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APHA Scientific Session and Event Listing

Firoozeh Molaparast Vali, PhD, Research Department, New Jersey Hospital Association/HRET, 760 Alexander Road, Princeton, NJ 08543, 609-275-4146, fvali@njha.com and Jennifer Barrett, MHA, Research Department, New Jersey Hospital Association, 760 Alexander Road, Princeton, NJ 08543.

NJ FamilyCare, New Jersey's SCHIP program, is operated by the state, and its multiple plans cover children between 133% and 350% FPL and parents up to 100% FPL. At the same time, the County Boards of Social Services, in addition to welfare programs, administer Medicaid for children up to 100% FPL and determine eligibility of those with higher incomes (up to 150% FPL, NJFC plans A and B). It is critical that eligibility determination and renewal processes of CBOSSs and NJFC are well coordinated so families whose incomes change over time may transition across programs and plans smoothly and with no interruption in their coverage. As part of this coordination effort, an NJFC liaison is stationed at CBOSSs, and CBOSS workers are out-stationed at hospitals and clinics. New Jersey's Covering Kids and Families project, which is part of a national program funded by The Robert Wood Johnson Foundation, conducted a survey of CBOSSs to understand their services and procedures and identify their specific issues/barriers/needs related to NJ FamilyCare enrollment. Questions focused on three topics: hospital out-stationed workers, presumptive eligibility and renewal of multiple programs using ex parte strategy. The compiled list of identified needs and barriers will be presented, and the process of working with the state Division of Medical Assistance and Health Services to address them will be described. Next steps and necessary procedural, policy, organizational and systemic changes that would ensure efficient coordination of eligibility determination efforts at the state and county levels will be discussed.

Learning Objectives: At the conclusion of the session, the participants will be able to

• Describe the systems of eligibility determination for Medicaid and NJ FamilyCare in New Jersey.
• Differentiate between processes used by the state vendor to determine eligibility of children for NJFC and those used by the CBOSS.
• Discuss the needs for coordinating the enrollment processes across both systems
• Identify system barriers and recognize the issues families face if these enrollment systems are not coordinated.
• Describe processes used by CBOSSs, including roles and activities of out-stationed workers in hospitals and performing presumptive eligibility.
• Assess the extent to which Ex-Parte strategy is employed by CBOSSs to renew enrollments in New Jersey.
• List the CBOSSs’ identified needs and barriers and possible ways to remove them.
• Discuss the next steps and necessary procedural, policy, organizational and systemic changes that would ensure efficient coordination of eligibility determination efforts at the state and county levels.

Keywords: Medicaid, Coordination

Presenting author's disclosure statement:

Not Answered