This story is being republished under a special NJ News Commons content-sharing agreement related to COVID-19 coverage. Link to story: njspotlightnews.org/2023/06/fqhc-federally-qualified-health-center-inspira-health-medicaid-nj-family-care-county-health-rankings-university-of-wisconsin-population-health-institute-robert-wood-johnson-foundation-gov-phil-murphy
Expanding a community health worker program in Millville. Connecting more pregnant women with pre-natal services. Ensuring behavioral health clients have transportation to their appointments in rural South Jersey.
These are among the initiatives that are set to benefit from as much as $20 million in additional Medicaid funding this fall, thanks to a decision by the Cumberland County government and regional health and social service leaders who opted to join a new county hospital fee program earlier this year. That initiative leverages additional federal dollars to boost outcomes in areas with significant public-health needs. The program has also led to additional collaboration that leaders said will also benefit county residents.
New Jersey first launched the program in 2018 as a pilot project targeted at its seven most populous counties. State officials expanded the effort in 2022 to include five other counties with serious health challenges, including rural Cumberland and Burlington. For the first time, all 12 eligible counties will be participating in the fiscal year that started July 1.
Cumberland County Commission Director Doug Albrecht said the benefits of the new Medicaid program were obvious to him and his fellow commissioners, given the long list of regional public health challenges, from homelessness to teen pregnancy. “We know that this is just one of the many important steps in improving health outcomes in our community, and we look forward to further collaboration with our hospital partners to best serve all,” he said.
More than money: But while the money is critical—especially in one of the poorest, most unhealthy counties in the state—Albrecht said the program has also brought together county leaders from various sectors in a new way that gives him hope they can tackle longstanding problems. “Money doesn’t solve the issue, it helps, but it doesn’t solve the issue. But having the people who are actually working on the problem working together will help, hopefully,” he said.
The county hospital program allows eligible counties to design a plan—which must be approved by state and federal Medicaid officials—to raise funds from fees on certain hospital procedures. The money is transferred to the state, which uses it to leverage additional matching dollars through the Medicaid program, the state and federally funded insurance program for low-income Americans. Funds are then returned to the participating county through higher Medicaid payments to hospitals located there or to the insurance companies that manage Medicaid programs in that county.
Hospitals are not allowed to pass the cost of the fees on to patients or insurance plans, under the law. The county is permitted to retain nine percent of the fees they collect for administering the program and the state can keep one percent to cover its costs, while 90 percent is dedicated to improving care for county Medicaid members and residents who lack health insurance.
Gov. Phil Murphy’s proposed budget for fiscal year 2024, which he and lawmakers must agree to by July 1, anticipates the expanded program will generate nearly $558 million in fees by hospitals in those 12 counties, according to budget documents. That is nearly $273 million more—or practically double—than what was collected in the current fiscal year. Initially open to Atlantic, Camden, Essex, Hudson, Mercer, Middlesex and Passaic counties, the program now includes Bergen, Burlington, Cumberland, Monmouth and Ocean.
Information on the likely federal match for the fiscal year 2024 revenue was not immediately available. But in fiscal year 2021—when only seven counties were involved—the group raised $306 million and received $517 million from the federal Medicaid program, according to reporting at the time. That resulted in $823 million total, or nearly $741 million to help low-income residents once administrative costs were subtracted.
Falling through the gaps: New Jersey’s Medicaid program, also known as NJ Family Care, now covers 2.2 million low-income residents at a cost of roughly $20 billion, a mix of federal and state dollars. New Jersey’s system pays for a vast array of services but there are gaps in benefits and not all doctors accept Medicaid plans, leaving some patients struggling to access care that is both convenient and high quality.
These challenges are especially evident in rural Cumberland County, which ranked 20th out of New Jersey’s 21 counties in the latest County Health Rankings, a tool developed by the University of Wisconsin’s Population Health Institute with funding from the Robert Wood Johnson Foundation. (The foundation also supports NJ Spotlight News.) Neighboring Salem County ranked 21st. From adult obesity to smoking to sexually transmitted diseases, Cumberland’s rates are higher than those recorded statewide, and it has nearly three times as many teen births as New Jersey at large, the data show.
Amy Mansue, president and CEO of Inspira Health, the hospital system that partnered with Cumberland officials on the Medicaid program, said improving access to prenatal services is among the priorities for the new investment. “Part of the place that we fall off is that women can’t get to their prenatal services,” she said, noting that the existing health-care shuttle system is often booked by dialysis patients, many who need treatment multiple times a week. “That makes it hard to fit in an OB appointment.”
Cumberland County residents also struggle to access behavioral health services, Mansue and county leaders said, thanks in part to the transportation gaps. “It’s really about the coordination of services,” Mansue said, noting that Inspira has a large behavioral health program. “It’s really just about linking people into the programs that are near their home and best for them.”
County Commissioner Victoria Groetsch-Lods agreed that connecting people with these services is a priority, given the impact of addiction and mental health struggles she has witnessed as a teacher in some of the county’s most challenging school districts. “There are so many things that stem from that when somebody is suffering from a mental health component,” she said.
Like county commission director Albrecht, Groetsch-Lods said teaming up with Inspira and other stakeholders to address these issues has already proved the benefit of the new program. “The solutions are in the collaborative efforts with everything that we do, whether its transportation, public utilities, our roadways, our health care,” she said. “We can’t operate in silos. We have to be able to work together.”
Mansue agreed. “No one entity can solve these issues alone, not the schools, not the county, not the hospitals, not the FQHCs (Federally Qualified Health Centers, which run low-cost community health clinics). We’ve got to work together. We are really trying to break down those barriers and focus on the patient,” she said.
After all, many institutions are working with the same group of clients or patients, Mansue explained. “Regardless of whether they show up at my hospital or the FQHC, or with the county police, they’re the same people,” she said. “We need to create some structure that allows them to succeed.”