MedicaidCoverageMedium impact
Senior Services News Vol. 23, No. 01
New Jersey Medicaid·NJ · Pharmacy, Geriatrics·Pharmacy
Effective date
Jan 1, 2021
We identified it
Jun 20, 2026
Summary
New Jersey adjusted income eligibility limits for PAAD, Lifeline, HAAAD, and Senior Gold pharmacy assistance programs effective January 1, 2021, based on a 1.3% Social Security Cost of Living Adjustment. PAAD limits are now less than $28,769 (single) and less than $35,270 (married); Senior Gold limits are $28,769-$38,769 (single) and $35,270-$45,270 (married). Billing teams must verify patient eligibility against these new thresholds when processing pharmaceutical claims.
Action Required
By December 31, 2020: Billing team must update patient eligibility verification systems to reflect new 2021 income limits for PAAD and Senior Gold programs in New Jersey. Update intake forms and eligibility screening tools to reference the new thresholds: PAAD <$28,769 (single)/<$35,270 (married); Senior Gold $28,769-$38,769 (single)/$35,270-$45,270 (married). Train front desk and billing staff on new limits. Beginning January 1, 2021, verify all NJ patient eligibility against these updated limits before processing pharmaceutical assistance claims. Maintain documentation of income verification for audit purposes. Direct patient inquiries to 1-800-792-9745 or www.state.nj.us/humanservices/doas/services/njsave. Failure to apply correct limits may result in patients being enrolled in wrong program tier or denied coverage.