MedicaidCoverageMedium impact
Newsletter Vol. 6, No. 53
New Jersey Medicaid·NJ · OB-GYN·Eligibility
Effective date
May 18, 1996
We identified it
Jun 20, 2026
Summary
⚠️ CRITICAL DATING ISSUE: This policy is dated October 1996 but marked as 1 month old—this is a data error. The policy establishes that elected abortion procedures for New Jersey Medicaid patients enrolled in managed care are covered fee-for-service by Medicaid (not through HMO contracts), while related services (labs, ultrasound, pre-op clearance) must be coordinated through the patient's HMO. Providers cannot bill Medicaid fee-for-service for abortion-related services; these must be negotiated with the HMO.
Action Required
IMMEDIATE ATTENTION REQUIRED - VERIFY POLICY DATE: This newsletter shows a 1996 publication date but is flagged as 1 month old. The medical billing team must: (1) Confirm with compliance/management whether this 1996 policy is still current or if a superseding policy exists; (2) If still active, ensure billing staff understand that elected abortion procedures are billed to NJ Medicaid fee-for-service (not to HMO contracts) for managed care enrollees; (3) Verify that all related pre-operative services (labs, ultrasound, CBC, blood type/cross-match, pregnancy tests, H&P) are submitted to the patient's HMO per negotiated contracts—NOT to Medicaid fee-for-service; (4) Update billing system and staff training to prevent improper billing of abortion-related services to Medicaid when HMO responsibility applies. Contact NJ Medicaid Office of Managed Health Care at (609) 588-2705 for current guidance. Do not implement without confirming this policy supersedes any more recent guidance.