Published by Susan K. Livio on NJ.com
TRENTON — New Jersey’s Medicaid program consumes one of every five dollars in the state budget and insures one-fifth of the state’s residents, yet “too often it has failed to meet the basic” physical and mental health needs of its members, according to a report released on Monday.
All of this was true before Donald Trump was elected president on the promise of repealing and replacing the Affordable Care Act, according to Linda Schwimmer, president of the New Jersey Health Care Quality Institute, a research and advocacy organization that produced the report.
The future is even more uncertain now that the ideas for repeal include capping how much each state receives from the federal government. New Jersey has counted on $4 billion in federal aid every year to pay for the 550,000 people who signed up for Medicaid under the landmark health care law.
A team of 140 health care experts and organizations assembled by the institute spent the past year studying the massive entitlement program’s critical importance and its most glaring weaknesses.
The 72-page blueprint lays out a set of 24 recommendations the experts say could save an estimated $100 million to $300 million and improve the quality and consistency of medical care for Medicaid’s 1.8 million enrollees.
“The New Jersey Medicaid Program is at a critical juncture. The state is in the midst of a years-long financial crisis, with no end in sight,” according to the report. “Therefore, no matter what happens at the federal level, state leaders must make wise decisions now, to improve the existing program in a thoughtfully strategic way.”
A spokeswoman for the Department of Human Services, which participated in the year-long discussion leading up to the report, responded by noting the Christie administration submitted an application just last week to change the Medicaid program in various ways suggested in the report. The U.S. Centers for Medicare and Medicaid Services must approve those changes.
“The Department and Medicaid were pleased to see the recommendations in the report since they are initiatives already completed, underway or in the planning stages,” department spokeswoman Nicole Brossoie said. “The recommendations made by stakeholders reinforce the merit of the delivery system reforms, efficiencies, and advances the Department has made, most significantly under the leadership of Governor Christie.”
A growing number of medical professionals, lawmakers and family advocacy groups say they nervous for the people who could lose coverage.
Among the report’s findings and recommendations:
Medicaid is a crucial benefit for children but cost-savings are possible.
Medicaid insures 813,400 of the 1.9 million minors in the state, and pays for 42 percent of all births, maternity care and postpartum care at a cost of nearly $1 billion a year.
Costs could be lowered if pregnant women received better prenatal care, said Matthew D’Oria, who as transformation officer at the institute co-authored the report.
“Our outcomes for all that money are not great. We still have very high c-section rates as well as pre-term, low-weight babies,” D’Oria said. “Infants born with these conditions often require long stays in neonatal units that are thousands of dollars per day. Some require long-term care at very high costs to the taxpayers.”
Hospitals and other medical providers could be enticed to provide better service by compensating based on an “episode of care” rate, covering conception to 60 days after delivery, D’Oria said.
The state already uses a “bundled” payment rate for maternity services and for the newborn’s first 60 days of life, Brossoie said.
Using tele-health services could address the physician shortage.
Using the internet, patients would be able to “see” their doctors, and primary care physicians would be able to hold consultations with specialists. The approach reduces wait time for appointments and expand access to treatment, and prevents costly trips to the emergency room, D’Oria said.
The state has requested the federal government approve a reimbursable tele-health program, Brassoie said.
Make mental health treatment as much of a priority as physical health.
Patients who suffer from both mental illness and physical ailments — a common occurrence – get behavioral health care from one professional and standard medical care from another.
“That’s because managed care providers do not have an incentive to provide care that is both individualized and integrated…resulting in poor physical and behavioral health outcomes at increased costs,” according to the report.
The report suggests overall patient care will improve by changing the insurance carriers’ contracts to require mental and physical health be managed together.
This proposal is also contained in the request for federal approval, Brossoie said.
Simplify Medicaid by putting it under one roof.
The report recommends creating an Office of Health Transformation within the governor’s office, rather than letting Medicaid remain spread out across four state departments. The office would “have strategic responsibility for all health care decisions in the state,” D’Oria said, who called this recommendation the most critical to making the other improvements.
“There is a great political uncertainty about the future of federal Medicaid funding,” said Joan Randell, chief operating officer for the nonprofit Nicholson Foundation, which paid for the research project.
“Here in New Jersey a new governor and new legislators will take office in 2018. No matter who these future policy makers are, they will have common concerns about health care,” Randell said. “They will benefit from having a ready to implement plan.”