MEDICAL ASSISTANCE DEPARTMENT
Medicaid is a State and Federal Medical Assistance Program that pays medical bills for eligible, needy persons. Most payments are made directly to the providers of medical and other health care services. On average these payments total more than $175 million per year in Mercer County. Depending on the program, some clients are in managed care, while others are in fee for service plans. Again, depending on the program, various services may be covered or excluded.
There are several Medicaid Programs, all geared to serve different populations. Each has different rules and regulations. These programs include: Medicaid Only (community and institutional), Medicaid Special (pregnant women and children, and aged, blind and disabled), Medically Needy, Presumptively Eligible Medicaid, Home and Community Based Medicaid Waiver, Community Care Program for the Elderly and Disabled, Community Resources for Persons with Disabilities, AIDS Community Care Alternative Program, Traumatic Brain Injury, Assisted Living/Alternate Family Care, Community Medical Assistance Programs (Home Care Expansion Program), Medical Emergency Payment Program for Aliens, Workability, Breast & Cervical Cancer Initiative, Family Care and Hospice.
The Medical Assistance Department also makes referrals for assistance programs administered through other organizations which include but are not limited to: Supplemental Security Income, Pharmaceutical Assistance for Aged and Disabled, Lifeline, Hearing Aid Assistance to the Aged and Disabled and RX4NJ (Prescription Assistance Programs). Additionally, referrals may be made to other programs offered within MCBSS such as, Adult Protective Services and Medical Transportation Services.
In 2004, the Medical Assistance Department processed a record number of applications (4,604) and completed 4,996 redeterminations. This was accomplished while the department experienced a number of personnel changes that included an administrative transition due to the Early Retirement Initiative.
The department made some system processing changes in 2004. Direct access into the Medicaid Eligibility System was instituted. This provided update capability for case information entry from within the Medicaid Assistance Units, no longer requiring a support unit for data entry. Direct input has had a positive impact by entering information into the system more timely and by reducing the error turn-around time.
Additionally, access for update capability for New Card Registration was a positive change for the department. This allowed the units to maintain accurate, updated case information without requiring data entry support staff.
The Medical Assistance Department will be faced with many challenges in the upcoming year such as:
- Legislation introduced through the New Jersey State Assembly to expand the New Jersey Family Care Program.
- Implementation of the Medicare Drug Entitlement Law which will mandate non-duplication of prescription drug coverage benefits.
- Beginning in October 2005, the Division of Medical Assistance and Health Services Bureau of Quality Control will institute payment error rate measurement requirements on all Medicaid programs. Although MCBSS is already diligent in administering the numerous Medicaid programs currently being offered, it will be interesting to see what impact this will have on the department.
To that end, the Medicaid Department is prepared to meet the challenges while continuing to perform to the high standards that have been established without any increase in staff.
The goal of the department is to continue its tradition of caring and excellent service to the community. It is imperative that the department maintains a consistency throughout for the distribution of all program services.
Our customers are comprised of individuals from all socio-economic backgrounds, the majority of whom come to us to seek assistance at very stressful periods of their lives. It is our duty to treat each individual with dignity and respect and continue to make customer service an integral part of the department’s mission.
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