MedicaidAdministrativeMedium impact
Senior Services News Vol. 16, No. 01
New Jersey Medicaid·NJ · Geriatrics·Provider Notice
Effective date
May 1, 2013
We identified it
Jun 20, 2026
Summary
This New Jersey policy clarifies income handling procedures for dually eligible residents (Medicare/Medicaid) in nursing facilities. When a resident's monthly income exceeds the amount needed to offset Medicaid payments due to facility absence or Medicare coverage, facilities must deposit excess income into the resident's Personal Needs Allowance (PNA) account rather than applying it to care costs, and must monitor PNA account balances to maintain Medicaid eligibility.
Action Required
By May 1, 2013: Long-term care facilities in New Jersey must implement revised resident income collection procedures. Billing and accounting teams must: (1) Identify instances where monthly resident income exceeds Medicaid care offset amounts due to facility absences or Medicare coverage gaps; (2) Redirect excess income to the resident's PNA account instead of applying it to facility charges; (3) Track PNA account balances monthly to ensure they do not exceed the maximum allowable amount for Medicaid eligibility under N.J.A.C. 8:85-1.16(c)1; (4) Update billing system workflows and resident accounting procedures to reflect this change. Finance and compliance teams must train staff on the new procedures. Failure to comply may result in improper Medicaid billing and resident eligibility issues.