Gettysburg, Pa. (August 4, 2019) – OPEN MINDS has released an updated suite of Medicaid market intelligence resources on the state of New Jersey. The resources include an analysis of the New Jersey’s Medicaid system, Medicaid managed care vendor contracts, and additional state-specific information
New Jersey contracts with five health plans to deliver physical health and long-term services and supports (LTSS) for most populations, including families and children, Medicaid expansion adults, and aged and disabled adults.
Most behavioral health benefits are included in the health plan’s capitation rate for individuals receiving managed long-term services and supports (MLTSS) and Department of Development Disability services, as well as for dual eligibles enrolled in an aligned D-SNP. The health plans are responsible for all hospital admissions, including psychiatric unit admissions in general acute hospitals, psychiatric hospitals, and specialty care hospitals. The health plans are not responsible for state or county psychiatric hospital admissions.
For all other enrollees, behavioral health services are excluded from the health plan’s capitation rate and covered FFS by the state.
All but one health plan is available statewide. Individuals have a choice of plans in their county. Contracts for the five health plans are available for download:
- Aetna Better Health
- Horizon NJ Health
- UnitedHealthcare Community Plan
- WellCare (all counties except Hunterdon)
The health plans are eligible for performance incentive payments based on five physical health quality measures:
- Pre-term births
- Prenatal care timeliness
- Postpartum care timeliness
- Body mass index documentation
Note: The state sets the amount of money in the performance pool each year.
The New Jersey Medicaid Managed Care Contracts are available now for all Elite OPEN MINDS Circle members. Individual contracts may be purchased in the OPEN MINDS shop for $1,500 each.
Additionally, the OPEN MINDS team has four in-depth profiles of the New Jersey state health system:
- New Jersey Health Care System Landscape: An OPEN MINDS State Profile, which provides information on each state’s largest health plans, Medicaid expansion policy, health insurance marketplace plans, demographics, population health insurance coverage by payer, and more.
- New Jersey Medicaid System: An OPEN MINDS State Profile, which provides a detailed exploration of each state’s Medicaid financing system, including a review of the managed care financing systems, largest health plans by enrollment, key players in the state Medicaid department, and plans for future system changes and contract reprocurements.
- New Jersey Behavioral Health System State Profile Report, which provides a comprehensive listing of behavioral health benefits in the state, care coordination programs related to behavioral health, and behavioral health subcontractors for health plans.
- New Jersey Medicaid/Medicare Dual Eligible System: An OPEN MINDS State Profile, which provides an overview of each state’s dual eligible financing system, as well as the largest Medicare health plans serving dual eligibles and details on new initiatives involving the dual eligible population.
The New Jersey suite of state profiles is now available now for the Elite OPEN MINDS Circle members. In addition, the OPEN MINDS team has a wealth of additional New Jersey-specific resources. A monthly OPEN MINDS market intelligence update is available to all health and human services executives. To sign up, OPEN MINDS Circle members should set their email preferences under the My Account Settings.
All of these resources, and more, are available as part of an OPEN MINDS Circle Elite membership. Membership includes unlimited organizational access to all OPEN MINDS content and databases, plus executive education events, and other exclusive Elite member benefits. Learn more about becoming an Elite OPEN MINDS Circle member online at www.openminds.com/elite.
For additional questions and inquiries, please contact Sarah C. Threnhauser, Executive Vice President, OPEN MINDS at 717-334-1329 or email@example.com.
ABOUT OPEN MINDS
OPEN MINDS is an award-winning information source, executive education provider, and business solutions firm specializing in the domains of health and human services serving consumers with chronic conditions and complex support needs. For thirty years, we’ve been pioneers for change – helping organizations implement the transformational business practices they need to succeed in an evolving market with new reimbursement, competition, policies, and regulations.
OPEN MINDS is powered by a national team of experienced executives and subject matter experts with specific expertise and experience in nine key market areas – mental health, addictions, chronic conditions, autism and intellectual/developmental disabilities, long-term care, children’s services, social services, juvenile justice, and corrections health care. Our mission is to improve the quality of care for consumers with complex support needs by improving the effectiveness of those serving them – provider organizations, payer and insurance organizations, government agencies, pharmaceutical organizations, and technology firms. Learn more at www.openminds.com.