ASSEMBLY, No. 4569




DATED:  MARCH 11, 2019


      The Assembly Human Services Committee reports favorably Assembly Bill No. 4569.

      This bill provides for an improved system for eligibility determinations under the Medicaid and NJ FamilyCare programs, implementing a recommendation contained in the New Jersey Health Care Quality Institute’s report, “Medicaid 2.0:  Blueprint for the Future.”

      This bill requires the Commissioner of Human Services to develop an information technology platform for the intake, processing, and tracking of applications for benefits under the Medicaid and NJ FamilyCare programs.  The goals of the system will be:  to simplify the applications and eligibility determination processes for both applicants and eligibility determination staff; to standardize the application of eligibility policy across the various agencies responsible for eligibility determination; to allow for real-time tracking of the status of applications; to allow the rapid exchange of data relevant to applications among various State and county agencies and contractors; and to provide a platform to expand the system to encompass other social service program applications and eligibility determinations as the technology permits. 

     The bill requires the commissioner to establish a system to evaluate the performance of all entities responsible for intake and processing of applications for the Medicaid and NJ FamilyCare programs, including all county welfare agencies and the State’s contracted health benefits coordinator.  The system will allow for the measurement of a set of relevant common metrics related to applications intake and eligibility determination. 

     The bill requires the commissioner to annually publish on the Department of Human Services website, the results, including those for each of the common metrics established by the bill and by individual entity, that were obtained from the performance evaluation system.

     The bill also provides for the commissioner to establish a system of rewards and penalties for all entities responsible for intake, processing of applications, and processing of redetermination applications.  The rewards and penalties system is to provide incentives for high performance on the bill’s metrics, including incentives for county welfare agencies to streamline their processes and utilize the information technology platform required by the bill.

     The bill also requires the commissioner to designate a customer service liaison team, composed of employees of the department, to receive complaints that result from the eligibility application process.  The customer service liaison team will have authority to review all records of the cases about which complaints are submitted; to interview individuals who submit complaints, as well as the individuals who have assisted with their applications, and the State and county staff who have worked on their cases; and to recommend corrective actions to State and county agencies to address specific complaints and reduce future complaints.

     As reported by the committee, this bill is identical to Senate Bill No. 499 (2R) (Vitale/Madden), which the committee also reported on this date.