The report’s goal is to help devise a program to innovate and improve health care delivery under Medicaid and FamilyCare, New Jersey’s publicly funded health insurance program, focusing on health care delivery improvements for “super-utilizers.” The working group analyzes of Medicaid data to inform its discussions.
The report’s findings are relevant to ending homelessness in New Jersey as many “super-utilizers” of the health care delivery system are also chronically homeless. In 2013, Medicaid spent approximately $9.4 billion in direct patient care for approximately 1.6 million New Jersey recipients.
Small groups of high-cost recipients account for disproportionately large shares of this total spending. Specifically, recipients in the top 1% of the spending distribution account for 28% of total statewide spending and those in the top 10% account for approximately 75% of statewide spending.
Individuals in the top 1% spending group have a number of distinguishing characteristics. Eighty-five percent of them are Medicaid eligible because they are aged, blind, or disabled. Many chronically homeless individuals are also disabled. Others who are over-represented in the top 1% spending group include children in the foster care system. Youth aging out of the foster care system are at risk for homelessness.
While high-cost Medicaid recipients are extremely diverse in terms of their physical health problems, the vast majority of these recipients have a mental health and/or substance abuse problem. Many chronically homeless individuals also have mental illness and/or substance abuse problems.
In 2013, 86% of individuals in the top 1% spending group had a mental health or substance abuse diagnosis, while 1/3 of these individuals had at least one diagnosis classified as a severe mental illness.
The report makes recommendations in five general areas. The general area and recommendations probably most relevant to ending homelessness relates to the integration of behavioral and physical health – models treating the whole person.
Specific steps recommended under this general area include:
Accelerate the implementation of Behavioral Health Home (BHH) pilots to two or three additional counties with the highest concentration of eligible beneficiaries.
Pursue care models locating behavioral health services in primary care settings, such as Federally Qualified Health Centers (FQHCs), for patients with severe chronic physical health conditions and co-occurring behavioral health problems who are ineligible for the BHH model.
The four other general areas are:
Identify & Develop Interventions for Populations with Persistently High Costs
Expand Opportunities to Coordinate Social Service and Public Health Initiatives with Medicaid