During a conference call with stakeholders earlier today, Jennifer Velez, Esq., Commissioner, New Jersey Department of Human Services (DHS), announced that the Centers for Medicare and Medicaid Services (CMS) has approved the state’s application for a Comprehensive Medicaid Waiver.
“Today is a great day. This is a lot to celebrate for New Jersey. This approval sets us on a course for long-term, sustainable reform of Medicaid,” Commissioner Velez said.
“We will work to implement the initiatives under a revised timeline,” Commissioner Velez said, adding that the estimate of initial savings to result from the waiver implementation would also be adjusted. Furthermore, she indicated that the steering committees for the Administrative Services Organization (ASO) and Managed Long-Term Services and Supports (MLTSS) will be reconvened to address time frames and, in the case of MLTSS, to make policy decisions that are still needed.
Commissioner Velez summarized the three main components of the waiver:
Maximizing federally matched funding for services that had been solely funded by the state
Reforming the delivery system — the largest components are transitioning the adult mental healthcare and addiction treatment system to an ASO, and expansion of MLTSS for seniors who have intellectual/developmental disabilities (I/DD)
The waiver approval authorizes DHS to:
Institute reforms that will allow for integration of behavioral and physical health care
Establish a federally funded support program for adults who have I/DD and are living at home
Increase utilization of MLTSS as an alternative to nursing facilities and other institutional care
Transition funding from the hospital subsidy fund to an incentive payment model
Increase services, including case management and individual supports, for children who have both developmental disabilities and mental illnesses
However, the following requests were not granted:
Retroactive Medicaid eligibility – Commissioner Velez explained that this is a “Maintenance of Effort” issue.
Immediate increase of the Federal Medical Assistance Percentage for parents in FamilyCare – CMS indicated that this would require Congressional action.
Passive enrollment into Special Needs Plans – This was denied because it is a Medicare component.
Peer decision making – However, the federal government is allowing flexibility in decision making.
Retroactive payment of unpaid claims under Medicare Part B
It is anticipated that CMS will soon post its approval letter, as well as special terms and conditions, on its website. NJAMHAA will continue to check this website and notify members when this information is available.