Legislation designed to make the application process for Medicaid and NJ FamilyCare simpler and more accessible and to improve the eligibility determination system for these programs was signed into law Aug. 23 by Gov. Phil Murphy
The measure was sponsored by Assembly members Joann Downey, D-11th District, Eric Houghtaling, D-11th District, and Andrew Zwicker, D-16th District,
“Medicaid is a critical lifeline for so many low-income, elderly, or disabled New Jersey residents, who would otherwise have no access to health insurance,” Downey said. “The process to become a Medicaid beneficiary, however, can be incredibly confusing and tedious. Enhancing the eligibility determination system will streamline the process and make it easier for people to get the coverage and care they need.”
Under the current Medicaid eligibility system, applicants must navigate a patchwork of county, state, and federal agencies that use different processes for enrollment, resulting in varying timing and accuracy rates. Beneficiaries who have trouble getting through the system may lose coverage.
The new law, Assembly Bill 4569, requires the Commissioner of Human Services to develop an information technology platform for use by the State, county welfare agencies, and State contractors for the purpose of intake, processing and tracking of applications for benefits under Medicaid and NJ FamilyCare programs.
The goals of the system will be to simplify the applications and eligibility determination processes for both applicants and eligibility determination staff; standardize the application of eligibility policy across the various agencies responsible for eligibility determination; allow for real-time tracking of the status of applications; allow the rapid exchange of data relevant to applications among various State and county agencies and contractors; and provide a platform to expand the system to encompass other social service program applications and eligibility determinations as the technology permits.
The Commissioner of Human Services is also required to establish a system to evaluate the performance of all entities responsible for intake and processing of applications for the Medicaid and NJ FamilyCares programs. The results from this evaluation will be posted on the department’s website annually.
In addition, the law establishes a system of rewards and penalties for all entities responsible for intake, processing of applications, and processing of redetermination applications. This system will provide incentives for performance on the metrics, as well as incentives for county welfare agencies to streamline their processes and utilize the information technology platform. The Commissioner of Human Services will also designate a customer service liaison team to receive complaints that result from the eligibility application process.
The measure was approved by the full Assembly in June by a vote of 75-0, and by the Senate in October, 40-0.