MedicaidCoverageMedium impact
Senior Services News Vol. 28, No. 02
New Jersey Medicaid·NJ · Pharmacy, Geriatrics·Pharmacy
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
New Jersey has updated income eligibility limits for pharmacy assistance programs (PAAD, Senior Gold, Lifeline, and HAAAD) effective January 1, 2026, with a 2.8% increase based on Social Security COLA. PAAD limits are now less than $54,943 for singles and less than $62,390 for married couples; Senior Gold ranges from $54,943-$64,943 for singles and $62,390-$72,390 for married couples. Billing teams must update patient eligibility verification and ensure accurate program enrollment documentation.
Action Required
By December 15, 2025: Update billing system eligibility verification rules to reflect new PAAD and Senior Gold income thresholds for calendar year 2026. Billing team must verify patient income against updated limits when processing pharmaceutical claims. Front desk staff should update patient eligibility verification procedures and communicate new limits to patients during enrollment. Update patient-facing materials and website with new income thresholds. Failure to apply correct eligibility limits may result in claim denials or improper program assignment. Direct patients with eligibility questions to 1-800-792-9745 or the Division of Aging Services.