New Jersey: an experiment with Medicaid Accountable Care Organizations in 15

With 396,000 more recipients of NJ FamilyCare (the name of New Jersey’s Medicaid program) at the end of 2014 compared with the start of the year, the stakes for delivering effective, efficient Medicaid services have grown.

This crucial safety-net insurance program for low-income residents (as well as most who receive long-term care) is in the midst of multiple changes. Topping the list in the coming year is the rollout of Medicaid Accountable Care Organizations (ACOs). Seven coalitions of healthcare providers in geographic areas that span the state have applied to be a part of the program, which allows doctors to manage the healthcare of Medicaid recipients by hiring nurses as care coordinators and to target care quickly to those patients with the greatest, most-complex needs.

It’s likely that the ACOs will start in the first half of the year, allowing for some early results from the project to begin to be assessed by the end of the year.

The application process itself has revealed one of the challenges for the state program. The ACOs must include 75 percent of the primary-care providers in their respective ZIP codes — but provider listings on insurance websites are in many cases out of date.

Another Medicaid challenge could come in the form of fewer doctors. A two-year increase in Medicaid reimbursements that was part of the Affordable Care Act — which allowed primary-care doctors to obtain the same reimbursements from Medicaid patients as they do with Medicare patients — has expired. (Congress didn’t vote to extend it.) Thus, doctors that took on new Medicaid patients may be reluctant to do so in the future.

Sen. Joseph F. Vitale (D-Middlesex) says it will be interesting to see whether patients enrolled in the ACOs receive more of their care in primary-care offices instead of hospitals, what are the health issues that cause them to seek care, and what effect the organizations will have on the amount of charity care provided by nearby hospitals.