Initial Medicaid Implementation: New Jersey initially implemented Medicaid in January 1970, the deadline for states to begin their Medicaid programs if they wanted to maintain their funding for low-income individuals. In the early years of Medicaid, Congress debated the funding level of the FMAP after it was determined that the cost of the Medicaid program was higher than anticipated. A measure was passed that would have reduced the federal share of the payments to as low as 25 percent for some wealthier states. Since New Jersey would likely fit that definition of states that would receive a lower federal match, their senator was the only one to object to the bill and it passed as part of a tax bill in the Senate. At the time, New Jersey was also a very fiscally conservative state and waited until the “deadline” of the end of the Kerr Mills federal dollars in order to accept the Medicaid program. At the implementation of the program, the state elected not to provide for medically indigent category of eligibility.
Key Medicaid Political Issues: In the early to mid-1990s the state went through a retrenchment in its Medicaid program with reductions in hospital spending accompanied with deregulation and mandatory managed care enrollment for cash assistance beneficiaries. These changes were largely due to a change in the political makeup of the legislature and economic conditions in the state. Republicans took control of the legislature at the same time that periodic recessions affected the state budget. This created a climate for reductions in Medicaid spending. New Jersey has taken many steps to address more public health and social determinants of health through its Medicaid program. The state has run programs to provide supportive housing which benefits the Medicaid program. In 2012 the state passed a waiver that created several integrated managed care programs addressing behavioral and social factors that affect health. Maternal mortality and the racial differences in maternal mortality rates have been a concern for the state in recent years.
Medicaid Expansion Implementation: New Jersey began their Medicaid expansion with enrollment beginning in October of 2013 and coverage beginning in January of 2014. New Jersey was one of the five states that decided to expand Medicaid coverage prior to 2014 using a flexibility within the law that allowed states to expand coverage early. However, the state only extended coverage for adults up to 23% of the federal poverty level beginning in April of 2011. Chris Christie was the governor of New Jersey at the time and there was some concern that he may not implement the program as a Republican governor. In the early days of the Medicaid expansion in New Jersey, the state had significant issues redirecting the Medicaid applications from the federal HealthCare.gov website to the state Medicaid program which led to delays in Medicaid beneficiaries receiving a determination of whether they were able to enroll in Medicaid.
General facts about New Jersey Medicaid:
Medicaid program name: Medicaid
CHIP Program name: NJ Family Care
Separate or combined CHIP: Combination
Medicaid Enrollment: 1.8 million (2018 estimate)
Total Medicaid Spending: $15 billion (FY 2017 estimate)
Share of total population covered by Medicaid: 17%
Share of Children covered by Medicaid: 33% (estimate)
Share of Medicaid that is Children and Adults: 79%
Share of Spending on Elderly and people with disabilities: 64%
Share of Nursing Facility Residents covered by Medicaid: 57% (estimate)
Expansion state: Yes
Number of people in expansion: 563,000 (2018 estimate)
Work Requirement: No