NJ healthcare partnership: Private practices increasing access to insurance through NJ FamilyCare presumptive eligibility applications

This study reports on the use of innovative strategies to engage community primary care practices in increasing applications and enrollments in NJ FamilyCare (New Jersey's Medicaid and CHIP programs) and facilitate their participation as Medicaid and presumptive eligibility (PE) providers. These efforts are part of a project, funded by a CMS CHIPRA Outreach/Enrollment Grant, which focuses primarily on families at the point of healthcare service (e.g., hospitals, clinics, local health departments and other healthcare sites), where they are most receptive to information about the importance/need of healthcare coverage. When uninsured children present at a point of healthcare service seeking care, the most efficient way to get them enrolled is through the PE process, in which the provider applies directly online on behalf of the patient and gets the coverage started immediately. Previously in New Jersey, only hospitals, FQHCs, local health departments and a few state service facilities served as PE sites. This project is bringing PE into private practices in the community (pediatricians and family physicians) and is enhancing/streamlining the PE process in other areas, including universal enrollments of eligible newborns. By educating, encouraging and supporting practices through the processes of becoming Medicaid providers, joining the managed care networks of the NJ FamilyCare program and getting trained and certified as PE providers, more uninsured families will be reached. The project partners will identify challenges and work with state officials to address them. The study will measure the impact of this strategy on enrollments and assess its potential for future expansion.