In September, 2010 a state law (NJ P.L. 2010, Chapter 74) was passed directing Medicaid to establish a three-year pilot demonstration for medical homes focusing on the frail elderly and those with chronic diseases. In response to the legislation, the Department of Human Services, Division of Medical Assistance and Health Services (DMAHS) entered into a Memorandum of Agreement (MOA) with the four Medicaid contracted managed care organizations (MCOs) in NJ to participate in a pilot to enhance or create infrastructure, within their networks, for medical home services. Three of these MCOs are also participating in the statewide Comprehensive Primary Care (CPC) initiative in New Jersey.
New Jersey has two publicly funded Behavioral Health Home programs and a privately funded primary care/behavioral health care project. New Jersey is currently working on the development of a Medicaid Health Homes program based on the experiences with these programs that will focus on individuals with behavioral health care needs.
Dual Eligible | 2703 SPA | CPC | CPC+ | PCMH QHP | PCMH Legislation | Private Payer |
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Program Name | Payer Type | Coverage Area | Parent Program | Outcomes |
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New Jersey Comprehensive Primary Care Initiative | Multi-Payer | Statewide | CMS Comprehensive Primary Care Initiative | |
New Jersey Comprehensive Primary Care Plus | Multi-Payer | Statewide | CMS Comprehensive Primary Care Plus (CPC+) |
Program Name | Payer Type | Coverage Area | Parent Program | Outcomes |
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Cooper University Care Management Teams | Grant | Camden | CMS Health Care Innovation Award (Round 1) | |
Developmental Disabilities Health Services Health Home Model | Grant | New Jersey | CMS Health Care Innovation Award (Round 1) | |
New Jersey Health Homes | Medicaid | Bergen and Mercer counties | ACA Section 2703 Health Homes | |
New Jersey Medicaid ACO demonstration project | Medicaid | Trenton, Newark, Camden, Atlantic City, Ventnor, New Brunswick | ||
New Jersey Medicaid Medical Home Demonstration Project - Medicaid Managed Care | Medicaid | Statewide | ||
State Innovation Model (SIM) Design Award - New Jersey | Grant | CMS State Innovation Model (SIM) |
Legislation | Status | Year |
---|---|---|
NJ P.L. 2011, Chapter 114 In August 2011, Governor Christie signed this bill into law requiring the Department of Medcial Assistance and Health Services (DMAHS) to establish a three year Medicaid Accountable Care Organization (ACO) demonstration project. |
Enacted | 2011 |
S. 2022 Provisions of the 2021-2022 state appropriations legislation establish a requirement that Medicaid Managed Care Organizations report the percentage of total medical expenditures devoted to primary care. Requires the State Department of Pension and Benefits to report on primary care spending for state-run health plans, such as the state employees' plan. |
Enacted | 2021 |