6. Evaluation of PE Process

Although I think the Salem Pilot may have some potential, I think we really need to evaluate the true role of the county in this process. In other states, outstation workers can be the employee of the FQHC, hospital, or other entity. Why has NJ not tried this approach yet? Also, the county does not provide workers for every site. This means that some high volume sites may not have an outstation worker since the county does not have enough employees. Should we not look at another model that does not include the county? The time has come to see how other states approach this.
Kathy Davis

Submitted by Kaye Marrow:

All women presenting for prenatal services should be asked for their insurance information. If she does not have commercially available insurance, the NJ FamilyCare/Medicaid Member Verification System (MVS – on line [EMVS] ) should be checked. If the woman does not have any evidence of any type of coverage, she should be sent, while on site, to the presumptive eligibility (PE) worker on site (at a hospital or an FQHC).

The Presumptive Eligibility Worker would then complete a PE application and provide the woman with the “Important Information Letter” and a copy of documents which most likely would be requested later by the County Board of Social Services in order to establish full Medicaid eligibility.

If there is no presumptive eligibility worker on site, any provider may distribute a copy of the NJ Medicaid/Family Care Application (or the web site address; http://www.njfamilycare.com).

In the meantime, there is a program, being piloted in Salem County, that allows outstation worker to access the County file, in real time, process the information, and verify that she examined whatever paperwork is required;
this relieves the woman from going to the County Board of Social Services, the application is filled out, on the spot, and an HMO selection is made at the time of application.

Recommendation: provide funding for additional “my pc.com” licenses and encourage others counties, hospitals and FQHCs to comply with the requirement that an outstation worker be on site with office space and connectivity. It is also recommended that a provision be built into the $4.8M grant to Medicaid for Emergency Room diversion to utilize the staff placed in the emergency room