Houghtaling & Downey Bill to Improve Medicaid Eligibility System Now Law

Aiming to make the application process for Medicaid and NJ FamilyCare simpler and more accessible, legislation sponsored by Assembly Democrats Joann Downey and Eric Houghtaling to improve the eligibility determination system for these programs was signed into law Friday by Governor Phil Murphy.

“Medicaid is a critical lifeline for so many low-income, elderly, or disabled New Jersey residents, who would otherwise have no access to health insurance,” said Downey (D-Monmouth). “The process to become Medicaid beneficiary, however, can be incredibly confusing and tedious. Enhancing the eligibility determination system will streamline the process and make it easier for people to get the coverage and care they need.”

Under the current Medicaid eligibility system, applicants face a patchwork of county, state, and federal agencies which use different processes for enrollment, resulting in varying timing and accuracy rates. Beneficiaries who have trouble navigating the system may lose coverage.

This new law (A-4569) requires the Commissioner of Human Services to develop an information technology platform for use by the State, county welfare agencies, and State contractors for the purpose of intake, processing, and tracking of applications for benefits under Medicaid and NJ FamilyCare programs.

The goals of the system will be:

  • to simplify the applications and eligibility determination processes for both applicants and eligibility determination staff;
  • to standardize the application of eligibility policy across the various agencies responsible for eligibility determination;
  • to allow for real-time tracking of the status of applications;
  • to allow the rapid exchange of data relevant to applications among various State and county agencies and contractors; and
  • to provide a platform to expand the system to encompass other social service program applications and eligibility determinations as the technology permits.

The Commissioner of Human Services is also required to establish a system to evaluate the performance of all entities responsible for intake and processing of applications for the Medicaid and NJ FamilyCares programs. The results from this evaluation will be posted on the Department’s website annually. The evaluation system will measure the following metrics, including but not limited to:

  • the number of complete and incomplete applications of each type received;
  • the time between receipt of completed applications and the completion of the eligibility determination;
  • the time between receipt of an application and the request for supporting documentation sent to the applicant;
  • the number of applicants granted extensions; and
  • the accuracy of eligibility determinations.

“Healthcare coverage can quite literally change a person’s life,” said Houghtaling (D-Monmouth). “There are great options available for low-income adults families in New Jersey, but those programs won’t do anyone good if the application process is too taxing to navigate. We have to ensure the system is accessible for all Medicaid applicants.”

“Programs like Medicaid and NJ FamilyCare serve some of our state’s most vulnerable residents, from children with special needs to elderly adults in nursing homes,” said Zwicker (D-Somerset, Mercer, Middlesex, Hunterdon). “Many are New Jerseyans who depend on Medicaid to be able to access quality health care. No one should never be at risk of a lapse in coverage, or be unable to get coverage at all, because of a confusing application process. It’s time to create an improved, client-centric system.”

Additionally, the law also establishes a system of rewards and penalties for all entities responsible for intake, processing of applications, and processing of redetermination applications. This system will provide incentives for performance on the metrics, as well as incentives for county welfare agencies to streamline their processes and utilize the information technology platform. The Commissioner of Human Services will also designate a customer service liaison team to receive complaints that result from the eligibility application process.

The measure was approved by the full Assembly in June by a vote of 75-0, and by the Senate in October, 40-0.


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