Medicaid/NJ FamilyCare Preparing to Cover ABA for Children with Autism

May 06, 2019


In the coming months, children whose health insurance is NJ FamilyCare will be able to access coverage for ABA services. As described in this article, the state’s publicly funded health insurance program is responsible for ensuring that children under age 21 have access to comprehensive high-quality health benefits. Autism New Jersey commends Governor Murphy, Commissioner Carole Johnson, and Medicaid Director Meghan Davey who are committed to launching this benefit on behalf of the estimated 20,000 children with autism whose health insurance is NJ FamilyCare.

What’s Happened So Far?

Public input requested and plan submitted

The State of New Jersey organized a stakeholder group that met throughout the summer and fall of 2018 to discuss the treatments and provider qualifications that would be included within this benefit. The state also held an open forum and requested public input. The recommendations from the stakeholder group and public comment were used to create a formal document called a State Plan Amendment (SPA) to add this coverage to the state’s existing Medicaid contract with the federal government to secure federal funding. The SPA was submitted on March 29, 2019. Federal approval is possible within the next few months, and then state regulations will likely be drafted and shared for public comment.


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KHN’s ‘What The Health?’: Trump Turns To Medicare

President Donald Trump tried to change the subject from his impeachment investigation by going to Florida to unveil changes to the Medicare program before an audience of seniors. The changes consist largely of enhanced benefits in private Medicare Advantage plans, which Republicans have long championed as replacements for government-run Medicare benefits.

Meanwhile, the Trump administration this week also issued guidance allowing states to add “wellness” programs to plans on the individual insurance market. The program, part of the original Affordable Care Act, was never implemented by the Obama administration. However, numerous studies have shown that wellness programs that raise or lower premiums based on participation or health goals neither save money nor improve health significantly.

This week’s panelists are Julie Rovner of Kaiser Health News, Alice Miranda Ollstein of Politico, Kimberly Leonard of the Washington Examiner and Rebecca Adams of CQ Roll Call.


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Medicare for All Loses Support Amid Lack of Detail on Costs to Voters

Messaging for the idea is complicated by other health proposals aired by the Democratic primary field

Support for Medicare for All is showing signs of slipping as top-tier Democratic presidential candidates Sens. Elizabeth Warren and Bernie Sanders struggle to sell the proposal without providing specifics on the financial costs for voters.

Meanwhile, an abundance of other health proposals aired by the Democratic primary field is complicating messaging efforts as polls show many voters still don’t understand what specific plans would do. Fifty-one percent of Americans back the Medicare-for-All proposals, which is down 5 percentage points since April, according to a poll released Tuesday by the Kaiser Family Foundation.

“The details matter,” said David Blumenthal, president of The Commonwealth Fund, an independent research firm. “Those details will be central to the national debate on health care and health insurance coverage as the 2020 campaign season progresses.”

What Is (and Isn’t) Medicare for All

What Is (and Isn’t) Medicare for All
Medicare for All has dominated the Democratic presidential campaign. Some candidates support Sen. Bernie Sanders’s plan, but others have different ideas for how to get to universal coverage. WSJ explains what Medicare for All is, what it isn’t, and how some of the major health-care proposals out there would change the health-insurance industry.

Medicare for All would replace the current health system with a federal plan that would cover everyone. The proposal backed by Sens. Warren and Sanders would largely end private insurance. Ms. Warren took heat during and after Tuesday’s Democratic debate for not directly answering questions about whether her version of the proposal would increase taxes on the middle class.

“My view on this and what I have committed to is, costs will go down for hard-working middle-class families,” the Massachusetts senator said at the debate without providing details.

Plans to end the current U.S. health system for a new federally-run program come with widely divergent estimated costs. They range from $13.8 trillion to as much as $36 trillion over 10 years, according to studies from organizations including Rand, Urban Institute and the Mercatus Center.

A near universal coverage plan that also covers undocumented immigrants could cost more than $30 trillion over 10 years, according to a report released after the Tuesday debate by The Commonwealth Fund and the Urban Institute, an economic and social-policy research think tank.

The U.S. is already on track to spend about $3.5 trillion in 2020 on health care. The single-payer approach that included coverage for everyone in the U.S. would increase that amount to $4.2 trillion, according to the report.

Advocates for universal coverage say any increase in costs to individuals would be offset by lower state and employer health-care spending, the elimination of out-of-pocket costs and an expansion of coverage by offering more robust benefits. But voters remain worried that their current health insurance premiums, which are known amounts, would be replaced by some unknown and unspecified tax, according to some health analysts and academics.

Sen. Elizabeth Warren (D., Mass.) has absorbed criticism for not directly answering questions about whether her version of Medicare for All would raise taxes on the middle class. PHOTO: ELISE AMENDOLA/ASSOCIATED PRESS

And complex policy changes can cause people to wonder whether they have lost something—even if they haven’t: There was a gap between the share of people who got tax cuts in 2018 and those who thought they did.

The argument that overall costs would go down also depends in part on the federal government wringing efficiency out of the system or imposing a tax that is progressive.

Kenneth Thorpe, chairman of the health policy and management department at Emory University, who helped the state of Vermont study a single-payer proposal, reviewed Mr. Sanders’s Medicare-for-All plan in January 2016. He projected that 71% of households with private insurance would wind up paying more than they would under the current system.

The Vermont senator disputes that assertion. While Mr. Sanders hasn’t advocated a specific, detailed plan to pay for his Medicare-for-All plan, he has outlined a menu of options that includes a 4% income-based premium—a tax by another name—paid by households that he says would raise $2.5 trillion over 10 years. He says a typical middle-class family would save more than $4,400 a year under the plan.

California Sen. Kamala Harris, who is also seeking the Democratic nomination, has disavowed the 4% income-based premium as hitting the middle class too hard.

Beyond the costs, some voters also are also skeptical of the various proposals because it is unclear whether they can keep their insurance, another issue some candidates aren’t specifically discussing, said Robert Blendon, a health policy professor at Harvard University.

“Those are the two issues moving voters,” he said. “They know what they pay every month. They get nervous that at the end of the day they’ll pay more in taxes than in premiums.”

While support is dipping for a fully government-run health-insurance program, the Kaiser Family Foundation poll showed support for proposals giving consumers the option to purchase a government-administered plan has risen to 73% of Americans, up 8 percentage points from 65% in July 2019.

Democratic presidential hopeful Pete Buttigieg, the mayor of South Bend, Ind., has launched fresh digital ads featuring analysts criticizing Medicare for All. He promoted a plan that would maintain private insurance and provide a public option, a proposal that overlaps some with one offered by former Vice President Joe Biden, who also is seeking the party’s nomination.

The variety of buy-in proposals means there are also wide cost disparities. Under Mr. Buttigieg’s and Mr. Biden’s plans, the uninsured would be automatically enrolled in a government insurance plan and others with employer coverage could buy into it. Subsidies for people on the Affordable Care Act exchanges would also increase. He has said it would cost about $1.5 trillion over a decade and be paid for by cost savings and corporate tax changes.


Which health-care approach sounds more appealing to you? Why? Join the conversation below.

Mr. Biden would provide premium-free access to a Medicare-like program for people in states that didn’t expand Medicaid, the federal insurance program for people with low incomes or certain disabilities. He would also boost access to subsidies that reduce premium costs on the individual health-insurance market, and allow the federal government to negotiate drug costs in Medicare. Overall, his plan would cost about $750 billion over a decade, senior Biden campaign staff said.

“Look, the last thing the Democrats should be doing is playing Trump’s game and trying to con the American people to think this is easy,” Mr. Biden said Wednesday in Ohio.

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Richard Rubin contributed to this article.


Elizabeth Warren’s Medicare for All Dilemma

In September, 2017, as Republicans in Congress were pursuing an effort to abolish the Affordable Care Act—which ultimately failed in the Senate by one vote—Senator Bernie Sanders introduced the Medicare for All Act of 2017, which would have enrolled all Americans in a new national health-insurance scheme called the Universal Medicare Program. “At a time when millions of Americans do not have access to affordable health care, the Republicans, funded by the Koch brothers, are trying to take away health care from up to thirty-two million more,” Sanders said. “We have a better idea: guarantee health care to all people as a right, not a privilege.”

Although the Medicare for All Act was primarily identified with Sanders, who had proposed the same idea during his 2016 Presidential bid, it was co-sponsored by sixteen other Democratic senators. At least six of them were also considered to be possible 2020 Presidential candidates: Cory Booker, Al Franken, Kirsten Gillibrand, Kamala Harris, Jeff Merkley, and Elizabeth Warren. The bill had the endorsement of a large number of progressive groups, including Our Revolution, MoveOn, the Working Families Party, Friends of the Earth, credo, and the Progressive Campaign Change Committee. With the G.O.P. in control of both houses of Congress, the bill went nowhere, but the support it achieved confirmed that many progressive Democrats were eager to move beyond Obamacare and embrace a single-payer system.

In April of this year, Sanders reintroduced his Medicare for All Act and issued a white paper laying out some options for financing such a system, which, according to an Urban Institute study of Sanders’s 2016 campaign proposal, would ultimately raise federal expenditures by about three trillion dollars a year. The options included higher taxes on the rich; a 7.5 per cent payroll tax paid by employers; and a “4 percent income-based premium paid by employees, exempting the first $29,000 in income for a family of four.” Because private-insurance plans would be eliminated under the Sanders bill, insurance premiums would also vanish, and the white paper asserted that “the average American family will save thousands of dollars a year because it will no longer be writing large checks to private health insurance companies.” Still, the fact remained that implementing Medicare for All would likely require raising income taxes on a majority of American households.

By April, Franken had resigned, and Merkley had decided not to enter the 2020 race. The four confirmed contenders from the Senate, aside from Sanders—Booker, Gillibrand, Harris, and Warren—all co-sponsored the Medicare for All Act again, which was hardly surprising. If they had backed away from the Sanders bill, they would have attracted criticism from the left. None of them were doing particularly well in the polls at the time, and so sticking to their prior position must have seemed like the safest political move.

Even so, at least a couple of them tried to preserve some wiggle room. Warren started out the year by portraying her support for Medicare for All as a statement about aspirations rather than a commitment to the particulars of the Sanders plan. In an interview with Bloomberg Television, in January, she identified “affordable health care for every American” as her goal and said that there were “different ways we can get there.” At a CNN town-hall meeting in March, she said that there were “a lot of different pathways” to universal coverage, and added, “What we’re all looking for is the lowest cost way to make sure that everybody gets covered.”

But, unlike in many other policy areas, Warren didn’t propose an over-all health-care-reform plan of her own, as Harris did, or back away from the commitment to eliminate private insurance, as Booker did, sort of. Warren was rolling out so many proposals that her campaign started selling T-shirts emblazoned with the slogan “warren has a plan for that.” But in the area of health care she confined herself to relatively narrow proposals, including measures to reduce the cost of prescription drugs, expand rural health-care programs, and tackle the opioid crisis. (That’s not to say that these proposals weren’t important individually, merely that they didn’t add up to a comprehensive reform plan.)

At the first Democratic debate, in June, Warren said, “I’m with Bernie on Medicare,” and she also raised her hand when the candidates were asked to indicate whether they favored getting rid of private health insurance. But she didn’t emphasize this in her over-all pitch, and she didn’t get pressed on it. Things changed after she began vying for the lead with Joe Biden in the polls. Front-runners get treated differently than mere contenders: the media scrutinizes everything they say and do, and their fellow-candidates try to take them down. During Tuesday’s debate, Biden, Pete Buttigieg, and Amy Klobuchar zeroed in on Warren’s apparent reluctance to acknowledge explicitly that taxes would go up as part of a Medicare for All plan. “We owe it to the American people to tell them where we will send the invoice,” Klobuchar said. In response to these criticisms, Warren restated her support for Medicare for All, but also tweaked it slightly, saying, “I will not sign a bill into law that does not lower costs for middle-class families.”

The debate left Warren with a dilemma. Should she stick to her current position, which is at least partly designed to avoid giving Trump and the Republicans a talking point—“Warren wants to raise your taxes”—or should she refine it in some way? Some progressives believe she is in the right place. “Democratic voters want to beat Trump and appreciate Democratic politicians who are savvy,” Adam Green, a co-founder of the Progressive Change Campaign Committee, told The Hill on Wednesday. “I don’t see why we would give the insurance companies rope to hang Democrats with a deceptive talking point. The bottom line is that Medicare for All will function like a tax cut for families.” Felicia Wong, the president of the Roosevelt Institute, a liberal think tank, also defended Warren’s approach. In an e-mail to me, Wong wrote, “Senator Warren has started with the basics: Everyone needs health care. And everyone agrees that the system isn’t working. So we need a big national conversation about structuring government as a public provider. That’s an upstream fight. And that is the campaign Sen. Warren is running.”


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