鈥淣ew Jersey is a national leader in its coverage of children, with one of the most generous CHIP programs in the country,鈥� said Velez. 鈥淭o support these efforts, and to ensure continuity in our health care programs and services, we must control Medicaid鈥檚 skyrocketing costs while improving health care delivery.鈥澛�
The goal is to give New Jersey the flexibility it needs to define who is eligible for Medicaid, the benefits they receive and the most cost-effective service delivery. The concept paper proposes to restructure the administration of the program to engage Accountable Care Organizations and Medical Home Models to ensure clients are receiving the primary and preventive care they need to remain healthy. It also promotes home and community-based care instead of institutionalization or nursing homes.
鈥淭his concept paper provides a roadmap to reasonable program reform for New Jersey. The initiatives, collectively, present an opportunity for the state to sustain the safety-net by preserving and improving the delivery of services for the most at-risk populations,鈥� Velez added.
The Medicaid program was enacted in 1965 as a state and federal entitlement partnership created to provide basic health insurance at no cost for very low-income families, the aged and individuals with disabilities. Over the decades, however, the program has expanded to provide coverage and services to an increasing number of people at higher income levels. As a result, its costs have increased rapidly, placing a considerable financial burden on states鈥� budgets.
In the proposed Fiscal Year 2012 Budget, Medicaid will cost New Jersey鈥檚 taxpayers $5 billion. Nearly $1 billion in non-recurring federal Medicaid funding expired and needs to be made up in the Fiscal Year 2012 State Budget.
Over the next few weeks, the Department will be meeting with various stakeholder groups to talk through the concept paper鈥檚 initiatives. Concurrently, it will work with representatives at CMS to finalize the formal waiver application.
The Comprehensive Medicaid Waiver concept paper also includes the state鈥檚 plans to:
鈥⒙燜reeze enrollment in the adult Medicaid expansion program.
鈥⒙燫e-bid the state鈥檚 managed care contracts to capture best available rates for Medicaid services.
鈥⒙營ntegrate primary, acute, long term care and behavioral health care.
鈥⒙燩romote increased utilization of home-and-community based services for individuals in need of long-term care
鈥⒙燩romote efficient and value-added health care through Medicaid accountable care organization pilots
鈥⒙燩rovide flexibility to promote primary and preventive care
鈥⒙燩romote healthy behaviors and member responsibility for their health care
鈥⒙燬upport families鈥� ability to afford private third-party insurance with Health Insurance Premium Payment assistance.
鈥⒙燩romote proper utilization of Medicaid services by clients through cost-sharing strategies.
鈥⒙燙onsolidate the eight separate waivers operating through DHS, the Department of Health and Senior Services and the Department of Children and Families. This will reduce the administrative burden of multiple waivers with multiple rules and requirements.
More information about the Comprehensive Medicaid Waiver can be found on the Department of Human Services鈥� website: .
