New Jersey: CMS approves NJ FamilyCare demo; significantly expands Medicaid scope & eligibility period

via NJ Gov. Murphy's website:

Feds Approve Innovative NJ FamilyCare Projects Addressing Housing, Behavioral & Physical Health, Providing Care & Other Creative Approaches

• 1115 Demonstration Approval Continues Long-Standing Medicaid Programs and Allows New Innovations

TRENTON – The Centers for Medicare and Medicaid Services (CMS) has approved innovative NJ FamilyCare projects designed to address priorities such as housing, integrating behavioral and physical health services, and new and creative approaches to providing care.

CMS signed off on the projects by approving NJ FamilyCare’s Comprehensive 1115 Demonstration renewal. The 1115 demonstration provides the state with federal authority to operate large parts of the NJ FamilyCare program.  The approval is in effect from April 1, 2023 through June 30, 2028.

“A holistic approach to supporting the well-being of Medicaid beneficiaries in our state is critical to ensuring better health outcomes for countless New Jersey residents,” Governor Phil Murphy said. “This federal approval further enables Jersey’s efforts to support the mental health, housing, maternal health, and other needs of the families and communities served through NJ FamilyCare. It is our hope these innovative projects will also serve as a model for other states in providing comprehensive services that will benefit residents in communities throughout our country.”

“We are thrilled by this federal approval and look forward to these innovative approaches benefiting NJ FamilyCare members,” Commissioner Sarah Adelman said. “With this approval, we maintain momentum on our existing innovations and enhance our ability to serve individuals and communities with the best possible care. This plan is built around a simple yet vital premise – a healthier New Jersey must include everyone, and must do so with high-quality, integrated and evidence-based care.”

NJ FamilyCare is New Jersey's publicly funded health insurance program that includes CHIP, Medicaid and Medicaid expansion populations. It provides free or low-cost coverage to about 2.2 million New Jerseyans, or about 24 percent of state residents.

The plan includes new programs such as:

• A multifaceted, integrated housing strategy for Medicaid beneficiaries that incorporates coverage for additional targeted services, and coordination across state and community resources involved in the provision of health and housing services. This includes:
  • Targeted Medicaid coverage of key housing-related services, including housing transition and tenancy support services;
  • Strengthened requirements for managed care organizations (MCOs) to employ dedicated housing specialists;
  • MCO innovation and accountability for assessment of members’ housing needs and coordination of appropriate services to improve health outcomes;
  • A newly created, dedicated unit responsible for implementing these housing strategies with community partners and tracking progress towards housing-related milestones for Medicaid-related populations; and
  • Ongoing, enhanced engagement between MCOs and public housing authorities, developers, shelters, and other housing-related community resources.

“For many Medicaid beneficiaries, the lack of affordable, appropriate housing is frequently a critical barrier to wellness,” Commissioner Adelman said. “This can lead to unnecessary hospitalization, institutionalization, or other avoidable instances of costly care that often come with negative outcomes and chronic conditions. Housing supports can make a particular difference for those with serious mental health concerns or substance use disorders, older adults, people with disabilities, members who were once incarcerated, and individuals and families who have experienced or are at risk for homelessness.”

This is a big deal. I'm not sure whether New Jersey is the first state in which housing is considered part of Medicaid's scope, but it sounds like it may be.

• A Community Health Worker Pilot that will focus on overcoming health disparities within local communities by providing care coordination services and directly providing preventive or related services; 
• 12 months of continuous eligibility to adults whose Medicaid eligibility is based on Modified Adjusted Gross Income;
• New incentives for Medicaid behavioral health providers to implement new HIT functionality, to support integrated and high quality care; 
• A new Autism Adjunct Services Pilot to support and provide children living with autism rehabilitative and therapeutic services; and
• Increased coverage of nutrition services, including a medically indicated meal pilot for individuals at risk of gestational diabetes.

While all of these are important, the one which stands out to me is the extension of income-based eligibility to a full 12 months. This is especially important given the "Medicaid Unwinding" redetermination process which just kicked off nationally a week or so ago.

The plan also includes enhancements to existing programs such as:

• Extension of full state plan benefits to postpartum individuals enrolled in Medicaid or CHIP for up to 12 months from the last day of an individual’s pregnancy;
• Providing the state with flexibility to better integrate behavioral and physical health care over time, based on input from stakeholders;
• Enhancing New Jersey’s Managed Long Term Services and Supports (MLTSS) program to allow more aged and disabled members to remain in the community, and provide additional supports to family caregivers; and
• Adjustments to the Supports and Community Care Programs for adults with Developmental Disabilities to allow greater flexibility and support members receiving needed services.

New Jersey is already one of the 30 states which provide Medicaid coverage to postpartum individuals for a full 12 months, so I'm not sure what the change is there. Additional services included, perhaps?

“Our plan addresses key social determinants of health, focusing on the greater integration of behavioral and physical health, and the continued availability of appropriate behavioral health services for all Medicaid beneficiaries,” said Assistant Commissioner Jennifer Langer Jacobs who directs the Division of Medical Assistance and Health Services that oversees NJ FamilyCare. “It continues our focus on addressing gaps and improving the quality of care in maternal and child health, while also supporting better access and outcomes for communities of color and individuals with disabilities. We want a healthier New Jersey for everyone, including historically marginalized groups.”

“We thank our many community partners for their input and partnership in helping get this plan approved,” said Greg Woods, the chief innovation officer for New Jersey’s Medicaid program. “We look forward to working with them as we implement these exciting projects.”