Hospital officials and healthcare professionals told Trenton lawmakers a lack of details from the Christie adminsitration has left them unclear on how a major state shakeup of Medicaid funding will affect patient care.
Thirteen representatives of hospitals, nursing homes and medical daycares the Assembly Health Committee on Tuesday that they were struggling to understand how the state aims to save $540 million without closing off patients' access to primary or long-term care.
"We have very few answers right now," said Sherl Brand, president and CEO of the Home Care Association of New Jersey, which represents member agencies across southern New Jersey.
At the same time, the panel said a bad economy and implementation of federal healthcare reform drove up the demand for Medicaid.
"Preserving access has to be a priority," said Suzanne Ianni, president of the NJ Hospital Alliance, which represents hospitals in urban areas including Camden and Ocean counties.
As Gov. Chris Christie's proposed budget aims to restructure the state's Medicaid program that serves low-income patients in hospitals and nursing facilities, the administration said it would seek a "global waiver" from Washington to allow the state to adjust eligibility requirements for patients in Medicaid programs.
That means the state would be able to include or exclude patients from claiming medical services under Medicaid, the panel said. Christie estimates that would save $300 million in fiscal year 2012.
But healthcare representatives on the panel said they had been given practically no information about how those savings would be achieved, and whether they would limit what hospitals would be reimbursed for treating Medicaid patients.
Health Commissioner Jennifer Velez testified that afternoon that the $300 million represented an estimate of what the state could save under a global waiver, a collection of at least eight specific waivers New Jersey had asked for.
Out of the state Medicaid cost, she said the $300 million was "a six-percent saving," adding that the percentage matched what other states like Vermont have achieved under similar waivers.
That only compounded concerns by some that the administration had not worked out the overhaul and what its local impact would be.
"That figure is there for accounting purposes only," said Democratic Assemblyman John Burzichelli, D-Cumberland, Salem, Gloucester counties. "The details simply aren't there."
Velez told members she hoped to present details on the global waiver in the next two weeks.
State officials are still planning the overhaul, according to Brand, who represents 13 agencies active in Atlantic, Cape May, Cumberland and Ocean counties, including Atlanticare HomeCare.
In addition to the waiver, the panel considered a second plank of Christie's Medicaid reorganization: The state has proposed saving $240 million by transferring 121,000 low-income disabled or senior citizens who now receive Medicaid into a managed-care program, under an arrangement where the state would want HMOs to handle services for the aged, blind or disabled.
The state also plans to cut state reimbursement to nursing homes. But because the state has not finalized any arrangement for these changes, even with the budget due for passage by July 1, healthcare leaders said they felt uninformed
"We have not been given a timeline of how this is meant to work," Ianni said.
Around 17 percent of patients who receive treatment through Atlanticare Regional Medical Center are eligible for Medicaid, said Atlanticare spokeswoman Jennifer Tornetta.
But Medicaid reimbursement covers just 66 percent of the medical center's costs for providing care, she said: "Hospitals are already woefully underpaid by Medicaid."
"Until we have details on the proposal, we don't know how it will affect hospitals," Tornetta said in a statement about Christie's budget. While Medicaid needs to be more efficient and cost-effective, she said access to service effectively reduced healthcare costs in some patients' cases, where preventative and outpatient care helped to manage chronic conditions.
"Otherwise, their care ends up being costlier in total -- even with cuts -- since they end up in the Emergency Department or as a hospital inpatient for conditions that could have been prevented or managed earlier in a less costly care setting," she explained.
The panel brought its own ideas for how to streamline Medicaid, including agreeing on a fully automated registration.
That would be timely, given that federal healthcare reform, which was passed in 2010 and is currently being phased in, would rely on expanding Medicaid in every state.
"Under healthcare reform, 300,000 New Jersey residents could become eligible for Medicaid," Ianni said.
The unspoken challenge would be to make Christie's proposed shifts while the Medicaid population would be growing, she added.
While Christie's budget would make significant and unprecendented changes to Medicaid, the state is not alone.
In Washington, Health and Human Services Secretary Kathleen Sebelius sent a letter last month to 33 governors, offering what she called "new tools and resources to achieve both short-term savings and longer term sustainability" under Medicaid.
The letter was in response to the governors' request that Sebelius lift a provision of the healthcare reform law that stops states from trimming Medicaid rolls ahead of the law's full rollout in 2014.
Federal Republican lawmakers are also considering shifting Medicaid payments to a block-grant system.
Paul Langevin, president of the Health Care Association of New Jersey, said that change alone would "mean less money for states" - quite apart from any changes Christie had proposed.
New Jersey also lost $1.1 billion in federal stimulus funds for Medicaid that lapsed this fiscal year. The state also says it will not reimburse the $107 million still due to reimburse Medicare prescription programs for serving patients with dual eligibility for Medicaid and Medicare.
Looking at the sketchy details of the overall proposals, Assemblywoman Bonnie Watson Coleman, D-Mercer reacted angrily.
If lawmakers can't take care of the poor and the neediest, she said, "I don't know what the hell we're doing here."
Assemblyman Jay Webber, R-Morris, said Watson Coleman was wrongly claiming a state of emergency for healthcare provision.
"Assemblywoman Watson Coleman's umbrella to stop the sky from falling is available at the door," he said.