MedicaidAdministrativeMedium impact
Newsletter Vol. 27, No.09
New Jersey Medicaid·NJ · Geriatrics·Provider Notice
Effective date
Aug 1, 2017
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid has clarified that Pre-eligibility Medical Expenses (PEME) are available for both nursing facilities and assisted living facilities, allowing facilities to request payment for bills incurred up to 3 months prior to Medicaid eligibility through the recipient's monthly cost share. A specific PEME request form must be submitted to the County Welfare Agency.
Action Required
Immediately: Billing teams at nursing facilities and assisted living facilities in New Jersey must begin using the new PEME request form when seeking payment for pre-eligibility medical expenses. Submit PEME requests to the appropriate County Welfare Agency as soon as residents are determined Medicaid eligible. Ensure all services are billed at Medicaid rates and submitted to third parties first before requesting PEME approval. Do not include room and board rates in PEME calculations for assisted living facilities.