New Jersey Section 1115 Waiver Amendment - McDermott+Consulting

New Jersey Section 1115 Waiver Amendment

On February 27, 2020, New Jersey submitted to the Centers for Medicare and Medicaid Services a request to amend the state’s existing Section 1115 demonstration program. This amendment would make two modifications. First, it seeks to expand Medicaid coverage for eligible pregnant women to 180 days postpartum. Second, it requests federal funding to support the Substance Use Disorder Promoting Interoperability Program. The state requests approval for the waiver amendment through June 30, 2022. The federal comment period will be open through May 1, 2020.

Read on for a summary of the waiver amendment.

Expansion of Postpartum Coverage

Currently, New Jersey’s Medicaid program (NJ FamilyCare) provides comprehensive coverage to pregnant women with incomes up to 205% of the federal poverty level. NJ FamilyCare coverage of pregnant women expires at the end of the month in which the 60-day postpartum period ends.

Through the waiver amendment, New Jersey seeks to extend NJ FamilyCare coverage to eligible pregnant women for a 180-day period from the last day of a woman’s pregnancy. This extended coverage would apply only to pregnant women who meet all other requirements for NJ FamilyCare eligibility and do not otherwise qualify for continued coverage (after 60 days) through another eligibility category. Thus, only women with family incomes between 138% and 205% of the federal poverty level would be affected by this proposed amendment. The state projects that roughly 8,700 women would receive four additional months of Medicaid coverage each year if this amendment is approved.

The delivery system and benefit package would remain unchanged for beneficiaries determined to be eligible for extended coverage under this amendment. The state estimates that the cost of extending coverage will be approximately $13.6 million for demonstration year nine and $13.9 million for demonstration year 10, which will be funded by state and federal matching funds.

Federal Funding for Substance Use Disorder Promoting Interoperability Program

  • Milestone 1 – Participation Agreement / Electronic Health Records (EHR) Vendor Contract Agreement
  • Milestone 2 – EHR Go-Live or Upgrade
  • Milestone 3 – New Jersey Health Information Network / Health Information Exchange Connectivity
  • Milestone 4 – Prescription Monitoring Program Connectivity
  • Milestone 5 – New Jersey Substance Abuse Monitoring Systems Connectivity (optional, if supported by EHR vendor).

More information on these milestones is available here.

In order to be eligible to receive incentive payments for achieving these milestones, a provider must be an active Medicaid provider who is licensed by the New Jersey Department of Health and participates in the New Jersey Substance Abuse Monitoring System. The provider also must have admitted at least 50 documented SUD patients in 2018. A provider who meets all five milestones may be eligible for total incentive payments of up to $42,500. The current program, funded with state-only dollars, is slated to continue through March 2021.

With this waiver amendment, New Jersey requests approximately $5 million in additional federal funding. The money would be used to extend the SUD Promoting Interoperability Program for an additional 15 months through June 2022, provide continued incentive funding for eligible SUD providers who meet the five existing milestones after state-only dollars have been exhausted, and provide incentive funding for all eligible SUD providers who achieve two additional milestones:

  • Milestone 6 – Submission of Electronic Clinical Quality Measures
  • Milestone 7 – Participation in Behavioral Health Consent Management.

New Jersey estimates that the addition of milestones 6 and 7 would cost the federal government approximately $2 million. The state estimates that 190 providers would qualify for incentives by meeting requirements established for each new milestone.


For more information, contact Emma Zimmerman or Samuel Dobbs.