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New Jersey Blueprint for Reform

New Jersey Blueprint for Reform. Prepared by the Office of Governor Jon S. Corzine for presentation to the Coverage Institute September 25-28, 2007. New Jersey Landscape. Good News:

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New Jersey Blueprint for Reform

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  1. New Jersey Blueprint for Reform Prepared by the Office of Governor Jon S. Corzine for presentation to the Coverage Institute September 25-28, 2007

  2. New Jersey Landscape • Good News: • Highly regulated commercial insurance market (guaranteed issue, modified community rating, uniform plan design), healthy small business pool • National leader in state experimentation – SCHIP child eligibility to 350% FPL & and parent eligibility to 133% FPL -- Publicly funded charity care system • Bad News: • State budget Constraints • Uncertainty re: SCHIP

  3. The Uninsured in NJ • Approx. 1.3 million uninsured – 1 million adults and 250,000 children • Both a low income and high income concern -- 516,000 < 200% FPL 378,500 > 350% FPL • Many are eligible for existing programs but not enrolled – 167,000 children and 83,000 adults • Citizenship presents a challenge for estimated 22,000 children and 367,000 adults

  4. Goals • Long Term Goals: (1) Create a system for universal coverage for all in New Jersey (2) Ensure system is sustainable • Short Term Goals: (1) Improve and maximize existing public and private health insurance systems and markets (2) Create systems capacity to achieve universal insurance

  5. Improve and Maximize Existing Public Programs • Insure children and adults who are eligible for, but not enrolled in, Medicaid and FamilyCare --Streamline eligibility -- NYC facilitated enrollment model • Strengthen provider networks to create access to care. • Increase provider quality and improve eligibility process through integration of technology.

  6. Expand Medicaid and FamilyCare • Enroll parents to 200% FPL (from 133%) • Enroll childless adults to 100-200% FPL • Implement the FamilyCare Advantage Buy-In Program for children in families with income over 350% FPL

  7. Move to Universal Coverage: Short Run • Strengthen our commercial insurance market so as to make insurance more affordable and accessible through the private sector. • Merge the individual and small employer markets • Provide reinsurance for high cost claims • Reduce broker/agent commissions • Reevaluate medical loss ratios • Change participation requirements in the small employer market • Require Section 125 plans

  8. Move to Universal and Portable Coverage: Long Run • Still under discussion; elements under consideration include: • Individual mandate, with subsidies for low income population • Self-funded state run plan • Commercial carriers as ASOs with commercial rates to providers • Collaborative care systems for the undocumented and hard to serve

  9. Building a Sustainable System • Develop chronic care protocols • Develop insurance payment methodologies to redirect reimbursement to primary care doctors, case managers, nurses, and specialists; collaborate with carriers and physicians • Develop Health Information Technology strategies and infrastructure

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