MedicaidPrior AuthMedium impact
Newsletter Vol. 25, No.10
New Jersey Medicaid·NJ·Prior Authorization
We identified it
Jun 20, 2026
Summary
New Jersey has changed from non-delegated to delegated utilization review process for inpatient hospital services for NJ FamilyCare Fee-For-Service clients. This means hospitals can now make their own utilization review decisions instead of requiring state approval for covered services.
Action Required
Review current processes for NJ FamilyCare Fee-For-Service inpatient admissions. Contact NJ FamilyCare or participating hospitals to understand new delegated utilization review procedures. Update staff training on authorization requirements for inpatient services under the new delegated model.