Last month, on behalf of the New Jersey Chapter of the National Academy of Elder Law Attorneys (NJ NAELA), I met in Trenton with New Jersey Medicaid officials regarding future expansion of the NJ Medicaid program for home care and other community based services, including assisted living.  We were briefed on the status of a Medicaid Community Waiver program referred to as the “1115 Comprehensive Waiver” that the federal government approved for implementation on October 2, 2012.  However, to date, the Waiver has yet to be implemented.  State officials originally stated a program roll out date of January 1, 2014.  However, the state now gaveNewslettere us no specific time frame when the Waiver will be fully implemented, other than to say it will not be January 1, 2014.

According to NJ state officials, the Waiver was first proposed in order to emphasize community-based long-term care and “rebalancing” of Medicaid from institutional to community settings, while attempting to contain costs and reduce inefficiencies in the system.  The Waiver has the potential to provide additional benefits to elderly and disabled residents.  However, there are some potential pitfalls that need to be addressed.

The Waiver, among other items, calls for:

  • Move to managed care for all long-term care services including home and community based services.  The State is currently engaging in contract negotiations with managed care organizations (MCOs) to provide the long-term care services.
  • Expansion of the Medically Needy program for individuals with incomes over $2,130 a month.  Therefore, individuals with fixed incomes over $2,130 per month will be eligible for community based Medicaid programs for home care, adult day care, and assisted living residences.
  • Individuals who are already financially eligible (applicants at 100% of poverty or below) for Medicaid will have to complete and submit less paperwork to gain eligibility.  Individuals financially eligible for programs will be required to sign an “attestation” that no gifts were made during the five-year Medicaid look back.

Some of the potential pitfalls are:

  • MCOs potentially rationing care as a cost savings device.
  • The MCOs will be required to provide care management.  However, how the MCOs will be providing care management is undefined at this time.  Studies have shown that care management is a key ingredient to keeping the elderly and disabled at home.
  • How to define “gifts.”  The attestation that no gifts were made may put clients and their families in jeopardy when they or their representative signed the attestation in good faith. We pointed out to state officials that transactions such as cash withdrawals, small birthday gift checks, wedding gift checks, small payments to economically vulnerable family members to help them, may not be considered by the applicant as a gift.  Therefore, there must be clear guidance on how a gift is defined and how to uniformly process transactions that may be gifts.

I applaud the State of New Jersey for moving forward with the Waiver.  However, there are many unanswered questions remaining prior to implementation that need to be addressed in the days and months ahead.

Below is a link to an article from the Bergen Record regarding the Waiver.  I will update the status of the Waiver when more information is available.

http://www.northjersey.com/news/NJ_seeks_to_untangle_red_tape_to_get_seniors_care_at_home.html?c=y&page=1

 

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