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TRENTON - Department of Human Services Commissioner Jennifer Velez today released the Comprehensive Medicaid Waiver concept paper detailing the initiatives the state will pursue to reform Medicaid and protect benefits for the state’s most vulnerable citizens – children, the aged and individuals with disabilities. The narrative was sent to the U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS) for its consideration, in advance of the formal waiver application, which will be submitted in June.“New Jersey is a national leader in its coverage of children, with one of the most generous CHIP programs in the country,” said Velez. “To support these efforts, and to ensure continuity in our health care programs and services, we must control Medicaid’s skyrocketing costs while improving health care delivery.” 
The goal is to give New Jersey the flexibility it needs to define who is eligible for Medicaid, the benefits they receive and the most cost-effective service delivery. The concept paper proposes to restructure the administration of the program to engage Accountable Care Organizations and Medical Home Models to ensure clients are receiving the primary and preventive care they need to remain healthy. It also promotes home and community-based care instead of institutionalization or nursing homes.
“This concept paper provides a roadmap to reasonable program reform for New Jersey. The initiatives, collectively, present an opportunity for the state to sustain the safety-net by preserving and improving the delivery of services for the most at-risk populations,” Velez added.
The Medicaid program was enacted in 1965 as a state and federal entitlement partnership created to provide basic health insurance at no cost for very low-income families, the aged and individuals with disabilities. Over the decades, however, the program has expanded to provide coverage and services to an increasing number of people at higher income levels. As a result, its costs have increased rapidly, placing a considerable financial burden on states’ budgets.
In the proposed Fiscal Year 2012 Budget, Medicaid will cost New Jersey’s taxpayers $5 billion. Nearly $1 billion in non-recurring federal Medicaid funding expired and needs to be made up in the Fiscal Year 2012 State Budget.
Over the next few weeks, the Department will be meeting with various stakeholder groups to talk through the concept paper’s initiatives. Concurrently, it will work with representatives at CMS to finalize the formal waiver application.
The Comprehensive Medicaid Waiver concept paper also includes the state’s plans to:
• Freeze enrollment in the adult Medicaid expansion program.
• Re-bid the state’s managed care contracts to capture best available rates for Medicaid services.
• Integrate primary, acute, long term care and behavioral health care.
• Promote increased utilization of home-and-community based services for individuals in need of long-term care

• Promote efficient and value-added health care through Medicaid accountable care organization pilots

• Provide flexibility to promote primary and preventive care

• Promote healthy behaviors and member responsibility for their health care

• Support families’ ability to afford private third-party insurance with Health Insurance Premium Payment assistance.
• Promote proper utilization of Medicaid services by clients through cost-sharing strategies.
• Consolidate the eight separate waivers operating through DHS, the Department of Health and Senior Services and the Department of Children and Families. This will reduce the administrative burden of multiple waivers with multiple rules and requirements.
More information about the Comprehensive Medicaid Waiver can be found on the Department of Human Services’ website:

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