Medicaid Expansion Update—Enrollment Glitches

In November, the NJ Medicaid program advised that for individuals applying through the federal Marketplace there would be a lag time between federal and New Jersey approval. It further advised that it was able to handle the lag and that New Jersey had the second highest number of Medicaid enrollments of states using the federal Marketplace.

On December 20th, a story broke indicating that State officials said that those who applied for health coverage using the federal government’s website are actually unable to be enrolled because the State cannot process the eligibility information from the federal web site.  Per the article, “New Jersey Medicaid said in­formation it received from the federal insurance marketplace for about 25,000 residents who qualify for free health coverage from New Jersey’s program for the poor is ‘unusable.’  Their applications can’t be processed, and they can’t yet be enrolled for coverage that is supposed to begin on January 1.” See more.

But, MSNJ was recently informed that though,

“the flat file sent to NJ Medicaid by the federal Marketplace still is unusable…individuals who applied to the Marketplace between October 1 and December 31, who are verified as Medicaid eligible, will have their coverage backdated to January 1.

MSNJ immediately asked the Division for guidance and was given the following advice:

-This problem actually affects about 60,000 patients.

-Patients in this category will have letters from CMS stating that they are considered eligible by CMS. This letter only confirms eligibility; it does not place the patient in a plan or provide an ID number. Please be advised that CMS is telling patients that physicians will be able to confirm enrollment, but that is not the case.  The following advice that CMS is giving to patients is not accurate for enrollees in New Jersey:

“If you received a letter telling you that you have been enrolled in Medicaid or CHIP, but you haven’t received an enrollment card from your state agency or from one of its health plans, you should still be able to get health care services. If you need care, show your provider a copy of your eligibility letter. Your provider can verify your enrollment when you go for care.”

– As such, these patients will be treated much like presumptively eligible patients are already treated in New Jersey: they will be considered traditional Fee for Service (FFS) until the State has been able to confirm their eligibility and enroll them in a plan.

-True Medicaid HMO plan enrollment cannot be done until February 1st, which is the next enrollment period for Medicaid plans.

-While other states are asking patients to re-enroll directly with the State Medicaid program, New Jersey is not doing so.  NJ Medicaid will work to process the applications that came through the federal exchange as soon as possible.

View the CMS FAQs.

Bottom line for our members: You may wish to see a patient who presents a CMS letter, but there is no obligation to do so.  The clients will be considered traditional FFS until they select and are enrolled in an HMO, so a provider would bill Medicaid and get paid the FFS rate.  Once enrolled in a health plan, the client will have to go to a provider within that network.


About MSNJ

Founded in 1766, the Medical Society of New Jersey is the oldest professional society in the United States. The organization and its dues-paying members are dedicated to a healthy New Jersey, working to ensure the sanctity of the physician–patient relationship. In representing all medical disciplines, MSNJ advocates for the rights of patients and physicians alike, for the delivery of the highest quality medical care. This allows response to the patients’ individual, varied needs, in an ethical and compassionate environment, in order to create a healthy Garden State and healthy citizens.

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