Nearly ten years ago, the Quality Institute convened stakeholders across New Jersey to answer a fundamental question: how should we redesign Medicaid for the future? The result was Medicaid 2.0: Blueprint for the Future, a roadmap with 24 recommendations to modernize how care is delivered, paid for, and accessed across the state.
Medicaid covers nearly 2 million New Jersey residents. It is a central pillar of our health care system and a primary driver of access, equity, and system stability. As the Blueprint approaches its ten-year milestone, the focus now is on how we can build from this foundational document to best sustain a healthy Medicaid program for the people it serves.
Progress Made and Work Still Ahead
Over the past decade, New Jersey has made meaningful progress on several of the Blueprint’s recommendations. At the same time, implementation has been uneven. Roughly half of the recommendations have been advanced, while others, particularly structural reforms around eligibility and enrollment systems, data transparency, network directories, universal provider credentialing, and the managed care contract and oversight, remain incomplete. That unfinished work matters, especially now.
New Jersey is at an inflection point. Federal changes under H.R.1 threaten coverage stability, financing, and access to care. At the same time, shifts in the individual marketplace and broader economic pressures may increase the number of uninsured residents. Collective action on these structural issues cannot be delayed.
In this environment, the Blueprint’s original premise feels strikingly current: Medicaid must be designed to be both high-performing and resilient. The stakes are significant. Medicaid not only provides individuals with coverage for essential health care, it is a primary source of revenue for hospitals, community providers, children’s mental health systems of care, and nursing homes. Medicaid is a primary driver of maternal and child health coverage and outcomes. And it is a critical tool for advancing health equity.
The next phase of Medicaid reform must build on what has worked, while addressing what has not.
Where to Focus Next
- Blueprint Recommendation #2: Increase Transparency for Medicaid Data
- Blueprint Recommendation #3: Eligibility Processing
- Blueprint Recommendation #6: Medicaid Regulations and Managed Care Contract Update Blueprint Recommendation #8: Statewide Universal Credentialing System
- Blueprint Recommendation #9: Network Directories
- Blueprint Recommendation #10: Standardized Quality Measures
- Blueprint Recommendation #15: Managed Care Organizations Performance Incentives
Blueprint Recommendation #17: Statewide Patient-Centered Medical Home
Although some details have changed over the decade, conceptually the recommendations remain the same. New Jersey must modernize its core infrastructure, consistent with Blueprint Recommendations #3 and #6. The State continues to face challenges with eligibility processing, fragmented enrollment pathways, and outdated systems that contribute to coverage loss and administrative burden. Strengthening eligibility systems and upgrading Medicaid regulations and managed care contracts are foundational steps to ensuring the program functions effectively and can better support access to care.
The State must strengthen managed care oversight and network performance, building on Blueprint Recommendation #9, Network Directory Accuracy, while also advancing Blueprint Recommendation #8 to implement a statewide universal credentialing system. Managed care organizations play a central role in ensuring access, yet persistent issues with inaccurate provider directories, limited appointment availability, and weak enforcement continue to undermine that role. At the same time, administrative barriers to provider participation delay entry into networks and further constrain access, particularly in high-need areas such as behavioral health, oral health, and doula care. Together, improving network directory accuracy and streamlining credentialing would reduce burden on providers, accelerate participation, and meaningfully improve real-world access to care.
New Jersey must better leverage its data and purchasing power to drive accountability and system improvement, consistent with Blueprint Recommendations #2 and #10. The State already collects significant data on cost, utilization, and quality, but it is not consistently used or publicly reported to inform decision-making. Standardized quality measures and transparent reporting are necessary to evaluate performance across managed care organizations and providers and to guide continuous improvement.
Finally, the State must continue the transition to a more advanced delivery and payment model, consistent with Blueprint Recommendations #15 and #17. This includes strengthening managed care performance incentives and expanding value-based payment models, such as patient-centered medical homes and integrated models of care. These reforms are essential to moving away from volume-based care toward a system that rewards quality, coordination, and improved outcomes.
Looking Forward
The original Medicaid 2.0 Blueprint was grounded in a simple but powerful idea: that New Jersey could build a more efficient, high-quality Medicaid program through collaboration, data, and accountability. Our recently released outline how organizations throughout the state can help Medicaid in these efforts – especially on eligibility, enrollment and communications at the community level.
Ten years later, that vision remains unfinished but more relevant than ever. With new leadership, renewed urgency, and a , New Jersey has an opportunity to evaluate what is working, address what is not, and strengthen Medicaid to better serve the nearly 2 million residents who rely on it.