The Centers for Medicare and Medicaid Services has approved NJ FamilyCare’s plan to address priorities such as housing, integrating behavioral and physical health services for Medicaid recipients.
The Biden Administration has been encouraging states to use the Medicaid waiver process — which allows states to experiment with new types of Medicaid care — to expand health care coverage and access, reduce disparities, improve innovation and emphasize “whole person care.”
CMS signed off on the projects by approving NJ FamilyCare’s Comprehensive 1115 Demonstration renewal, which provides the state with federal authority to operate large parts of the NJ FamilyCare program.
NJ FamilyCare is New Jersey’s publicly funded health insurance program that includes CHIP, Medicaid and Medicaid expansion populations and 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.
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.
- 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.
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.
The approval is in effect from April 1, 2023 through June 30, 2028.