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Draft proposal advances integration and efficiency in state’s health care system

TRENTON – The Christie Administration today released for comment the state’s draft renewal application for the Comprehensive Medicaid Waiver. The document represents the state’s next-steps and vision for the health care system that serves low-income residents eligible for Medicaid services. Over the course of the next few weeks, the Department of Human Services (DHS) will engage with stakeholders, NJ FamilyCare members and health providers to refine and finalize the proposal.

“The renewal application is really just the start to an extended conversation with our stakeholders about how to build upon the successes we’ve had in developing and implementing programs and services that meet NJ Family Care’s members’ needs in an efficient way,” said Elizabeth Connolly, acting Commissioner of DHS, which administers the Medicaid program. “In the last four years, we’ve made Medicaid very patient-centered by adopting national best practices and uniquely tailoring our health care model.”

The Comprehensive Medicaid Waiver is a five year demonstration project that was approved in October 2012 and expires in June 2017. It set the stage for New Jersey to streamline its Medicaid services, to advance managed health care strategies for seniors and people with disabilities and, to realign resources to support home and community-based care rather than institutional care.

Under the proposal for waiver renewal, the state intends to:

  • Increase access to services and supports for individuals with a dual diagnosis of intellectual or developmental disabilities and mental illness.
  • Move to an integrated behavioral health delivery system of care.
  • Develop an uninterrupted reentry system to health care for individuals incarcerated.
  • Provide housing-related services to any Medicaid members who need it by expanding the use of the High-Fidelity Housing First (HFHF) model to meet the needs of individuals who are at-risk for homelessness or who are considered to be chronically homeless.
  • Advance a value-based purchasing strategy that includes data-driven performance measures.
  • Enhance access to critical providers and underserved areas through alternative provider initiatives.
  • Continue DSRIP funding to promote and foster health care delivery system innovations.
  • Maintain Managed Long Term Services and Supports (MLTSS)
  • Further streamline NJ FamilyCare eligibility and enrollment processes.
  • Increase care coordination for people who are dually eligible for Medicaid and Medicare through a seamless enrollment option.

In accordance with federal rules, New Jersey is providing a 30 day public comment period for stakeholders and other interested parties. After the comment period has ended, the state will review the comments, make any changes to the application based on those comments and submit the application to CMS.

Once the renewal application package is received by CMS, it has 15 days to determine if it is complete; the 30 day federal, public, comment period follows; CMS then will review comments received and begin negotiations with the state regarding the renewal’s provisions.

Accomplishments achieved under the Comprehensive Medicaid Waiver, to date, include:

  • Implemented a comprehensive integrated community-based MLTSS benefit.
  • Consolidated and streamlined reporting of the New Jersey Medicaid program and CHIP under a single waiver authority.
  • Improved the Medicaid eligibility system by reducing the backlog of new application and redetermination applications.
  • Implemented Health Homes serving individuals with chronic mental illness, addiction disorder and physical health conditions. 
  • Piloted three Medicaid Accountable Care Organizations (ACOs) in underserved areas of the State.
  • Launched Behavioral Health Homes in five counties, integrating mental illness, addictions and physical health treatment for patients.
  • Rebalanced the inequalities of primary and preventive services by targeted increases to physician reimbursement rates.
  • Implemented targeted home and community-based programs for beneficiaries with serious emotional disturbance, autism spectrum disorder; and intellectual and developmental disabilities.

Medicaid staff already has multiple stakeholder meetings scheduled during which details of the state’s proposal will be discussed. 

Individuals interested in commenting on the waiver renewal application can send submissions as follows:

By email to -

By fax to 609-588-7343

or by mail to:

Margaret Rose

Division of Medical Assistance and Health Services

PO Box 712

Trenton, NJ 08625-0712

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