Now that House Speaker Paul Ryan and his fellow Republicans’ first proposed health care bill has failed, New Jersey health industry experts may have a better chance of implementing their own changes to the state’s Medicaid program.

The New Jersey Health Care Quality Institute, a nonpartisan health advocate organization, gathered a large group of health providers and stakeholders to create Medicaid Blueprint 2.0, a plan to redesign and improve the state’s largest health care delivery system intended to support vulnerable populations.

“Finding more efficient ways to deliver and pay for health care will be critical as we enter a time of increasing pressures on the state’s budget,” said Linda Schwimmer, president of the health care institute.


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More than 1.7 million people were on Medicaid in New Jersey as of December, according to the Department of Medical Assistance and Health Services. About 553,000 low-income adults obtained health care coverage after the state opted into the Affordable Care Act’s Medicaid expansion in 2014.

The blueprint report, funded by the Nicholson Foundation, found New Jersey’s Medicaid population has expanded significantly over the years. All but two counties have more than 10 percent of their populations on Medicaid.

Cumberland County has one of the highest percentages, with nearly one in three people on Medicaid.

Ryan and the majority of Republican legislators supported an overhaul of Medicaid in the American Health Care Act, which included giving less federal money to states to support their programs. The bill did not have enough support from Republicans for a vote and was withdrawn.


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Blueprint plans included ways the state can modernize Medicaid to better serve patients and financially support the health care industry, including potentially saving the state up to $450 million in projected spending.

New Jersey’s Medicaid program costs taxpayers about $15 billion annually, the report states.

“Our committee groups looked at our current Medicaid system, what was working, what could be done better, and we looked at other parts of the country to see what was working there,” Schwimmer said. “Recommendations in the Blueprint have the potential to save New Jersey Medicaid spending.”

The blueprint report places emphasis on keeping the state’s Medicaid expansion coverage in place as it has improved insured rates and decreased the numbers of people relying on emergency and charity care at hospitals.

Twenty-four recommendations were aimed at reducing Medicaid costs while not losing quality of care, but those avenues would include some upfront costs.

Experts recommended establishing a New Jersey Office of Transformation, increasing transparency of Medicaid data, improving how eligibility is determined, expanding telehealth services, updating Medicaid regulations and reducing fraud, waste and abuse of the program.


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Additional improvements would benefit those getting treatment for mental health, substance abuse disorders and other behavioral health issues, children’s health, maternity and end-of-life care.

In the event that federal changes to Medicaid are made — so far, any changes are aimed at reducing funding to expansion states — Schwimmer said adjustments to the blueprint and recommendations might be made going forward.

“Right now, we’re developing a working plan for the next steps, and now we have to gather feedback from interested parties,” she said, including a new governor’s administration. “The phone is ringing off the hook, so we’re planning on assessing things that have the most support and things that make sense to move forward with quickly.”

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N.J. health experts build blueprint to improve Medicaid reform – Press of Atlantic City