New Jersey's Christie Touts "Cost-Cutting" Medicaid Expansion

Of the nation’s governors, which one would you pick to brag about adding more than 500,000 residents to Medicaid? Or cite this core tenet of “Obamacare” as a source of savings?

Would you have guessed New Jersey’s Chris Christie?

The same Republican one-time presidential candidate, and now close adviser to party nominee Donald J. Trump, did both earlier this week. More than 2 years removed from February 2013 Brietbart headline, “Christie caves on Obamacare,” the New Jersey governor held a press event Monday that was meat-and-potatoes government: Christie and the acting commissioner of the Department of Human Services (DHS), Elizabeth Connolly, appeared to talk about the recent success of NJ FamilyCare, with 3 pages of charts and bullet points to make their case.

The high points of their story were impressive: Since January 2014, New Jersey has enrolled 336,141 newly eligible adults, 101,644 adults and children who were previously eligible but not enrolled, and kept 128,870 adults in Medicaid due to expansion. Overall, NJ FamilyCare covers 1.7 million people, or about 19% of the state’s estimated 8.93 million population.

Christie highlighted that due to federal cost sharing under the Affordable Care Act, the rising numbers came with shrinking costs per beneficiary: per member costs in fiscal year 2015 were $8940, down 7.7% compared with $9690 in fiscal year 2014.

Political reporters who cover Christie daily took note of his decision to trumpet the news, to push back at the “naysayers” who criticized him for expansion. Charles Stile of The Record noted that the Breitbart chairman whose outlet skewered the governor in 2013 is now CEO of the Trump campaign. There’s speculation, Stile reported, that Christie is looking past November and wants to compare favorably with Ohio Governor John Kasich, who famously described the need to answer to “St. Peter” when expanding Medicaid.

And, just about a year ago, Kasich released a report describing Medicaid as a management tool that resulted in savings.

Christie’s action also reflects what the Kaiser Family Foundation’s Drew Altman recently called the unique ability of governors to put their personal stamp on Medicaid expansion, regardless of party. Altman wrote how the changing fortunes of statehouse would have dramatic effects on the expansion population—those earning between 100% and 138% of the federal poverty level (FPL)—in 2 states: Kentucky and Louisiana.

In Louisiana, Democrat John Bel Edwards made good on his campaign promise to expand Medicaid. Since June, his administration has been able to enroll more than 289,000 people in less than 3 months—including 10,000 in the 2 weeks after recent floods. In Kentucky, where Republican Matt Bevin replaced Democrat Steve Beshear, the state just filed a plan with CMS to amend Beshear’s original order, adding work or volunteer requirements, premium and “lockout” provisions, and removing vision and dental care as automatic benefits. Bevin said that expansion has brought more than twice the projected enrollment and cannot be sustained.

A key similarity between Bevin and Christie is the focus on substance abuse—something that Christie made a hallmark of his presidential campaign. The Bevin administration request seeks a pilot that would allow Medicaid eligible adults ages 21-64 to gain short-term stays in mental health facilities that today are not eligible for reimbursement. Christie’s event Monday highlighted $127 million in the current budget to increase mental health reimbursement rates and to transition to a fee-for-service system.

There’s also a key difference between Christie and many other Republican governors: he operates with a legislature controlled by Democrats, so acceptance, if not full-throated support, was not a surprise back in 2013. Christie did not, however, pursue a state-run exchange and opted to use HealthCare.gov.

Medicaid expansion in New Jersey has had its bumps. A December 2014 report by NJ Advance Media O’Brien found that computer failures stranded thousands of families who applied for Medicaid through county welfare offices. When asked today how wait times have changed, DHS spokeswoman Nicole Brossoie said that NJ FamilyCare applications come in through 3 routes: 1) federal exchange applicants deemed Medicaid eligible; 2) applicants through the state’s Health Benefits Coordinator; and 3) applicants from county agencies. Brossoie said the state is using cloud-based technology to obtain data submitted on the federal exchange, and determinations are being made within the 45-day timeframe.