Friday, April 4, 2025
4/4/2025
The State Flexibility to Stabilize the Market Cycle II Grant Program - New Jersey has experienced significant variances in health insurance enrollment since the Affordable Care Act went into effect in 2014. Enrollment in the individual market initially increased, but subsequently saw declining enrollment until more recently. Enrollment in the small employer market has decreased steadily after initial gains. Beginning in 2018, New Jersey enacted several reforms to the individual market including a reinsurance program, individual mandate, beginning the transition to a state-based exchange and creating a New Jersey state subsidy in the individual market. While these policies have had a major stabilizing effect on the individual market in many respects, the small employer market continues to see enrollment declines. In summary, the New Jersey health insurance market has seen significant stabilization in certain aspects with continued instability in others. Moreover, the enactment of recent state legislation addressing mental health parity, specifically P.L. 2019, c. 58 (the “Act’) signed into law on April 11, 2019, has increased the role of the NJ Department of Banking and Insurance (NJ Department) in mental health parity detection and enforcement. Carriers, including those offering coverage in the individual, small employer and large group markets, are now required to provide coverage for mental health conditions and substance use disorder under the same terms and conditions as approved for any other sickness consistent with the terms of the Paul Wellstone and Pete Domenci Mental Health Parity and Addiction Equity Act of 2008 (“MHPAEA”) and implementing federal guidance and regulations. Among other requirements, the Act directs the Department to implement and enforce applicable provisions of MHPAEA, including ensuring compliance by and detecting violations in individual and group contracts, policies, plans and enrollee agreements and to provide consumer education of mental health parity. New Jersey intends to pursue funding through the State Flexibility to Stabilize the Market Grant Program (State Flexibility Grant) for an actuarial analysis and microsimulation to explore several innovative policy measures to address what the State views as a problem with enrollment and retention – a guaranteed availability and renewability problem, in addition to a separate analysis with respect to mental health parity review and detection, enforcement and consumer education – an issue of nondiscriminatory offering and administration of essential health benefits. Specifically, using information from the actuarial and microsimulation analysis, New Jersey intends to explore - the Affordable Care Act’s Basic Health Program Option, consumers’ purchase of Medicaid, Medicaid-like or NJ FamilyCare Plans, and combining the individual and small group market risk pools in addition to a study on the decline in enrollment in the small employer market. The NJ Department also intends to hire a mental health parity consultant to advise as to how to improve its ability to detect mental health parity violations and ensure fair and equitable access for consumers to mental health treatment in accordance with both state and federal law and to develop a broad consumer outreach program to educate the public about mental health parity issues. The NJ Department is budgeting $470,527.00 towards the actuarial/microsimulation analysis of innovative policy measures, to be developed by an independent actuarial consulting firm, specifically Oliver Wyman. For this purpose, contract terms have been negotiated. The balance of the funds from the State Flexibility Grant totaling about $215,000.46 will be directed towards a mental health parity consultant to detect mental health parity violations and ensure fair and equitable access for consumers to mental health treatment in accordance with both state and federal law; and to develop a broad consumer outreach program to educate the public about mental health parity issues.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).