MedicaidReimbursementMedium impact
Newsletter Vol. 32, No.21
New Jersey Medicaid·NJ · Geriatrics·Reimbursement
Effective date
Jul 1, 2022
We identified it
Jun 20, 2026
Summary
New Jersey implemented a tiered per diem rate increase for Assisted Living Residences and Comprehensive Personal Care Homes effective July 1, 2022. Reimbursement rates now range from $0 to $35 additional per diem based on the facility's percentage of Medicaid/NJ FamilyCare enrollees (calculated from Oct 2021-Dec 2021 census data). Rates will be recalculated annually in July through March 2025 when federal HCBS funding sunsets.
Action Required
By July 1, 2022: Billing team must verify the facility's Medicaid/NJ FamilyCare enrollment percentage tier from the tiered rate schedule and update billing system rates accordingly. Confirm the calculation methodology uses average daily census of Medicaid/NJ FamilyCare enrollees from Oct 1, 2021 - Dec 31, 2021 divided by total Department of Health licensed beds. Beginning July 2023: Providers must recalculate facility tier annually based on updated census data to ensure accurate per diem billing. Contact Gainwell Technologies Provider Services at 1-800-776-6334 for system updates or rate verification. Failure to apply correct tiered rates will result in underbilling or claim denials.