The Medicaid Assistance and Advisory Council (MAAC) meeting, held on July 20, featured an update on the Fee for Service (FFS) transition from Department of Human Services (DHS) Assistant Commissioner, Liz Shea.
Liz focused on a brief history of the transition and gave updated numbers in a variety of different areas impacted by the transition. Below are some highlights of the presentation:
- Moving to a two waiver system (Community Care Waiver and the Supports Program) has enabled the Division of Developmental Disabilities (DDD) to significantly reduce the Waiting List and going forward, should result in less time spent on the list for individuals. Through utilization of the waivers, DDD receives more revenue from the federal match.
- To date the Waiting List has been reduced by 5,000 individuals
- The Priority Waiting List has been reduced to 2,500 individuals from double that number
- Instead accessing services and supports solely from DDD, individuals now access services from a variety of state agencies, which increases the number and kind of services available.
- With the CCW approval at the end of March, DDD has been able to move forward with the residential transition to FFS. The first provider claim was made last week through Molina in the new residential FFS system.
- The Supports Program, which is part of New Jersey’s Comprehensive Waiver (1115), has 3,000 individuals enrolled, please see below for the timeline for enrollment:
- October 2017 4,000 individuals
- December 2017 5,500
- March 2018 7,000
- June 2018 9,000 (represents full enrollment)
- The Supports Program and Private Duty Nursing program has enrolled 45 individuals. Liz thanked the disability advocates for pursuing this issue as it is a small program but for those who need it is essential.
- The 2017 graduates not on the CCW were enrolled directly into the Supports Program and also in self-directed options.
- Below is a timeline for CCW enrollment under FFS:
- July 1, 2017 – June 30, 2018 convert all in-state individuals except those in Community Care Residences (CCR’s)
- July 1, 2018 – June 30, 2019 convert CCR’s and out of state placements
- June 30, 2019 full implementation
- The discussion regarding incorporating the CCW into the 1115 waiver is ongoing and would be implemented only to streamline administration of the waivers and not for any other reason.
- The CCW brings with it access to a housing voucher from the recently established Supportive Housing Connection (SHC), making the transition for providers doubly complicated.
- With providers simultaneously handling both transitions and more changes, such as in care management, Liz thanked the providers for all their hard work in preparing for the transition.
- Currently, if you are in the CCW you can access a housing voucher. As for Support Program housing, she indicated advocacy would be necessary to increase funding to provide housing for this population.
- Please see the current numbers regarding the FFS transition itself:
- 200 plus individual provider FFS readiness meetings have been held
- 90 Support Coordination agencies have been approved
- 334 Service Providers have been approved
- 9,000 individuals are enrolled in Medicaid
- 21,000 individuals have completed the NJCAT assessment
- 480 plus webinars and presentations have been conducted by the DDD for stakeholders
- Liz reassured individuals and families that people who have been receiving services for years will not have their services change with a few exceptions. Care management changes to support coordination, if a person is in a funded residential placement there will be additional documentation to sign and for individuals self-directing there is a new fiscal intermediary and a new model for service provision. Also, services not reimbursed by Medicaid will need to be funded through individuals and families. However, there may be some services that are now Medicaid approved that will result in less individual spending.
- Liz indicated the new system will have a greater mix of services and allow for more choice of providers. The new system has resulted in new in-state providers as well as out-of-state providers interested in providing services.
- DDD and Support Coordinators will provide guidance to families. Individuals, to participate in the new system, need to complete the following: Medicaid eligibility, DDD eligibility, NJCAT and selection of a Support Coordination agency.
- Below are Liz’s responses from the Q & A after the presentation:
- New Presenters declared an emergency will be enrolled on the CCW.
- The % of individuals that have not completed the NJCAT is much smaller than the number who have completed it, which is 21,000. A letter went out in June to all individuals receiving services about the need to complete the assessment by July 31st. By September if individuals have not yet completed the assessment, they risk service discontinuation.
- There have been several concerns from parents who have children self-directing about the new Fiscal Intermediary. Liz remarked the impact is felt by a small number of families, however, the confusion about transitioning to the new FI has been widespread.
- DDD is not looking to make a lot of policy changes under the HCBS – while still looking to the future, since the federal government has delayed implementation. However, the requirement for leases and residency agreements will be implemented because the transition to the SHC and FFS makes it an opportune time to begin. Liz stated enforcing landlord tenant rights is an open ended legal question.
NJACP members still have several concerns about the transition, which are being discussed at the Provider Leadership meetings.
Mental Health Transition to FFS
Below are a few updates from the Division of Mental Health and Addiction Services:
- 79 providers have transitioned to FFS to date
- FFS transition stakeholder group continues to meet
- DHS developed a FFS “help desk” for questions
- The Division developed monthly limits for providers that can be increased if they approach their cap
- Providers will receive 2 month cash advance repayable in the same fiscal year
- The number of consumers in FFS is 1,183 but changing every day
- To date, 50% of claims are residential
- From January 2017 to June 2017 $4.474 million in funding has been distributed
NJ Family Care Update
An update on New Jersey’s Medicaid program was also provided:
- 7 million New Jerseyans are enrolled in Medicaid, with 20% of the population enrolled and one-third are children
- 31% of enrollees are from the Medicaid expansion with 555,000 enrolled
- Medicaid is New Jersey’s largest federal revenue source at $9.4 billion/year and 17% of general revenue
- The Comprehensive waiver approval from CMS is expected at the end of July, however, there have been some extensions. Meghan Davy will walk through the waiver at a future MAAC meeting after approval.
- The Logisticare contract was approved for non-emergency transportation. Specifics will be discussed at the next meeting.
The next meeting of the MAAC will be held on October 19, 2017.