are now on the decline, raising concerns about the effect of vaccine hesitancy. State officials are actively working to overcome that trend in their campaign to vaccinate 4.7 million adult New Jerseyans by July.
“We have been working closely with the five managed-care organizations that administer our state Medicaid program on vaccine rollout, particularly on the best ways to deploy some of our state’s health-equity strategies,” DHS acting commissioner Sarah Adelman told members of the Senate Budget and Appropriations Committee on Tuesday in response to a question from Sen. Troy Singleton (D-Burlington).
The committee discussed the department’s $7.29 billion spending plan as part of its ongoing review of Gov. Phil Murphy’s budget proposal for the coming year. DHS has set aside more than $50 million over two years to help pay for COVID-19 vaccination administration among Medicaid patients, officials said. The federal government currently covers the cost of the shots themselves.
Adelman said DHS also worked with the insurance companies “on a more granular level” to review medical histories to identify those who were most at risk for COVID-19. The analysis revealed hundreds of thousands of Medicaid members with chronic illness or daily assistance needs that indicated they should be prioritized for immunization, she said. These groups were targeted for phone calls.
“When that outreach was made, in many cases it has included assistance in signing up for a vaccine, a warm handoff to the Department of Health (vaccine appointment-scheduling) hotline, and if the individual needed assistance with transportation to their vaccine appointment, the (insurance) plans can help with that as well,” Adelman said.
The five Medicaid plans — run by Horizon Blue Cross Blue Shield, UnitedHealthcare, Amerigroup, Aetna and WellCare — have also been asked to collect biweekly data to help the state track immunization progress and identify where additional investment is required. But the numbers are often delayed and incomplete, according to program leaders at DHS, who declined to share numbers Tuesday.
Push for vaccine equity
While the outcome of this investment may not yet be clear, the need for greater vaccine equity has been obvious for months. Murphy and Health Commissioner Judy Persichilli have regularly highlighted the need to improve interest in and access to COVID-19 shots among minority groups, low-income residents and others most at risk for infection.
The administration has partnered with churches and other community organizations, hosted virtual town halls, and expanded its advertising and other public outreach to boost vaccine equity. But Black and Hispanic individuals are still being inoculated at a slower pace than their white counterparts, state figures show.
Efforts to immunize frail, elderly individuals in nursing homes and other long-term care — a process overseen by the federal government, not the state — started slowly but has largely been successful, with at least 85% of nursing home residents now inoculated. Many of these residents are covered by Medicaid.
But DHS identified another 1.2 million Medicaid members who live in the community and were eligible for the vaccine early on based on their preexisting conditions. This group includes more than 583,000 members age 65 and up and who have multiple chronic medical conditions; nearly 260,000 of these individuals are considered the highest priority based on their past diagnoses or the fact that they live alone. This group is the focus of the “high touch” outreach conducted by the insurance plans, officials said.
Early in the pandemic the insurance plans sought to ensure that Medicaid members at risk had access to the health services and daily assistance as needed, program officials explained. As the outbreak ramped up, this evolved to helping individuals who were infected with COVID-19, tracking positive case numbers and coordinating hospital discharges.
Eventually the focus shifted to vaccines, with the bilingual mailings in late February to highlight the reasons to get immunized — like the protection it can offer to other family members — and information on how and where to sign up for a shot. Direct phone calls were added later for those in the highest-risk categories.
One company’s approach
Horizon Blue Cross Blue Shield — the state’s largest insurance provider, with some 960,000 Medicaid members on its rolls, nearly 134,000 of whom are considered most high-risk — deployed their existing care managers to make calls and pulled from a pool of more than 500 nurses and social workers elsewhere in the company to pitch in, according to Wendy Morriarty, the company’s vice president and chief Medicaid officer.
“In a crisis we have these troops available,” she said. “But it was all hands on deck.”
Thanks to relationships Horizon has already established with its medical providers, including community clinics and other local organizations like churches, Morriarty said the company has also been able to do more direct in-person outreach in some neighborhoods. Through these partnerships, community health fairs become opportunities to connect people with a health-care plan, food assistance and vaccine access. “We’ve got that group mobilized literally on the street,” she said.
Like the other plans, Horizon has also tapped internal “data wizards” to help wrangle information from the state’s vaccine database, claims forms and federal sources, Morriarty said. But gaps in these systems leaves them with an incomplete picture of who is getting immunized. The company is also tracking vaccine uptake and refusals through its calls, she said, and all these figures are compiled in massive, complex spreadsheets that it shares with DHS.
What the data does show is “we’re not near done,” Morriarity said. “The next big hurdle for us, for this population, is folks who just don’t want to leave their house,” she added. They may not technically be homebound, but they might have limited mobility, or fear of getting sick.
“How do we make it easier to get the vaccine to them? That’s the next step,” Morriarty said.