1. New Jersey Blueprint for Reform
Prepared by the Office of Governor Jon S. Corzine
for presentation to the
Coverage Institute
September 25-28, 2007
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2. New Jersey Landscape Good News:
Highly regulated commercial insurance market (guaranteed issue, modified community rating, uniform plan design), healthy small business pool
National leader in state experimentation – SCHIP child eligibility to 350% FPL & and parent eligibility to 133% FPL
-- Publicly funded charity care system
Bad News:
State budget Constraints
Uncertainty re: SCHIP
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3. The Uninsured in NJ
Approx. 1.3 million uninsured – 1 million adults and 250,000 children
Both a low income and high income concern --
516,000 < 200% FPL
378,500 > 350% FPL
Many are eligible for existing programs but not enrolled –
167,000 children and 83,000 adults
Citizenship presents a challenge for estimated
22,000 children and 367,000 adults
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4. Goals
Long Term Goals:
(1) Create a system for universal coverage for all in New Jersey
(2) Ensure system is sustainable
Short Term Goals:
(1) Improve and maximize existing public and private health insurance systems and markets
(2) Create systems capacity to achieve universal insurance
There are four components to the plan, as explained by the next few slides.
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5. Improve and Maximize Existing Public Programs
Insure children and adults who are eligible for, but not enrolled in, Medicaid and FamilyCare
--Streamline eligibility
-- NYC facilitated enrollment model
Strengthen provider networks to create access to care.
Increase provider quality and improve eligibility process through integration of technology.
Facilitated enrollment: NYC developed model to improve eligibility determinations. The City approves hospitals, doctors, and community groups to help complete Medicaid applications. The agency completes the application online and scans income and resource information into the system. The application and documentation are retrieved electronically by a City eligibility worker, verified, and eligibility is established.
Provider Networks: The rate at which NJ reimburses its Medicaid providers ranks us among the lowest in the nation. Inadequate reimbursement has contributed to a shortage of providers and has created access issues for our current Medicaid and FamilyCare population, the impact of which will only be exacerbated by reforms that do not address this issue. The State must also work to strengthen access to providers through our managed care plans – switch from FFS has not yielded the expected access and outcomes we anticipated.
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6. Expand Medicaid and FamilyCare
Enroll parents to 200% FPL (from 133%)
Enroll childless adults to % FPL
Implement the FamilyCare Advantage Buy-In Program for children in families with income over 350% FPL
Parent Expansion: Assuming a 77% participation propensity, 12,326 parents between 133% and 149% FPL would enroll in Year One at a cost to the State (assuming 35% state share) of $8.2 million. Approximately 8,686 parents between % FPL would enroll in Year One at a cost to the State (assuming 35% state share) of $4.7 million.
Childless Adult Expansion: Assuming a 77% enrollment propensity and approval of a federal waiver for 50% federal match, it will cost the State $74 million for 12 months to enroll childless adults to 100% FPL and $214 million for 12 months to enroll adults to 200% FPL.
Buy-In: Created by statute to allow children in families earning over 350% FPL ($70,000 for a family of 4) to receive FamilyCare coverage at a premium that reflects the cost to the state.
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7. Move to Universal Coverage: Short Run
Strengthen our commercial insurance market so as to make insurance more affordable and accessible through the private sector.
Merge the individual and small employer markets
Provide reinsurance for high cost claims
Reduce broker/agent commissions
Reevaluate medical loss ratios
Change participation requirements in the small employer market
Require Section 125 plans
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8. Move to Universal and Portable Coverage: Long Run
Still under discussion; elements under consideration include:
Individual mandate, with subsidies for low income population
Self-funded state run plan
Commercial carriers as ASOs with commercial rates to providers
Collaborative care systems for the undocumented and hard to serve
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9. Building a Sustainable System
Develop chronic care protocols
Develop insurance payment methodologies to redirect reimbursement to primary care doctors, case managers, nurses, and specialists; collaborate with carriers and physicians
Develop Health Information Technology strategies and infrastructure
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