Comprehensive Waiver Rebalances the System to Preserve Access and Advance Innovation in Healthcare
“This waiver reflects months of constructive and thoughtful collaboration among stakeholders and consumers,” said DHS Commissioner Jennifer Velez. “The final product rebalances the system to generate greater flexibility, increase choices and expand services for those who need it most.”
Last May, the Department issued a Waiver Concept Paper that outlined various initiatives for successful short- and long-term improvements to Medicaid. That blueprint began the dialogue necessary to redesign the program - which grew in enrollment by 18 percent over the course of three years - to safeguard services to the state’s aging population, people with disabilities and, individuals and families with very low income.
Some of the initial proposals were refined; others were substantially revised. Changes include plans to continue enrollment in NJ FamilyCare for parents earning up to 133 percent of the federal poverty level and elimination of a hospital emergency room co-pay proposal for non-emergency conditions.
“We responded to the valuable input provided by the Medicaid stakeholder community - upon which we depend to operate a quality, effective safety net program - while advancing necessary reforms and innovative practices. The savings realized will support reinvestment that improves services for the currently underserved, particularly seniors and citizens with developmental disabilities,” said Velez. “This Administration will advocate persuasively with Washington to advance our plan.”
Included in the waiver are ideas to: promote home- and community-based care instead of institutionalization or nursing homes, where appropriate; expand in-home behavioral health support services to serve children up to age 21, who are dually diagnosed with mental health disorders and developmental disabilities; and integrate primary, acute, long-term and behavioral health care.
The waiver will be posted online today at: http://www.state.nj.us/humanservices/dmahs/home/waiver.html.
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A Medicaid/NJ FamilyCare Program that Protects and Serves New Jerseyans Who Need It Most
• Protecting Enrollment of Parents in NJ FamilyCare. Maintaining the eligibility of parents earning up to 133 percent of the federal poverty level in NJ FamilyCare to foster the continued enrollment of uninsured children.
• Advancing Innovation in Healthcare with Better Primary Care Options. The Christie Administration will pursue innovative avenues with the promotion of Medical Home models and Accountable Care Organizations in order to provide quality primary care to low income and marginalized patients. Pursuing best practice initiatives to redirect Medicaid recipients to primary care settings will reduce reliance on hospital emergency rooms for non-emergent care.
• Moving Away from Institutional Care to More Appropriate, Community-Based Services. The Christie Administration is committed to reducing reliance upon institutionalized care and investing in services that allow our aging citizens and individuals with disabilities to stay in the community. This waiver calls for reinvesting a portion of state savings into expanding and enhancing community-based services.
o It also maximizes federal reimbursement to allow us to begin effectively addressing the Community Services Waiting list for people with developmental disabilities by expanding family and individual supports, including enhanced and alternative services to meet individuals’ needs.
• Expanding Services to New Jerseyans with Developmental Disabilities and Mental Illnesses. The Christie Administration is looking to pilot programs to provide safe, stable and therapeutically supportive community-based environments for young adults and children with mental health disorders, developmental disabilities and those who are dually diagnosed.
• Reinvesting in Services for Children with Complex Needs. Specifically, the Christie Administration’s proposal would allow New Jersey to continue its commitment to children who are dually diagnosed with developmental disabilities and mental illness. The State will expand the continuum of services for those who meet the state psychiatric hospital level of care and who would benefit from additional behavioral supports in and outside the home.
• Adding Services Previously Uncovered. New Jersey also recognizes that a number of individuals with Medicaid coverage have Pervasive Developmental Disabilities (PDD) diagnoses, such as autism, and are unable to receive PDD-related services through the Medicaid State Plan. As a first step, this waiver includes a pilot program for a limited number of children to receive services such as applied behavioral analysis (ABA), and other intensive, in-home behavioral supports.
• Eliminating Co-Payments for Non-Emergency Use of Hospital Emergency Rooms. The Christie Administration initially proposed charging Medicaid clients a $25 co-pay for non-emergency uses of hospital emergency rooms in order to encourage people to use primary care providers. Conversations with stakeholders made clear this could not alone change behavior and that hospitals would experience difficulty collecting these payments. As such, the co-payment proposal has been eliminated and the Administration will pursue other initiatives to reduce the inappropriate use of hospital emergency rooms.
• Creating Choice and Flexibility in Patient Health Care. Competitively bidding managed care contracts to ensure consumers have diverse options in primary, specialty, inpatient, outpatient and long term care and, that state tax dollars are being used efficiently to support that care.
• Implementing an Administrative Services Organization (ASO). Establishing a service delivery tool for all adults with behavioral health needs to improve care coordination, integration between physical and behavioral health, improve utilization and quality.
