MedicaidCoverageMedium impact
Newsletter Vol. 34, No.05
New Jersey Medicaid·NJ · Geriatrics, Physical Therapy, Occupational Therapy +1 more·Provider Notice
Effective date
Jun 1, 2024
We identified it
Jun 20, 2026
Summary
New Jersey now allows certified family members to provide homemaker-home health aide (CHHA) and personal care services to Medicaid/NJ FamilyCare beneficiaries under age 21, effective immediately. Family members must be certified by the NJ Board of Nursing, employed through a home health agency or health care service firm, and work under registered nurse supervision. Services are billed using standard PCA billing codes and require prior authorization through MACC or the member's MCO.
Action Required
Immediately: Billing team must update internal policies and training to recognize family member-provided CHHA and personal care services as billable when: (1) the family member is certified by NJ Board of Nursing, (2) employed by a licensed home health agency or health care service firm, (3) services are for Medicaid/NJ FamilyCare beneficiaries under age 21, and (4) services are under RN supervision. For non-managed care members: home health agencies must submit PCA assessment requests to the appropriate MACC county office. For managed care members: agencies must request authorization from the member's MCO using the State-sanctioned PCA assessment tool. Ensure billing reflects that services are billed using standard PCA codes (same as non-family member providers). Flag for compliance: family members cannot be reimbursed for pre-certification services, and the employing agency must cover certification costs with no repayment required from the family member. Update agency contracts and credentialing processes to reflect this change.