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Vitale-Whelan Bill To Ensure Quality, Accessible Care For Medicaid Population Receives Final Approval

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 Wednesday by a vote of 29-9, receiving final legislative approval.

“While I disagree with the presumption by some that New Jersey cannot afford health benefits for the uninsured, I do agree that we can find better, more cost-effective ways to provide access to care,” said Senator Vitale, D-Middlesex. “Access to quality health care is a fundamental right, not a privilege, and this bill would maximize savings and cost efficiency by exploring new modes of care which save dollars and improve patient outcomes. This bill would move New Jersey away from inefficient, ineffective models of health care and towards a patient-centric system which treats the person, and not just the symptoms.”

“We need to look at proposals that put our existing health care resources to the best use possible, and ACOs have the potential to reshape how health care is administered in this country,” said Senator Whelan, D-Atlantic. “Under the ACO model of health care, we would have cost-efficiency standards, results-based review and objective metrics to not only chart our progress, but ultimately to maximize our efficiency and help the most people possible through the Medicaid program. We need to make the most of the State’s health care investment, and this bill is a significant step in the right direction.”

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 federal health care reform, states were given to partner with ACOs to provide coordinated, cost-effective health care which improves outcomes for Medicaid recipients and saves public resources,” said Senator Whelan. “By shifting to this model, we’ll be able to fill in the gaps for the health care safety net, and stretch out current investment in health care coverage for the uninsured even further. This measure will allow us to capitalize on the changing philosophy of health care administration and get the biggest bang for our buck in terms of Medicaid dollars.”

“With the Christie Administration proposing funding levels which will essentially decimate Medicaid as we know it, we have to get creative to make our health care dollars go further than before,” said Senator Vitale. “The Medicaid ACO Demonstration project is a step in the right direction to help maximize the benefit and minimize inefficiency in the program. This bill ensures that fiscal prudence and social conscience are not mutually exclusive ideals, and will hopefully allow us to continue to serve people who would otherwise be without access to health care if the Governor’s Medicaid cuts are allowed to stand.”

The bill was approved earlier in the day by the Assembly, by a vote of 74-2, with two abstentions. It now heads to the Governor to be signed into law.

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