How does Medicaid Work in New Jersey?

Medicaid is a service operated by CMS, the Centers for Medicare and Medicaid Services, a federal government organization. While it’s a national agency, the way it works is that it provides guidelines and reimbursements for states, so the two governments work together to provide health care affordably for millions of Americans who wouldn’t be able to otherwise afford it. 

Healthcare for the masses

Medicaid is meant to cover healthcare costs for people at a low income level. 17% of all healthcare costs in the US are covered through Medicaid. There are about 75 million people in the system, and it’s the fourth largest expenditure in the federal government , only fronted by social security, Medicare, and defense expenditures.

Healthcare for New Jersey

In the state of New Jersey, Medicaid is the largest expense in the state budget at $16 million for the year 2019, slightly more than expenditures for pre-k education. Medicaid in New Jersey covers 1.7 million people who would not otherwise be able to afford healthcare costs. This includes the children’s healthcare program (CHIP) called NJ Family Care.

Members of the program are covered by one of five participating insurance companies who receive a payment per beneficiary monthly. To enroll, a person must meet one of these criteria:

  • Women who are pregnant and live at less than 200% of the poverty level
  • Children who are under the age of 18 and live at less than 350% of the poverty level
  • Someone who is elderly, blind, or disabled and receives payments from Social Security’s supplemental security program.
  • Any other adult up to 138% of the poverty level.

Federal reimbursements depend on the wealth of the state. New Jersey is considered a high-income state, and under the Affordable Care act received 50% of Medicaid costs from the government, with beneficiaries receiving 90% reimbursements. Federal aid covers 65% for the CHIP program.

The state government of New Jersey offers coverage for a wider range of services than those mandated by the federal government, including medications, optometry, and dental. Because of this generous program, average spending per patient is close to $10,000, one of the highest in the country. However, payments to providers are not high at all; this figure comes from the high costs of caring for the elderly, especially those who need long term care, and the disabled. Expenses for a disabled patient are almost $24,000, and expenses for the elderly are almost $20,000.

New Jersey also pays nursing care expenses that exceed the national average. Medicaid is a crucial part of New Jersey’s nursing home facility system, ensuring care for the poor, elderly and disabled, who make up a large part of the nursing home population and who need the financial support of Medicaid to take care of these people. The old and disabled make up 25% of Medicaid beneficiaries, but take up 67% of Medicaid spending. This also brings many jobs to New Jerseyans through nursing facilities. 

Hudson View’s professional administration can walk you through the specific Medicaid benefits that apply to you. Speak to one of our representatives for more information.

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