NJBIA's Public Policy Forum: The Road to Recovery REGISTER

The Medical Assistance Advisory Council recently held a Special Meeting on the Renewal of the 1115 NJFamilyCare Comprehensive Demonstration.  

The purpose of the demonstration was to allow for flexibility to design and evaluate the State’s Medicaid programs.  New Jersey’s current demonstration period expires on June 30, 2022, and the Division of Medical Assistance and Health Services (DMAHS) plans to submit a renewal application to the Centers for Medicare & Medicaid Services to continue existing elements of the demonstration as well as propose new programs.  

Key policy goals for the renewal of the demonstration include addressing behavioral health, substance use disorders, social determinants of health, with an emphasis on housing, maternal health and promoting health equity particularly with regards to access for marginalized communities. Currently, DMAHS is accepting public comments on the Draft Renewal Proposal and estimates that the Renewal will be submitted to CMS on November 1.  

The proposal extends many of the elements previously approved under the current demonstration, with modifications to key elements.  DMAHS intends to request an extension of the Managed Care delivery system with modifications, including additional behavioral health services which will be carved in to managed care.  

Home and community-based service programs will also be continued under the renewal, such as the Managed Long-Term Service and Supports (MLTSS) program, which will maintain its core elements with an emphasis on housing and expansion of certain benefits. Two critical changes will be proposed to the existing child support programs, which will be the full implementation of the existing waiver for children with intellectual or developmental disabilities and disregarding parental income when determining Medicaid eligibility for certain children receiving CSOC services.  

Additionally, the renewal proposes extending eligibility to those aged 18 and above, rather than 21 and above for the Supports and Community Care Programs under the DDD. The previously approved Home Visiting Pilot, which provides evidence-based home visiting services to promote health outcomes will expand to all 21 counties. 

As the substance use disorder initiatives are still relatively new, and the evaluation of these initiatives are ongoing, DMAHS is requesting these elements to be extended without modification.  

The renewal includes several new proposed elements. In order to address maternal and child health, coverage of pregnant women will be extended to 12 months postpartum, and the existing 1115 demonstration will be amended for earlier implementation.  

Additionally, as a part of the increased focus on the social determinants of health, the renewal incorporates health related housing needs, with elements addressing Medicaid coverage for housing related services, expanded eligibility for housing services, and enhanced MCO support for health-related housing needs. The proposal additionally emphasizes the integration of behavioral and physical healthcare provided through NJ Family Care.  

The Regional Health Hub Program will build upon the previously established network of non-profit organizations based in local communities. The demonstration aims to test the impact of expanding projects that can be supported by Medicaid funds undertaken by the Regional Health Hubs that would not otherwise be eligible for federal funds, such as investments in Health IT functionality or support of community-level health or wellness education for Medicaid beneficiaries.  

Such projects would be required to support the needs of Medicaid beneficiaries, and they would be limited to $5 million annually.  

The full proposal is available on the DHS website: https://www.state.nj.us/humanservices/dmahs/home/1115_demo.html 

Public comments on the Draft Proposal Renewal for the 1115 Demonstration will be accepted until October 11, 2021. Comments may be emailed to: dmahs.cmwcomments@dhs.nj.gov, sent by mail to: Margaret Rose, Division of Medical Assistance and Health Services, Office of Legal and Regulatory Affairs, P.O. Box 712, Mail Code #26, Trenton, New Jersey 08625-0712 or sent via fax: 609-588-7343.  

If you have any questions, please contact Chrissy Buteas, Chief Government Affairs Officer at cbuteas@njbia.org.