S4688

An Act concerning the State-based exchange and supplementing P.L.2019, c.141.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. a. The Department of Banking and Insurance, in collaboration with the Department of Human Services, shall develop and administer a six-month pilot program under which an applicant seeking health insurance coverage via the State-based exchange, established pursuant to P.L.2019, c.141 (C.17B:27A-57 et seq.), shall automatically be assessed for NJ FamilyCare eligibility and, if determined eligible, have the opportunity to select and enroll in a NJ FamilyCare managed care plan on the State-based exchange technology platform. The pilot program shall consist of up to five counties, chosen at the discretion of the Commissioner of Banking and Insurance from a pool of counties who opt to participate in the pilot program.

b. In order to effectuate the provisions of subsection a. of this section, the Department of Banking and Insurance shall contract with an entity that has developed a state-based exchange technology solution that provides secure, reliable Medicaid integration, including flexible options for assessment or determination and proven account transfer capabilities that help reduce coverage gaps and consumer churn between Medicaid and Qualified Health Plan programs. This contract shall be implemented either through:

(1) an amendment to the existing contract under which the State-based exchange technology platform, established pursuant to P.L.2019, c.141 (C.17B:27A-57 et seq.), was developed and currently operates, to the extent that doing so is permissible under State rules and regulations concerning purchasing or procurement; or

(2) the procurement of a new contract.

c. The pilot program shall commence upon the date on which the necessary updates to the State-based exchange technology platform have been implemented such that the provisions of subsection a. of this section are operable, and shall expire 180 days thereafter.

d. No later than 90 days following the conclusion of the pilot program, the Department of Banking and Insurance, in collaboration with the Department of Human Services, shall submit a report to the Governor and to the Legislature, pursuant to section 2 of P.L.1991, c.164, regarding the implementation of the pilot program. The report shall include, at a minimum, the following information:

(1) the number of applicants that were screened for NJ FamilyCare eligibility during the pilot program;

(2) the number of applicants determined eligible for NJ FamilyCare enrollment during the pilot program;

(3) the overall cost of the pilot program, broken down by component, such as software and administration;

(4) an analysis of NJ FamilyCare eligibility determination performance under the pilot program compared to traditional NJ FamilyCare eligibility determination agencies’ performance over the same period;

(5) an analysis of the pilot program’s impact on case load for traditional NJ FamilyCare eligibility determination agencies; and

(6) any recommendations for the continuation or modification of the pilot program.

2. There is appropriated from the General Fund to the Department of Banking and Insurance the sum of $1,500,000 to implement the provisions of this act.

3. The Commissioner of Human Services shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this act and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program.

4. This act shall take effect immediately.

STATEMENT

This bill requires the Department of Banking and Insurance (DOBI), in collaboration with the Department of Human Services (DHS), to develop and administer a six-month pilot program under which an applicant for health insurance coverage via the existing State-based exchange is automatically assessed for NJ FamilyCare eligibility and, if determined eligible, has the opportunity to select and enroll in a NJ FamilyCare managed care plan on the State-based exchange technology platform.

Under the bill, the DOBI is to receive a $1.5 million appropriation from the General Fund to support the pilot program. The pilot program is to: 1) consist of up to five counties, chosen at the discretion of the Commissioner of Banking and Insurance from a pool of counties who opt to participate in the pilot program; and 2) commence upon the date on which the necessary updates to the State-based exchange technology platform have been implemented such that the provisions of the bill are operable, and is to expire 180 days thereafter.

In order to effectuate the provisions of the bill, the DOBI is to amend the existing contract for the State-based exchange technology platform, or procure a new contract, provided that the contracted entity has developed a state-based exchange technology solution that provides secure, reliable Medicaid integration, including flexible options for assessment or determination and proven account transfer capabilities that help reduce coverage gaps and consumer churn between Medicaid and Qualified Health Plan programs. The existing State-based exchange technology platform, known as Get Covered NJ, was developed and implemented by GetInsured, under the parent company Vimo. Vimo has rolled out a Medicaid Express module that allows for real-time Medicaid eligibility determination on state-based exchanges.

No later than 90 days following the conclusion of the pilot program, the bill directs the DOBI, in collaboration with the DHS, to submit a report to the Governor and to the Legislature regarding the implementation of the pilot program. The report is to include, at a minimum, the following information: 1) the number of applicants that were screened for NJ FamilyCare eligibility during the pilot program; 2) the number of applicants determined eligible for NJ FamilyCare enrollment during the pilot program; 3) the overall cost of the pilot program, broken down by component, such as software and administration; 4) an analysis of NJ FamilyCare eligibility determination performance under the pilot program compared to traditional NJ FamilyCare eligibility determination agencies’ performance over the same period; 5) an analysis of the pilot program’s impact on case load for traditional NJ FamilyCare eligibility determination agencies; and 6) any recommendations for the continuation or modification of the pilot program.