NJ Comptroller fines private mental health facilities $2.7 million, alleging … – Hunterdon County Democrat – NJ.com

Boxer-TonyK.JPGState Comptroller Matthew Boxer, seen in this file photo, announced his office had levied a $2.7 million fine against the operator of three mental health facilities in central Jersey for Medicaid fraud.  

TRENTON — The Office of the State Comptroller today slapped a $2.7 million fine against the owner of three mental health care facilities, charging him with submitting fraudulent bills and seeking to bar him from the Medicaid program for five years.

The state has accused Howard Lundy, the owner of Guiding Light Behavioral Health Inc. and Guiding Light Drug and Alcohol Treatment Service, both in Neptune, and Brighter Day Behavioral Health Inc., Lawrenceville, of submitting more than 2,859 false claims from September 2009 to March 2012.

Comptroller Matthew Boxer said Lundy billed Medicaid for hundreds of patients in which no documentation could be found to verify the date of their care. In other cases, the patients had been treated by another facilities. Twice, one facility billed for health care and transportation services on days the centers were closed.

“The integrity of the Medicaid program is dependent on health care providers acting in an ethical manner,” Boxer said. “In this case, the overbillings that we allege occurred, along with the effort to cover up those overbillings, were particularly brazen.”

Robert Bonney Jr. of Freehold, Lundy’s attorney, released a statement late today that says state investigators had yet to provide “any specifics concerning the allegations.”

“Brighter Day and Guiding Light have been cooperating with the State Controller’s investigation for almost 2 years,” and will address the issues “in due course,” Bonney’s statement said.

“Guiding Light Behavioral Health and Brighter Day Behavioral Health have been providing treatment to over 230 patients for more than 18 years,” according to Bonney’s statement. “It is significant that none of the State’s allegations concern patient care in any way.”

The facilities are operated by Lundy and his wife, Gwendolyn, according to Boxer’s announcement.

Lundy may challenge the findings and request a hearing with the state Medicaid office, with an administrative law judge, or both, according to Boxer’s announcement. An appeal can be filed by Jan. 27, according to Boxer.

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Source Article from http://www.nj.com/politics/index.ssf/2014/01/nj_comptroller_fines_owner_of_private_mental_health_facilities_27_million_for_alleged_medicaid_fraud.html
NJ Comptroller fines private mental health facilities $2.7 million, alleging … – Hunterdon County Democrat – NJ.com
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Glitch will delay Medicaid for New Jersey’s poor – NorthJersey.com

State officials said Thursday that thousands of poor people who applied for health coverage using the federal government’s website are unable to be enrolled because of serious glitches in the system.


New Jersey Medicaid said in­formation it received from the federal insurance marketplace for about 25,000 residents who qualify for free health coverage from New Jersey’s program for the poor is “unusable.”


Their applications can’t be pro­cessed, and they can’t yet be enrolled for coverage that is supposed to begin on Jan. 1, said Nicole Brossoie, assistant commissioner of the state Department of Human Services, which runs Medicaid.


It is yet another problem in the disastrous rollout of the federal marketplace for people who want to sign up for health insurance. After assurances that the federal website would automatically send enrollment information to the state for those who qualify for Medicaid, New Jersey officials discovered this week that the state and the federal computer systems don’t communicate smoothly.


Worse, people who think they enrolled successfully in Medicaid have no idea that, in fact, their applications are in limbo.


State Medicaid “is working with the Centers for Medicare and Medicaid Services to receive a usable file as soon as possible,” Brossoie said late Thursday afternoon. She did not offer any timetable for when the problem might be resolved.


Governor Christie, who opposes President Obama’s health care overhaul, assented earlier this year to the expansion of NJ FamilyCare, as Medicaid is known in the state. It is expected to enroll an estimated 300,000 additional people over the next few years. Most are childless adults too poor to be able to buy the new plans offered on the federal insurance marketplace, even with subsidies.


The entire cost of the expansion during its first three years is to be paid by the federal government. Christie did not want to leave that money on the table but will reverse his decision if the program becomes a burden on taxpayers, he said.


Computer problems on healthcare.gov, the website that serves as the portal to both individual health plans and Medicaid, left many of the enrollees who used the site confused about whether they had actually signed up for Medicaid or not.


When they reached the point in the application process where a Web page informed them they qualified for NJ FamilyCare, users said, there was no enrollment button or any information about what was supposed to happen next.















Source Article from http://www.northjersey.com/news/bergen/bergen_county_news/Unusable_information_will_delay_.html
Glitch will delay Medicaid for New Jersey’s poor – NorthJersey.com
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Politics color governors’ decisions on Medicaid – Asbury Park Press

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WASHINGTON — Partisan politics are coloring governors’ decisions on whether to expand Medicaid in their states.

The question of whether more low-income people receive Medicaid coverage may have less to do with their need than with how their states vote in governors’ races.

Medicaid is the government health insurance program for the poor. Every Democratic governor has called for accepting larger-than-usual federal subsidies to expand coverage.

But the nation’s 30 Republican governors are split. Eight agreed to expand Medicaid — and most of them are from states President Barack Obama won.

At least 20 GOP governors have declined the offer. In doing so, at least one rejected advice from the commission he assigned to study the question.

Critics say some governors fear a tea party challenger in next year’s Republican primaries.

Source Article from http://www.app.com/viewart/20131214/NJNEWS11/312140038/Politics-color-governors-decisions-Medicaid
Politics color governors’ decisions on Medicaid – Asbury Park Press
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Medicaid enrollment jumps in NJ – Vineland Daily Journal

Medicaid enrollment jumps in NJ – Vineland Daily Journal
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Medicaid enrollment jumps in NJ – Asbury Park Press

Medicaid enrollment jumps in NJ – Asbury Park Press
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Medicaid applications up 35 percent since Obamacare exchange opened – NJ.com

StPeterultrasound Sapone.JPGDr. Ashwin Jadhav, maternal fetal medicine specialist does an ultrasound of a patient at Somerset Medical Center in Somerville.  

TRENTON — The opening of the Obamacare health exchange last month drove a 35 percent surge in new applications for Medicaid, the health insurance program for low-income people, the state Department of Human Services confirmed today.

The number of applicants to the State’s Medicaid program — known as New Jersey FamilyCare — during October totaled 21,946, an increase of 35 percent from September when 16,339 applicants were reported, according to NJ Citizen Action Health Policy Advocate Maura Collinsgru. She said she learned about the information during a Medicaid Assistance Advisory Council Meeting today.

Nicole Brossoie, spokeswoman for the Department of Human Services, which runs the Medicaid program, confirmed the application figures, but said it would not be until February before the state could confirm how many people qualified and successfully enrolled into the program.

New Jersey is one of 26 states that agreed to accept billions of federal dollars to expand the income eligibility limits in the Medicaid program. Doing so is expected to net the state $227 million in higher reimbursements while also enrolling 104,000 new people next year.

The development is a bit of good news to the law’s supporters after what has been an embarrassing national roll out of the Obamacare program. Numerous software problems have gummed up the website, healthcare.gov, and millions of people, including 800,000 in New Jersey, have received letters telling them their health plans did not meet the requirements of the Affordable Care Act and would be canceled.

“Enrollment in NJ Family Care is up and shows New Jerseyans are eager to get coverage,” Collinsgru said. Calls to the FamilyCare telephone line rose 60 percent, she added.

According to a Nov. 13 briefing by the U.S. Department of Health and Human Services, 23,021 applications from New Jersey residents had been submitted through the exchange but just 741 people had completed the application process and selected a plan. More than 17,000 of those applications came from people who qualified for Medicaid, according to the federal government.

People may apply for Medicaid directly at the NJ FamilyCare website.

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Source Article from http://www.nj.com/politics/index.ssf/2013/11/medicaid_applications_up_35_percent_since_obamacare_exchange_opened.html
Medicaid applications up 35 percent since Obamacare exchange opened – NJ.com
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"Given how expansive our program already was," expanding Medicaid in New … – PolitiFact

In a victory lap following his landslide re-election Nov. 5, New Jersey Gov. Chris Christie, a Republican, hit four of the five major Sunday morning talk shows.


On ABC’s This Week, host George Stephanopoulos talked about 2016 Republican primary prospects with Christie. Stephanopoulos flagged Medicaid as a potential source of criticism from Christie’s own party.


“You didn’t set up an exchange, but you did accept the expansion of Medicaid under Obamacare,” Stephanopoulos said. “And some of your potential rivals like Ted Cruz are going to come after you on that. What’s your answer?”


Christie’s response was in line with his standard “Jersey-first” approach to discussions of national politics.


“I do what’s best for the people in the state of New Jersey every day,” he said. “And expanding Medicaid in the state of New Jersey, given how expansive our program already was, it was a relatively small expansion. But it’s going to mean a lot. And it’s also going to benefit New Jersey’s budget.”


We wondered if Christie was right in saying that New Jersey only needed a minor Medicaid expansion to comply with Obamacare. (Christie’s office did not respond to an inquiry for this story, but we did hear from the New Jersey Department of Human Services.)


What the law says


First, some background on the law. The Affordable Care Act expands the pool of individuals who could be eligible to receive Medicaid, a health insurance program for low-income U.S. residents.


Previously, most of the people who were eligible were pregnant women, parents and children in low-income households. The law expands coverage to people 65 and under who have income up to 138 percent of the federal poverty level. This year, the poverty level is $11,490 for an individual.


Each state can individually decide whether or not to participate in this expansion, which the federal government will fully fund for the first three years.


How does New Jersey stack up?


To evaluate Christie’s claim, we sized up New Jersey’s Medicaid program against those of other states.


Leighton Ku, a Medicaid expert and professor at George Washington University, said it’s not enough to look at a list of how much money each state appropriates for Medicaid funding, because most of the money states appropriate go toward plans for the elderly and disabled — groups for which Obamacare isn’t expanding Medicaid.


New Jersey now covers parents with incomes up to 200 percent of the poverty level and childless adults at up to 23 percent of the poverty level, according to table 3 of the Kaiser Family Foundation report. Under Obamacare in 2014, that would expand to cover childless adults up to 138 percent of the poverty level.


New Jersey’s current Medicaid coverage puts it among the most generous states for Medicaid. For coverage of parents, Minnesota comes in first nationally at 215 percent of poverty, with New Jersey and two other states just behind. For childless adults, only 17 states offer any eligibility at all, so New Jersey’s 23 percent isn’t as restrictive, relatively speaking, as it might seem.


A 2011 Rutgers University study estimates that 100,000 more New Jersey residents will be eligible for Medicaid in 2014, which currently covers about 1.3 million people. That’s about a 7.7 percent increase in people eligible.


How does that compare to other states? We don’t yet have access to uniform, comprehensive, state-by-state data for the number of people who could benefit from Medicaid eligibility expansions, said Chris Lee, a Kaiser Family Foundation spokesman.


In all, 24 states (plus the District of Columbia) chose to expand Medicaid. However, we could only locate data for nine other states.


For these nine states, we divided the potential increase by the number of people already enrolled in Medicaid. This is an imperfect calculation, because the most recent numbers Kaiser provides are from fiscal year 2010. But it gives a rough sense of the scale.


Of the nine states, only Minnesota had a lower projected eligibility increase than New Jersey (3.7 percent). The other eight had a higher percentage. And, of course, many states aren’t expanding eligibility at all.


Our ruling


Christie touted New Jersey’s “expansive” Medicaid program. Because New Jersey was already generous in its Medicaid eligibility guidelines compared to other states, the potential increase in Medicaid enrollments due to Obamacare is relatively small. Only one out of the other nine states for which we found data had a lower percentage increase in the Medicaid-eligible population due to Obamacare. So Christie’s comment appears accurate, though the uncertainty due to the missing data leads us to rate it Mostly True.


Correction, Nov. 18, 2013: This report was corrected to note that New Jersey’s current Medicaid coverage is 23 percent, and that would expand under Obamacare in 2014 to up to 138 percent of the poverty level.  The rating is unchanged. Also, this item was updated shortly after publication to make clear that the New Jersey Department of Human Services did respond to our inquiry.

Source Article from http://www.politifact.com/truth-o-meter/statements/2013/nov/14/chris-christie/new-jersey-medicaid-expansion-was-small-given-alre/
"Given how expansive our program already was," expanding Medicaid in New … – PolitiFact
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Explainer: Medicaid Comprehensive Waiver Deploys Managed-Care Model – NJ Spotlight

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What it is

Medicaid — the joint federal-state healthcare program for residents with low incomes – is the principal source of funding for long-term care in the state. This includes nursing homes; community-based and home care for the elderly and disabled; and inpatient mental-health care. The federal government traditionally required the state to pay for Medicaid long-term care through a fee-for-service model, in which providers were reimbursed for each service they furnished.

In 2012, the federal Centers for Medicare & Medicaid Services (CMS) approved the state’s application for the New Jersey Comprehensive Waiver, which shifts long-term care toward the same managed-care approach currently used to meet Medicaid patients’ acute and primary healthcare needs. In managed care, the government pays insurers to manage all of the patient’s needs, rather than paying for each service separately. The managed-care insurers are aiming to provide more services in residents’ homes and in community centers, and the waiver will give them more flexibility to do so.

Why the state wanted it

The state was looking for more flexibility and lower costs so that residents capable of living at home or in the community could do so. Managed-care providers believe that funding services needed by an individual — even if they are nonmedical such as minor home construction — can keep that individual out of a nursing home, which is almost always more expensive for the government than home- or community-based care. State Human Services Commissioner Jennifer Velez has said that the change would provide more financial resources to fund home and community care.

The amount of money involved is substantial. From October 2011 to September 2012, of a total of $10.39 billion in Medicaid spending in the state, $3.54 billion — or 34.1 percent — went toward long-term care.

What else it does

In addition to shifting toward managed care, the waiver also changes other aspects of Medicaid in the state.

For one thing, it allows federal funding to support several programs, including treatment for low-income residents with mental illness and an opioid addiction, as well as services for low-income children up to the age of 21 with a serious emotional disturbance.

For another, the waiver increases support for community-based care for residents with developmental or intellectual disabilities who are eligible to live in one of the state’s developmental centers.

Why nursing homes are concerned about funding

While the state has been preparing to enact the shift to managed care, it has made a series of funding cuts and freezes in Medicaid funding for nursing homes.

But nursing-home operators have warned that facilities will go bankrupt and close if they do not have enough money to operate. While these facilities expect a rising number of residents as the population ages, these patients will be more costly because the waiver’s increased emphasis on home and community care will mean that patients with conditions like dementia will not be moved to a nursing home until their condition is severe.

The nursing homes’ concern has gained the attention of some legislators, including Assemblyman Gary S. Schaer, who grilled administration officials about the changes during a budget hearing in April.

Velez, however, said the system of funding for care has been biased in favor of nursing homes, but the waiver allows Medicaid funds to be used to meet patients’ individual needs.

What is happening now

The waiver lasts for five years, from July 2012 to June 2017, but if it’s judged to be successful it will likely be extended.

The residents who are already receiving home- and community-based care are scheduled to be shifted into managed care in January, while those who live in nursing homes are scheduled to move to managed care in July 2014. It is unclear whether any current nursing-home Medicaid patients will move to home-based care.

Source Article from http://www.njspotlight.com/stories/13/11/19/explainer-medicaid-comprehensive-waiver-deploys-managed-care-model/
Explainer: Medicaid Comprehensive Waiver Deploys Managed-Care Model – NJ Spotlight
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NJ Medicaid patients struggle to find doctors – Cherry Hill Courier Post

NJ Medicaid patients struggle to find doctors – Cherry Hill Courier Post
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With Medicaid Cuts Pending, Urban Hospitals Plead For Protection – NJ TODAY




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file000432821238-166x250by Andrew Kitchenman / NJ Spotlight

The hospitals that serve New Jersey’s poorest residents are asking state officials and legislators for protection from potential cuts in federal Medicaid funding, arguing that it’s premature to say how quickly they will benefit from increasing the number of residents with health insurance.

Under the 2010 Affordable Care Act, most Americans are required to have health insurance, which was expected to benefit the hospitals that have long provided charity care to the uninsured. With hospitals expected to receive more insurance payments, the law included a series of cuts to the federal program that traditionally funded charity care.

But hospitals are concerned that the cuts will occur before enough people become newly insured through private insurance.

Read the full story at NJ Spotlight



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Source Article from http://njtoday.net/2013/11/04/with-medicaid-cuts-pending-urban-hospitals-plead-for-protection/
With Medicaid Cuts Pending, Urban Hospitals Plead For Protection – NJ TODAY
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