NACDD: Designing Long Term Services and Supports for the I/DD Population- A View of the States. Shirla Simpson

New Jersey and the Managed Care System for Children and Adults with Intellectual and Developmental Disabilities

Shirla Simpson, Deputy DirectorNJ Council on Developmental Disabilities

Established Managed Care for over 10 years in New Jersey’s Children’s System of Care for Behavioral Health Services. The provider is PerformCare which supports members in the public and private sectors.

Children’s System of Care

PerformCare is a member of AmeriHealth and is the NJ Administrative Service Organization (ASO) for the Children’s System of Care since 2009. (They are the second ASO provider in NJ for the CSOC).

The Children’s System Provider

Access to Services

To access the Children’s and Youth services, parents, caregivers and system providers can call toll free 24 hours a day, 7 days per week. The system never closes.

Children and Youth with Intellectual/Developmental

Disabilities

As of January 1, 2013, the Children’s System of Care assumed responsibility for determining eligibility and providing services to children/youth with I/DD.

Funding

All Family Support funding is managed by PerformCare which includes Respite Care. Families also receive assistance for services such as Summer Camps through PerformCare.

Adult System of Care

In 1995, NJ Medicaid began moving Medicaid beneficiaries into managed care. Persons receiving Medicaid “enroll in a Health Plan which manages their healthcare and offers special services to which Medicaid clients are entitled.”

Taken from Division of Medical Assistance & Health Services Website.

Managed Care Providers

There are currently 5 providers in NJ:

Amerigroup NJ

Healthfirst NJ

Horizon NJ Health

United Healthcare Community Plan

WellCare

All companies do not serve statewide.

New Legislation

In August, 2011 NJ Governor Christie signed into law a 3 year Medicaid Accountable Care Organization (ACO) demonstration project. The project will test the ACO as an alternative to Medicaid Managed Care within the adult system to Integrate social services.

ACO applicants are required to be nonprofit organizations.

Managed Long Term Services and Supports (MLTSS)

Effective July 1, 2014, MLTSS replaces several Medicaid health plans including the Community Resources for People with Disabilities (CRPD). The CRPD was serving children and adults.

Issues: The CCW was not transitioned into this plan for the same services and they do not qualify for NJ DDD services under plan (day program).

Additional Issues for Families and System under Managed Care

• Hope by system providers that managed care MCO care managers would provide the high level of care coordination.

• Multiple providers of many services to individuals in the system, therefore many service plans.

• Perform Care is not in a care manager role, family is assisted by different person each time, not a constant.

NJ DD Council

• Have established Monthly meetings for a small group of statewide Family Support Council members to meet with the Assistant Commissioner of DDD to discuss many of these ongoing issues.

• Also Bi monthly meetings for members to also meet with the Director of the Department of Children and Families and PerformCare.

Council Continues……

• Advocate for all Managed Care representatives to be trained in the areas of Developmental Disabilities for the individuals and their families.

• Thank you for your time!