NJ – CMS Approves New Jersey Medicaid 1115 Waiver Extension

August 2017 ~

CMS has granted an extension of New Jersey’s Section 1115 demonstration entitled “NJ FamilyCare Comprehensive Demonstration.” According to the letter of approval from CMS, approval of the extension is under the authority of section 1115(a) of the Social Security Act, and is effective from August 1, 2017 through June 30, 2022.

Under the extension granted by CMS, New Jersey will continue and improve existing demonstration programs that increase options for those who need long term care by enhancing access to home and community based services (HCBS), simplifying eligibility for long-term care and supports, and transforming the state’s behavioral health system for adults.

The state will continue the Managed Long Term Services and Supports (MLTSS) program, Supports Program, Autism Spectrum Disorder Program and the Intellectual Developmental Disability Programs. Additionally, the state plans to enhance existing targeted HCBS programs provided to children with behavioral health challenges and intellectual and developmental disabilities.

New Jersey is also clarifying the level of care requirements for children seeking MTLSS. The new definition will allow the state to serve these children in the most appropriate setting. New Jersey will grandfather those children currently enrolled in the MLTSS program who do not meet the new level of care definition as long as they continue to meet other eligibility requirements for the program. The adult level of care criteria will remain the same.

The extension also will allow the state to convert the Children with Serious Emotional Disturbance (SED) and Intellectual/Developmental Disabilities with Co-Occurring Mental Health Diagnosis (IDDD/MI) pilot programs, authorized under the existing demonstration, into the Children’s Support Services Program (CSSP). The CSSP will expand services to additional youth that are not otherwise eligible for Medicaid due to individual or parental income, and provide additional benefits that are not currently authorized under the state plan.

New Jersey’s Delivery System Reform Incentive Payment (DSRIP) program will continue for the first three years of the renewal period at level funding. CMS states that during this time, it will work with the state on plans to phase-out the DSRIP program and transition to an alternative payment mechanism, by June 30, 2020. New Jersey also plans to enhance the current DSRIP program by creating more accountability and improving quality associated metrics.

Source(s): State of New Jersey Department of Human Services Division of Medical Assistance and Health Services; HMA Roundup;