Provider-Based Outreach for Continuous Medicaid Redetermination
As part of the COVID-19 public health emergency, Congress authorized under the Families First Coronavirus Response Act (FFCRA) of 2020 for states to maintain enrollment of nearly all Medicaid enrollees – known as the “continuous enrollment condition.” The Medicaid continuous enrollment condition ended on March 31, 2023 and states started to “unwind” the continuous enrollment by resuming redetermination. NJII is working in close partnership with the NJ FamilyCare/Medicaid, administered by the Division of Medical Assistance and Health Services (DMAHS), Department of Human Services (DHS),to support the statewide Medicaid redetermination process. This initiative is critical to minimizing coverage disruptions and ensuring eligible residents maintain access to essential healthcare services.
As part of this effort, NJII receives a monthly list of Medicaid beneficiaries who are at risk of losing eligibility. Using advanced data analytics, NJII matches this list with patient rosters from providers and facilities participating in the NJHIN. This process generates a customized Disenrollment File for each facility, identifying patients who are under their active care and are due for recertifying their Medicaid coverage. NJII distributes the Disenrollment Files via secure email to designated contacts at each TDSO, facilitating timely and targeted outreach to members at risk of losing Medicaid coverage.
This effort equips providers with timely, actionable information to help their patients keep their information up to date with the state before the month end to prevent loss of coverage.
Role of NJII
Strategic Collaboration
NJII collaborates with DMAHS to outreach healthcare providers, ensuring eligible individuals are informed about their Medicaid status.
Targeted Provider Engagement
The outreach focuses on Trusted Data Sharing Organizations (TDSOs)- healthcare providers, facilities, and organizations within the New Jersey Health Information Network (NJHIN).
Proactive Member Identification
NJII shares lists of NJ FamilyCare/Medicaid members nearing eligibility expiration, preparing providers to support members through the renewal process.
Guidance and Communication Tools
NJII provides recommendations for effective communication with members about their Medicaid status and actionable steps for renewing eligibility.
Contact Us
Providers can email us at medicaideligibilityrenewaloutreach@njii.com for additional information.
For more information about the NJHIN NJ Health Information Network contact us at Healthcare | NJHIN Contact
Get in Touch with Department of Human Services
If you are an NJ FamilyCare provider or partner organization with questions, please email DMAHS.CommunityCollab@dhs.nj.gov