At the Quality Institute, we support ways to keep people insured and to improve access to health care. The passage of H.R.1, along with other federal policy changes, make both goals much harder to achieve and will harm people living in the Garden State. To help State Leaders and health care providers prepare for those changes, and to mitigate the expected harms, in partnership with Parker Family Health Center, we created and convened the H.R.1 Health Care Access Workgroup last fall.

The Workgroup’s goals are to:

• Ensure the state is prepared to engage all individuals eligible for Medicaid enrollment and provide the communication, education, direct support, and technology resources needed to support their continued coverage.
• Provide access to essential health care services for individuals who are not eligible for Medicaid or other insurance and would otherwise be uninsured.
• Develop strategies, supported by state and private funds, to strengthen the safety net system of care and ensure access to care.

Our process engaged organizations including state and local government, technology companies, health plans, health systems, as well as other organizations with direct experience from the roll-out of the ACA, engaging communities during COVID-19, supporting messaging during the Medicaid Unwinding effort, and those that provide social services, legal supports, and free or subsidized care to people who are uninsured or underserved.  We met weekly with a volunteer steering committee and convened over 60 entities for an all-day session to support the creation of a report which includes recommendations for H.R. 1 implementation and action steps for each area of recommendations.  The recommendations align with the Healthcare Action Team Report just released by Governor Sherrill, including creation of a multistakeholder group and other critical steps to support the state.

We plan to continue this work and invite you to join us. If you are interested, please complete this survey.

Summary of the Recommendations

Our recommendations are divided into three areas.

First, we present ways to improve the state’s Medicaid Enrollment Systems and Technology to support compliance with H.R.1 requirements, which increase the frequency of verification for some people and will require proof that those same individuals are working or qualify for a work exception. Today, the enrollment system is fragmented into several different pathways that are built on outdated technology platforms and are opaque to the applicant trying to get Medicaid coverage. Moving these systems to one more modern platform for the users impacted by H.R. 1 should be a top priority. Another benefit to being on a modern platform is the future ability to better connect to other state sources automatically to prove eligibility to keep people rightfully enrolled automatically. Data source examples are SNAP, Taxation, or higher education organizations. Using better technology will also support the user experience, helping people know where their application is in the process and what additional information is needed or when they need to provide updated information.

Next, we focus on Outreach and Enrollment Assistance Actions to make the process clearer at every level to the public, people trying to get covered or renew coverage, health plans assisting their members, health care providers and systems assisting their patients, and caregivers or supporting organizations of all types. These materials and messaging must be clear, consistent, multilingual, culturally responsive, and written at an appropriate literacy level. Communication should be rolled out through many channels and trusted messengers from community partners to health care providers.

The state learned a lot about health insurance and public health outreach over the last eight years implementing the ACA, Medicaid expansion, Cover All Kids, COVID-19 vaccines, and then the Unwinding. These lessons should be applied to the H.R.1 communications plan and roll-out.

Finally, we address Access to Care for the Uninsured. Some people, because of the loss of enhanced ACA subsidies, or federal changes to whoever is eligible for Medicaid, will become uninsured. Others will not enroll due to federal immigration actions including attempts to obtain personal data from CMS and states. But these individuals, even with no health insurance, need access to health care, including dental and reproductive health. The recommendations acknowledge the role of hospitals, health centers (also known as FQHCs), and free clinics and satellite care sites. All these sites will be under further stress as more people will be uninsured and delay or forgo care. We propose steps to assess the current need, to build local partnerships with hospitals, providers, and funders, to deploy communications to reach people in need, and to design sustainable funding to support the work. Our goal is for people to have a medical and dental home, and to avoid using the Emergency Rooms for primary and preventive care, even though they may be uninsured.

Many of the recommendations will fall to government to implement, but not everything. There is a lot that organizations like those that are members of the Quality Institute can work on together. We can reduce the harm and build out systems that better support those living in the Garden State. I am thankful to the many organizations who worked on these recommendations, to New Jersey Medicaid for its strong partnership in this work, and to the Robert Wood Johnson Foundation for its generous support for this work.