State Government Profile
Governor: Chris Christie (R)
Lt. Governor: Kim Guadagno (R)
Attorney General: Paula Dow (D)
Legislature: Senate (Democratic control 24-16), General Assembly (Democratic control 47-33)
Legislative Leaders: Senate President Stephen Sweeney (D); Speaker of the Assembly Sheila Oliver (D)
2012 Legislative Session: Begins Jan. 10 (full time legislature)
Key Health Officials: Insurance Commissioner Thomas Considine; Department of Human Services Commissioner Jennifer Velez; Medicaid Director Valerie Harr
- Department of Banking and Insurance (DOBI)
- Division of Medical Assistance and Health Service (DMAHS)
- Department of Human Services
- Department of Health and Senior Services
- Governor’s Office
- State Legislature
State Population: 8,791,894 (2010 US Census data)
Medicaid Enrollment: 1,039,398 (July 2010, CMS)
Percent Enrolled in Managed Care: 76.80% (July 2010, CMS)
Uninsured Rate: 14.4% (three-year average, 2008-10, US Census Bureau)
Health Reform Projections: 390,490 – 567,852 (total new Medicaid enrollees, low and high participation scenarios, Kaiser Commission on Medicaid and the Uninsured)
1.2 – 2.5% (change in state Medicaid spending, low and high participation scenarios, Kaiser Commission on Medicaid and the Uninsured)
State Fiscal Year (SFY) 2011 Budget Appropriations: $28.028 billion (state general funds)
SFY2012 Projected Budget Shortfall: $10.5 billion (state general funds)
SFY2008 Medicaid Expenditures: $4.734 billion (state general funds)
Federal Medical Assistance Percentage (FMAP) Rates:
53.20% (January – March 2011)
51.20% (April – June 2011)
50.00% (July – September 2011)
50.00% (October 2011 – September 2012)
Health Reform Implementation Activities and Developments
Health Reform Implementation Structure:
- Governor Christie has established an internal workgroup for health reform issues consisting of advisors from his office, the Medicaid Director, and the Insurance Commissioner.
- Pending legislation (Senate bill 2239) would establish a New Jersey Health Care Reform Implementation Council to plan and coordinate implementation of the ACA in New Jersey. The council would develop policy recommendations, a strategic plan, and implementation timetable to be presented to Governor and Legislature within a year of the council’s initiation. The Implementation Council would be composed of the Commissioners of Banking and Insurance, Health and Senior Services, Human Services, and Children and Families, as ex officio members. An additional 25 public members would be appointed by the Governor with the advice and consent of the Senate, upon the recommendation of a designated stakeholder group for each council membership spot.
Legislation establishing an American Health Benefit Exchange in New Jersey has been introduced in each chamber of the state legislature and both are currently pending. The New Jersey Health Benefit Exchange Act (Assembly bill 1930) and its companion bill (Senate bill 2553) would create an independent governmental entity to operate a health benefit exchange providing coverage to eligible individuals and employees of participating small employers.
The state applied for and was awarded an Exchange Planning and Establishment Grant.
Amount Awarded: $1,000,000
Administrator: Department of Banking and Insurance
Initial Planning Activities:
- Research the number, demographic and health characteristics of New Jersey residents who will be eligible and likely to enroll in Medicaid or FamilyCare and subsidized and unsubsidized Exchange products (through individual and small employer Exchange(s)) in New Jersey.
- Conduct forums and on-line surveys to obtain stakeholder input into the design of Exchange(s) in New Jersey.
- Engage experts in benefit design, building provider capacity to accommodate the anticipated enrollment, transitioning existing Medicaid clients into the Exchange, coordinating with social services programs, and reviewing alternative delivery models.
High Risk Pool:
State-Run. As proposed in its Letter of Intent to HHS, New Jersey has built on existing state coverage options, such as the Individual Health Coverage Program, to provide a high risk pool program called NJ Protect.
Additional Grants and Funding:
- The state received a $1 million rate review grant
- The state received a consumer assistance program grant
Other State Actions, Indicators, and Health Reform Resources:
- DOBI bulletin to insurers regarding ACA provisions effective September 23, 2010
- DOBI Affordable Care Act Questions and Answers
- DOBI Letter to NAIC regarding Medical Loss Ratios (MLRs)