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New Jersey Delays Shift to Medicaid Managed Long-Term Care Programs

January 9, 2014

New Jersey is delaying the startup date for its Managed Long-Term Services and Supports (MLTSS) programs to July 1 — six months later than planned and for the third time, according to a recent article published in the Bergen County Record.

The state received a waiver from the Centers for Medicare and Medicaid Services in 2012 to shift Medicaid beneficiaries — age 65+ and adults with physical disabilities — out of fee-for-service programs into Medicaid managed-care programs.

Once operative, the MLTSS programs will take charge of coordinating home and community-based services, as well as the primary and acute healthcare needs, for Medicaid enrollees with long-term care needs. Nursing home residents in New Jersey were already scheduled to make the transition to manage care plans on July 1, 2014.

Four private insurance companies will be responsible for managing the MLTSS programs.

“The readiness of managed-care organizations, the state, and providers to ensure continuity of care management for beneficiaries was essential to the roll-out,” Nicole Brossoie, a New Jersey Department of Human Services (DHS) spokeswoman, is quoted as saying in the article.

The department conducted a “readiness review” of the new insurance company networks and regulations.

“This short delay will make for a more seamless transition,” Brossie reportedly told advocates and the MLTSS steering committee last fall.

The postponement of the MLTSS programs came as a “relief” to some advocates and care managers who are skeptical about turning over the management of long-term services and supports to the for-profit insurers, says the article. They “have been complaining in recent months that details have been slow to emerge, leaving many guessing about key elements like reimbursement formulas and government oversight.”

New Jersey, like New York and some other states, is pursing the shift to managed care in an effort to lower Medicaid costs and offer more flexibility in coordinating long-term services and supports to keep people out of nursing homes.

For more information on Medicaid managed long-term care, read:

— by Deane Beebe

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