MedicaidCoverageMedium impact
Medicaid Alert MA-2023-01
New Jersey Medicaid·NJ · Pharmacy·Coding
Effective date
May 12, 2023
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid/NJ FamilyCare now covers at-home SARS-CoV-2 test kits for members denied coverage by primary benefit plans (including Part D) from May 12, 2023 through September 30, 2024, without cost-sharing. Claims must be submitted as POS claims and are limited to 8 OTC tests per month without prescription, with additional quantities requiring prescriber authorization.
Action Required
By May 12, 2023: Billing team must implement procedures to identify and resubmit SARS-CoV-2 test kit claims that were denied by primary benefit plans (Medicare Part D, other drug plans) to Medicaid/NJ FamilyCare as POS claims. Update billing software to flag denied test kit claims for secondary submission to Medicaid. Pharmacy staff must verify member eligibility and enforce quantity limits (maximum 8 OTC tests per month without prescription; additional quantities require valid Medicaid-enrolled provider prescription). Train front-desk and billing staff on the 8-test monthly limit and documentation requirements. Retain this alert for reference through September 30, 2024. Failure to properly bill secondary claims may result in lost reimbursement; failure to enforce quantity limits may result in claim denials for non-compliant orders.