MedicaidCoverageHigh impact
Newsletter Vol. 19, No. 40
New Jersey Medicaid·NJ·Medical Policy
Effective date
Jul 1, 2009
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid HMOs will now cover all nursing facility services (skilled, custodial, rehabilitation, and post-acute care) for the first 30 days of admission for NJ FamilyCare A enrollees, instead of the previous fee-for-service billing. After 30 days, billing reverts to fee-for-service except for hospice care which remains HMO responsibility.
Action Required
Immediately for NJ FamilyCare A clients: Billing team must verify HMO enrollment before nursing facility admission and bill HMO (not Medicaid fee-for-service) for first 30 days of all nursing facility services. Contact client's HMO within 15 days of admission to request Pre-Admission Screening if stay will exceed 30 days. After day 30, contact HMO to terminate coverage before billing fee-for-service. Claims billed incorrectly will be denied.