Long-Term Care and Medicaid in NJ

At the moment in New Jersey, the medicaid payment process for nursing homes and assisted living facilities works the way you would expect. The state has a qualification process for skilled nursing care and Medicaid qualified patients are able to select from those facilities that best suit them, whether it is due to location, size, friends, or just the atmosphere. This means that when you are looking for a facility for mom or dad, you get to choose the facility that suits them best.

The major change happening is that the Medicaid Managed Care Plans in New Jersey (Horizon, United, AmeriGroup) will soon be allowed to negotiate contracts with these facilities and they will have the ability to not contract with all Medicaid qualified facilities. There are many reasons that it makes a lot of sense for the MLTSS (Medicaid Managed Long Term Service and Support) to make this change. The main reasons for it can probably be attributed to consistent quality of care, and frankly it makes fiscal sense for them. This means there will be a lot more restrictions of which facilities you can choose for your loved ones.

As far as the implications for those facilities, the fact that these MCO's will not need to contract with all of the Medicaid qualified facilities, means that small independent facilities should be very conscious of their next moves. Many independent long-term care facilities will have a lot of difficulty accepting the reimbursement rates that the MCO's will be offering Medicaid reimbursement. Additionally the less beds you have in the Medicaid Plan, and the less reach you have to regions within NJ, means that you will have a lot less negotiating power with the MCO’s and in many cases, will be subject to their whim.

That is not to say these facilities will no longer be able to survive, or even that they will significantly suffer. This just means that they will likely have to begin to rely less on a Medicaid model and more on other possibilities. Many have already begun to shift their focus to higher acuity rehabilitations (which are covered under Medicare) and others have begun to focus on a private payer model.

Either way it is something that will be changing in New Jersey and it is certainly something to keep our eyes on.