A New Jersey state bill recently passed that establishes community-based palliative care benefits under Medicaid.
The new legislation includes coverage for specialized medical care, emotional and spiritual support, as well as pain and symptom relief for Medicaid beneficiaries with advanced illnesses, including both adult and pediatric populations.
The state’s Department of Human Services (DHS) has two years to implement the changes.
A main concern is that the state’s Medicaid funding system may be strained to implement the community-based palliative coverage changes, according to New Jersey Governor Philip Murphy. Changes in Medicaid coverage require careful consideration around health care costs and the infractures needed to support payment, he stated.
“My only concern with this bill is that it takes effect immediately, presupposing that DHS) would be able to offer the benefit in a very short time frame,” Murphy said in a statement. “Adding any new form of coverage to Medicaid takes a substantial commitment of time and resources, including investing and designing the benefit, building out the information technology infrastructure and, critically, securing the federal approvals and financial participation necessary to reduce state costs. Accordingly, to design a comprehensive, equitable system of coverage, DHS will need to carefully study the current palliative care landscape and engage thoughtfully with our communities.”
The legislation authorizes licensed, Medicaid-approved home health and hospice agencies to provide palliative care in patients’ homes. The bill states beneficiaries are eligible to receive community–based palliative care services concurrently with services such as home health.
An estimated 56,062 patients are expected to utilize the benefit, representing 2.5% of New Jersey’s Medicaid beneficiaries. The resulting total cost savings for the state and federal governments are estimated to reach between $375.5 million and $563.5 million.
Introduced this past summer, the bill garnered bipartisan support from sponsors New Jersey State Sens. Richard Codey (D), Nellie Pou (D) and Edward Durr (R), as well as General Assembly members Shanique Murphy-Speight (D) and Carol Murphy (D). The bill was born from the advocacy work of the Goals of Care Coalition of NJ (GOCCNJ), whose lobbying efforts moved state Assemblywoman Angela McKnight, chair of the Assembly Aging & Senior Services Committee, who introduced the legislature.
The bill directs the New Jersey Commissioner of Human Services to apply to the U.S. Centers for Medicare & Medicaid Services to obtain any necessary amendments or waivers to implement the provisions of the bill and to secure federal funding for the program. The commissioner is also charged with developing regulations that need to implement the bill, including guidance on which patients would be eligible to receive the care.
Community-based palliative care coverage under Medicaid could go far in expanding access to these services among patients and families facing challenging financial issues, according to Cathy Rowe, executive director of the nonprofit group New Jersey Advocates for Aging Well.
“If Medicaid covers palliative care, we can redirect resources from costly care that might not yield the benefits people need or want, and towards person-centered,” Rowe told local news. “Too often when an older person is facing an illness, they get swept up in the health care system without being presented the option of noninvasive care. We get swept up in quantity, not quality of life.”