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Vitale-Whelan Bill To Ensure Quality, Accessible Care For Medicaid Population Approved

Bill Would Create Three-Year Pilot Program in Department of Human Services

TRENTON – A bill sponsored by Senators Joseph F. Vitale and Jim Whelan which would establish a three-year pilot program in the Department of Human Services in order to make sure Medicaid recipients have access to quality health care was approved by the Senate yesterday by a vote of 21-12.

“Our current health care system leaves Medicaid recipients at a disadvantage, and they are often unable to access the same high-quality, cost-effective health care services that people with health insurance take for granted,” said Senator Vitale, D-Middlesex, the Vice Chairman of the Senate Health, Human Services and Senior Citizens Committee. “As a result, we all pay more money for less-than-optimal results when it comes to positive patient outcomes for Medicaid recipients. It’s time that we move away from inefficient, ineffective models of health care, and invest in a health care system that helps vulnerable New Jerseyans access the care they need at a cost that makes sense for everyone.”

“This bill would allow New Jersey to put existing resources to better use, and spend State health care dollars more wisely for people who depend on the health care safety net in order to access medical treatment,” said Senator Whelan, D-Atlantic, and a member of the health panel. “We currently don’t have any kind of objective, results-based evaluation and cost-efficiency standards for the Medicaid program, and we need to do a better job, not only in evaluating our progress, but expanding access to health care services for New Jerseyans enrolled in the program. We need to adopt policies and practices which make the most out of our State’s health care investment, and this is a significant step in the right direction for people in need.”

The bill, S-2443, would create the “Medicaid Accountable Care Organization Demonstration Project” to ensure that Medicaid recipients in New Jersey have access to high-quality, cost-effective medical care. The bill would establish a demonstration project within the Department of Human Services to increase access to primary care, behavioral health care, and dental care by Medicaid recipients in a particular region. The bill would also improve the quality of health care by establishing objective metrics and relying on patient experience, and would reduce unnecessary and inefficient care without interfering with a patients’ access to the health care providers and services they need to stay healthy.

The bill would authorize Accountable Care Organizations (ACOs), defined as nonprofit corporations, to provide coordinated, high-quality care to Medicaid recipients in a municipality or defined geographic region with more than 5,000 Medicaid recipients. If the program proves successful in lowering costs and improving care, the sponsors said they would consider working with the Department to establish a permanent program.

“Under the federal health care reform law, states were given the option to empower ACOs to provide coordinated, cost-effective health care for Medicaid recipients,” said Senator Whelan. “By shifting over to this sort of model, the hope is that we’ll have a more complete health care safety net, and will be able to expand services which are currently hard to come by for Medicaid recipients. At the end of the day, it’s about getting the biggest bang for our buck and investing health care funds in programs that work in terms of expanding services for people who depend on Medicaid.”

“New Jersey has a history of serving as a laboratory for the best practices in administering and delivering health care,” said Senator Vitale. “The Medicaid ACO Demonstration Project is another step in the right direction, and will help us to maximize the benefit of our State’s limited health care dollars for New Jerseyans in greatest need. Through this bill, we can be both fiscally prudent and socially responsible, achieving cost efficiencies at the same time we expand access to care for New Jerseyans who have nowhere else to turn.”

The bill now heads to the Assembly for consideration, where identical legislation is pending review before the Assembly Budget Committee.

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