FY2026 Annual Report

20 75 th Anniversary T he HMO Council shares information, provides training and develops strategies to address challenges, currently those particularly associated with the continuing carve- in of behavioral health services to Medicaid managed care. In the past year, the HMO Council has largely focused on hosting presentations and facilitating discussions that answer questions and address challenges to support providers in the transition. In September, Kris Hathaway, Vice President for State Affairs at AHIP, the national trade association representing the health insurance industry, presented Health Plan Perspective of H.R.1. In March, Patrick Gillespie, Regional Vice President for State Affairs at Elevance Health, and Anya Nawrocky, Director of Member Experience and Growth at Wellpoint, presented H.R.1 Impacts on NJ Medicaid and other Topics ; and in January, Chris Barton, Senior Director, Behavioral Health Programs at Horizon Blue Cross Blue Shield of New Jersey, provided a presentation on innovation in behavioral health, beginning with exploring the drivers of innovation at the state and federal levels. In all FY2026 HMO Council meetings, the agendas included sharing answers to pre-submitted carve-in questions from members, addressing remaining pre-submitted questions to the MCO representatives and staff from the Division of Medical Assistance and Health Services (DMAHS, Medicaid) and the Division of Mental Health and Addiction Services (DMHAS) present, and/or opening the floor to additional questions or general discussion. Regular attendees include Steve Tunney, Director of Behavioral Health, and Shanique M. Power, Behavioral Health Program Manager, from Medicaid, and Geralyn Molinari, Director, Managed Provider Relations, DMHAS. At each meeting, many issues were clarified, others were brought back to DMAHS and the MCOs and later resolved, and direct communication lines opened between providers and MCO representatives when issues specific to claims or organizations were best taken offline. At the June meeting, discussion focused on claims, more specifically claim denials, and payment. Denials have increased since MCOs started leaving the transition phase and applying medical necessity. These discussions have helped to move NJAMHAA’s advocacy on important issues forward. T he Hospital Community Integration Council (HCIC) aims to foster collaborative planning and coordinated care beyond referrals by identifying barriers and creating shared system-level solutions; creating joint proposals to align incentives, streamline regulations and support flexible, person- centered care; and act as one voice with the Departments of Health, Human Services, and Children and Families, offering data-driven input during advisory groups, policy reviews and other opportunities. The group also aims to support innovative pilot projects to strengthen integrated, community-based care. An important part of the strategy to maximize the value and impact of this group is to increase active participation of hospital representatives. Through collaboration, these joint efforts will result in reducing backups in emergency departments; facilitating smoother referrals from hospitals to community providers; and jointly advocating on issues that affect all providers and the individuals they serve. CHAIR: Sam Currie, RPh Director of Pharmacy Services Horizon NJ Health CO-CHAIRS: Darian Eletto, LPC, LCADC Chief Clinical Officer, Behavioral Health Bergen New Bridge Medical Center NJMHI Board Member Brigitte D. Johnson, Esq. NJAMHAA Board Member President and CEO CarePlus NJ, Inc. Kristine Pendy, LCSW NJAMHAA Board Member Chief Operating Officer and Vice President, Clinical Services Vantage Health System Health Maintenance Organization (HMO) Council Hospital Community Integration Council