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Medicaid Expanding in New Jersey, But Who Will Have Access?

Health care providers, like Dr. Tom Ortiz in Newark, anticipate seeing more patients with insurance coverage, as a result of the Affordable Care Act.

Like 25 other states, New Jersey is expanding Medicaid access for thousands of state residents under the Affordable Care Act; half of the new patients who enrolled on Healthcare.gov in New Jersey this fall qualified for Medicaid’s free health coverage. But the expansion is facing significant challenges. Glitches in the system mean thousands of Medicaid applications haven't been processed. And once residents have insurance, experts are warning of a crisis in supply versus demand. Most New Jersey doctors have said they aren’t accepting any new Medicaid patients, according to a recent study in the journal Health Affairs.

COME JANUARY FIRST, WHO WILL HAVE COVERAGE?

COME JANUARY FIRST, WHO WILL HAVE COVERAGE?
Anyone who applied for the new health care plans or Medicaid by December 24th. 
However, there's been a last-minute problem in New Jersey for new Medicaid applicants who applied on Healthcare.gov, which manages the New Jersey Affordable Care Act marketplace. Some of those New Jerseyans who applied on Healthcare.gov and were told they qualified have not received their cards yet. That's because the electronic applications sent by the federal website, Healthcare.gov, to New Jersey Medicaid officials, did not have all the data needed by the state, to issue the cards.   
"We are getting questions from consumers as well as provider groups as to what will happen at the point of service if someone goes in on the New Year, January First or Second and has not yet had that Medicaid card," said Maura Collingsgru, a health policy advocate with NJ Citizen Action.
Collingsgru's group is advising customers who were informed to go ahead and see a physician and to bring all documentation they received from Healthcare.gov verifying that they qualified for Medicaid. 
"We are being told (by New Jersey officials) they are covered," Collingsgru said. 
Anyone who applied for the new health care plans or Medicaid by Dec. 24 should have coverage on Jan. 1.

But communication errors between healthcare.gov and state computer systems mean some Medicaid applications appeared to be incomplete — and the state is still trying to figure out who qualifies for coverage. As a result, insurance cards haven't been issued to many Medicaid patients who sought health insurance. 

"We are getting questions from consumers as well as provider groups as to what will happen at the point of service if someone goes in on the New Year, January 1st or 2nd, and has not yet had that Medicaid card," said Maura Collingsgru, a health policy advocate with NJ Citizen Action.

Collingsgru's group is advising customers who believe they qualified for coverage but might not have an insurance card yet to go ahead and see their physicians -- but bring all documentation they received from Healthcare.gov verifying that they qualified for Medicaid. "We are being told [by New Jersey officials] they are covered," Collingsgru said. 

ONCE THEY HAVE COVERAGE, WHERE WILL THEY GET CARE?

Liz Cruz is exactly the sort of person the Affordable Care Act was designed to help. When Cruz lost her full-time job as a flight attendant four years ago, she lost her health insurance, too. Now she’s a part-time bartender, paying out of pocket for health care. And if she has to go to the doctor, it means falling behind on her phone bills, gas and electric — even her mortgage.

When she saw an ad for the Affordable Care Act on TV, she decided to stop by the Urban League’s office in Jersey City to see if she qualifies for Medicaid. “I’m a little anxious,” she said as she ducked in to meet with a navigator there.  “I really hope I get approved because I really need it. It’s been a long time waiting.”

A few minutes later, she emerged, a wide smile stretching across her face. She just found out she qualified. “It’s just mentally relaxing to know I don’t have to pay for health insurance," she said.

In the past, people like Cruz — single adults without dependents — generally weren’t eligible for Medicaid. But under the Affordable Care Act, they are, as long as they meet the new, higher, income thresholds; up to about $15,000 a year for single people, and just over $30,000 for a family of four.

Advocates say expanding Medicaid means more preventative treatment, healthier people, and, ultimately, lower costs. But, there may be a catch. New Jersey has the lowest percentage of doctors who take Medicaid patients, and researchers at the Rutgers Council of Teaching Hospitals have said the state needs at least 1,000 more primary care doctors to meet the needs of new patients.

“What we’re going to end up doing is giving them a bus ticket to go nowhere if we haven’t expanded the capability and the capacity of the current system to take on those patients,” said Tom Ortiz, a doctor in North Newark.

Ortiz does accept Medicaid patients. But, because of the low reimbursement rate for Medicaid care, he said he does so at a loss. Ortiz said private insurance tends to pay about $100 dollars for a routine visit, while Medicaid pays just $25. So he recoups costs other ways, by renting out space in his office to specialists, and maintaining a consulting business on the side.  

“I always believed that doing the right thing for the folks that needed it the most, there would be rewards,” he said.

For now, there will be. Under the first two years of the Affordable Care Act, doctors who take Medicaid patients will get reimbursed at higher rates. The idea is to entice more physicians to take these patients. But there’s no guarantee the new, higher, reimbursement rates will last. Meanwhile, some community health clinics are adding doctors and extending hours. Ortiz himself has added another practitioner in anticipation, and is bracing for the influx.

And while patients like Liz Cruz are thrilled to have health insurance, in the new year they’ll face a different challenge: finding a doctor.